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3.
Hu Li Za Zhi ; 67(5): 65-73, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978767

RESUMO

BACKGROUND & PROBLEMS: Efficient handover is essential to ensuring high levels of caring quality and patient safety. In our psychiatric acute ward, it was noticed that there were many valueless tasks being performed during the nursing handover process that negatively affected efficiency. PURPOSE: To apply lean management principles to improve the nursing handover process in the psychiatric acute ward. RESOLUTION: In order to find the rightful solution, our task team analyzed the problem using the Value Chart of Lean Management and detected that the handover process was slowed down by motion, waiting, and defects. According to the rules of lean management, group discussion, decision making, and the cost-benefit matrix, we proposed improvement solutions including visual stocktaking, adjusting handover patterns, switching the handover location, and systematizing nursing handover procedures. RESULTS: The time required for stocktaking was shortened from 5 to 2 minutes (60% improvement). The waiting time was shortened from 114 to 49.6 minutes (56.6% improvement). The efficiency of the handover process increased from 66% to 90%. CONCLUSIONS: Applying lean management principles helped detect critical problems and reduce waste, which enhanced efficiency, improved handover, and helped maximize nursing value and benefit in an increasingly complex environment.


Assuntos
Unidades Hospitalares/organização & administração , Transtornos Mentais/enfermagem , Transferência da Responsabilidade pelo Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Eficiência Organizacional/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem
4.
BMJ Open ; 10(9): e039749, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994257

RESUMO

OBJECTIVES: The growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics. DESIGN: We combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability. SETTING: 91 Clinical Commissioning Groups (CCGs) in England. MAIN OUTCOME MEASURES: We merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities. RESULTS: We find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments. CONCLUSIONS: Evidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/normas , Pandemias , Pneumonia Viral , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Inglaterra/epidemiologia , Disparidades nos Níveis de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Prevalência , Saúde Pública/métodos , Saúde Pública/tendências , Melhoria de Qualidade/organização & administração , Fatores de Risco , Análise Espacial
8.
Med Care ; 58 Suppl 2 9S: S80-S87, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826776

RESUMO

BACKGROUND: Veterans Affairs (VA) has rolled out a holistic, multicomponent Whole Health care model nationwide, yet no pragmatic trials have been conducted in real-world clinical settings to compare its effectiveness against other evidence-based approaches for chronic pain management in veterans. OBJECTIVES: We describe the adaptation of the first large pragmatic randomized controlled trial of the Whole Health model for chronic pain care for diverse VA clinical settings. RESEARCH DESIGN: Informed by the Promoting Action on Research Implementation in Health Systems implementation framework, we conducted qualitative semistructured interviews to obtain feedback on trial design from VA leadership, frontline clinicians, and veterans with chronic pain at 5 VA enrollment sites. Next, we convened in-person evidence-based quality improvement (EBQI) meetings with study stakeholders (including frontline clinicians and administrators) at each site to discuss study design; review interview themes; and identify site-specific barriers, facilitators, and approaches to implementation. Ethnographic observations from EBQI meetings provided additional insight into implementation strategies. SUBJECTS: Seventy-four veteran and VA staff stakeholders were interviewed; 71 stakeholders participated in EBQI meetings. RESULTS: At each site, unique clinical contexts and varying resources for Whole Health and pain care delivery affected plans for trial implementation. We present examples of local adaptations that emerged through the formative evaluation process to facilitate implementation and yield a more pragmatic trial design. CONCLUSIONS: A systematic formative evaluation can facilitate engagement and buy-in of study stakeholders. Locally tailored pragmatic implementation strategies may improve the likelihood of successful trial execution as well as future implementation of evidence-based pain care approaches in real-world clinical settings.


Assuntos
Dor Crônica/terapia , Medicina Integrativa/organização & administração , Projetos de Pesquisa , United States Department of Veterans Affairs/organização & administração , Antropologia Cultural , Atitude do Pessoal de Saúde , Medicina Baseada em Evidências , Humanos , Entrevistas como Assunto , Seleção de Pacientes , Melhoria de Qualidade/organização & administração , Estados Unidos , Veteranos , Saúde dos Veteranos
9.
BMJ Open Qual ; 9(3)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32855158

RESUMO

Reforming the delivery of outpatient appointments (OPA) was high on the healthcare policy agenda prior to COVID-19. The current pandemic exacerbates the financial and associated resource limitations of OPA. Videoconsulting provides a safe method of real-time contact for some remotely residing patients with hospital-based clinicians. One factor in failing to move from introduction of service change to its general adoption may be lack of patient and public involvement. This project, based in the largest Island in the Inner Hebrides of Scotland, aimed to codesign the use of the NHS Near Me video consulting platform for OPA to take place in the patient's home. A codesign model was used as a framework. This included: step 1-presenting a process flow map of the current system of using Near Me to public participants and establishing their ideas on various steps in the process, step 2-conducting numerous Plan, Do, Study, Act (PDSA) tests and creating a current process flow diagram based on learning and step 3-conducting telephone interviews and thematic analysis of transcripts (n=7) to explore participants' perceptions of being involved in the codesign process. Twenty-five adaptations were made to the Near Me at Home video appointment process from participants' PDSA testing. Four themes were identified from thematic analysis of participants' feedback of the codesign process, namely: altruistic motivation, valuing community voices, the usefulness of the PDSA cycles and the power of 'word of mouth'. By codesigning the use of Near Me with people living in a remote area of Scotland, multiple adaptations were made to the processes to suit the context in which Near Me at Home will be used. Learning from testing and adapting with the public will likely be useful for others embarking on codesign approaches to improve spread and sustainability of quality improvement projects.


Assuntos
Assistência Ambulatorial/organização & administração , Agendamento de Consultas , Serviços de Assistência Domiciliar/organização & administração , Consulta Remota/organização & administração , Comunicação por Videoconferência/organização & administração , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde , Política de Saúde , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Melhoria de Qualidade/organização & administração , Escócia/epidemiologia , Medicina Estatal/organização & administração
10.
J Stroke Cerebrovasc Dis ; 29(9): 105068, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807471

RESUMO

BACKGROUND AND PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). METHODS: We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). RESULTS: A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 - 7.17, p = 0.021) CONCLUSION: Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.


Assuntos
Betacoronavirus/patogenicidade , Assistência Integral à Saúde/organização & administração , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Pneumonia Viral/terapia , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Procedimentos Clínicos/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sistema de Registros , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento , Fluxo de Trabalho
13.
Aging Clin Exp Res ; 32(9): 1883-1888, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32654005

RESUMO

The SARS-CoV-2 pandemic has led to a dramatic crisis of Health Care Systems worldwide, and older people have been among the most disadvantaged. Specific recommendations and reports have been released both at International and National level, regarding the diagnosis and management of COVID-19 in the elderly. However, little has been proposed for an appropriate response to older, frail and multimorbid patients in different settings of care (acute care units, long term care facilities, nursing homes and primary care) and for the management of geriatric syndromes (i.e. delirium, sarcopenia, falls). We presume that the current pandemic of will leads to substantial changes in health care systems, and we suggest some key guide principles that could inspire the provision of healthcare services to older people and their families. These principles are primarily directed to physicians and nurses working in the geriatric field but could also be useful for other specialists.


Assuntos
Infecções por Coronavirus , Serviços de Saúde para Idosos , Pandemias , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral , Melhoria de Qualidade/organização & administração , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/normas , Serviços de Saúde para Idosos/tendências , Humanos , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia
14.
Lancet Glob Health ; 8(8): e1061-e1070, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710862

RESUMO

BACKGROUND: Although gains in newborn survival have been achieved in many low-income and middle-income countries, reductions in stillbirth and neonatal mortality have been slow. Prematurity complications are a major driver of stillbirth and neonatal mortality. We aimed to assess the effect of a quality improvement package for intrapartum and immediate newborn care on stillbirth and preterm neonatal survival in Kenya and Uganda, where evidence-based practices are often underutilised. METHODS: This unblinded cluster-randomised controlled trial was done in western Kenya and eastern Uganda at facilities that provide 24-h maternity care with at least 200 births per year. The study assessed outcomes of low-birthweight and preterm babies. Eligible facilities were pair-matched and randomly assigned (1:1) into either the intervention group or the control group. All facilities received maternity register data strengthening and a modified WHO Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. Liveborn or fresh stillborn babies who weighed between 1000 g and 2500 g, or less than 3000 g with a recorded gestational age of less than 37 weeks, were included in the analysis. We abstracted data from maternity registers for maternal and birth outcomes. Follow-up was done by phone or in person to identify the status of the infant at 28 days. The primary outcome was fresh stillbirth and 28-day neonatal mortality. This trial is registered with ClinicalTrials.gov, NCT03112018. FINDINGS: Between Oct 1, 2016, and April 30, 2019, 20 facilities were randomly assigned to either the intervention group (n=10) or the control group (n=10). Among 5343 eligible babies in these facilities, we assessed outcomes of 2938 newborn and fresh stillborn babies (1447 in the intervention and 1491 in the control group). 347 (23%) of 1491 infants in the control group were stillborn or died in the neonatal period compared with 221 (15%) of 1447 infants in the intervention group at 28 days (odds ratio 0·66, 95% CI 0·54-0·81). No harm or adverse effects were found. INTERPRETATION: Fresh stillbirth and neonatal mortality among low-birthweight and preterm babies can be decreased using a package of interventions that reinforces evidence-based practices and invests in health system strengthening. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Mortalidade Infantil/tendências , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Serviços de Saúde Materno-Infantil/organização & administração , Melhoria de Qualidade/organização & administração , Natimorto/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Gravidez , Uganda/epidemiologia
16.
Nephrol Nurs J ; 47(3): 239-265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639125

RESUMO

Vitamin D deficiency is prevalent among patients with chronic kidney disease (CKD) and even more pronounced in patients with kidney failure who are undergoing peritoneal dialysis and hemodialysis. This project was a nurse practitioner-led quality improvement project conducted in an outpatient hemodialysis unit that focused on determining if educating providers and hemodialysis unit clinical staff on vitamin D guidelines increased the awareness and monitoring of patients on hemodialysis. The number of patients screened for vitamin D levels increased from 29% to 100%, and 70% of patients tested were deficient in vitamin D. While the follow-up monitoring yielded a result of only 32%, we recommend processes and structures for long-term sustainability, such as periodic re-education, reminders and prompts for conducting needed follow-up, continued outcome monitoring, and champions to support the ongoing processes and structures.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Medicina Baseada em Evidências/organização & administração , Corpo Clínico/educação , Diálise Renal , Insuficiência Renal Crônica/terapia , Deficiência de Vitamina D/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/estatística & dados numéricos , Profissionais de Enfermagem , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/organização & administração , Insuficiência Renal Crônica/epidemiologia , Deficiência de Vitamina D/epidemiologia
17.
Emerg Med Clin North Am ; 38(3): 633-646, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616284

RESUMO

Lean engineering is based on a process improvement strategy originally developed at Toyota and has been used in many different industries to maximize efficiency by minimizing waste. Lean improvement projects are frequently instituted in emergency departments in an effort to improve processes and thereby improve patient care. Such projects have been undertaken with success in many emergency departments in order to improve metrics such as door-to-provider time, left without being seen rate, and patient length of stay. By reducing waste in the system, Lean processes aim to maximize efficiency and minimize delay and redundancy to the extent possible.


Assuntos
Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Melhoria de Qualidade/organização & administração , Eficiência Organizacional/normas , Serviço Hospitalar de Emergência/normas , Humanos , Tempo de Internação , Satisfação do Paciente , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde
18.
Emerg Med Clin North Am ; 38(3): 705-713, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616289

RESUMO

Emergency department (ED) patient experience is a growing area of focus for leaders in the ED and throughout health care. While many factors intrinsic to the ED care environment add to the challenge of providing patients with an excellent experience, doing so holds many benefits, including improved patient compliance and health outcomes, improved workplace satisfaction and reduced provider and staff burnout, decreased malpractice risk, and increased revenue. Although wait time is a major driver of patient experience, provider and staff communication are critically important and excellent communication and perceived empathy may mitigate long waits, overcrowded environments, and other challenges.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Satisfação do Paciente , Serviço Hospitalar de Emergência/normas , Humanos , Melhoria de Qualidade/organização & administração
19.
Emerg Med Clin North Am ; 38(3): 715-727, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616290

RESUMO

Academic emergency departments (EDs) play a vital role in provision of emergency care and contribute to training of resident physicians. Academic EDs also generate innovations and discoveries through clinical research within academic medical centers. However, academic EDs face challenges when initiating operational process improvement efforts because of the medical complexity of patients, academic culture within academic medical centers, and variability in productivity and specialty training of trainees. To optimize operations within academic EDs, it is critical to understand characteristics shared by academic EDs, how to implement process improvement initiatives, trainee impact on ED operations, and how to promote operational research.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Eficiência Organizacional , Humanos , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/organização & administração
20.
J Pain Symptom Manage ; 60(3): e22-e27, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32525082

RESUMO

BACKGROUND: Increasing hospice need, a growing shortage of hospice providers, and concerns about in-person services because of coronavirus disease 2019 (COVID-19) require hospices to innovate care delivery. MEASURES: This project compared outcomes between hospice reauthorization visits conducted via telehealth and in person. After each visit, providers, patients, and caregivers completed telehealth acceptance surveys, and providers recorded reauthorization recommendations. INTERVENTION: Providers conducted 88 concurrent in-person and telehealth visits between June and November 2019. OUTCOMES: No statistically significant differences in reauthorization recommendations were found between telehealth and in-person visits. Satisfaction with telehealth was high; 88% of patients/caregivers and 78% of providers found telehealth services as effective as in-person visits. CONCLUSIONS/LESSONS LEARNED: Results indicate that telehealth can successfully support clinical decision making for hospice reauthorization. These findings show telehealth to be reliable and acceptable for certain types of hospice care even before COVID-19, which emphasizes its importance both during and after the current public health emergency.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Pneumonia Viral/epidemiologia , Melhoria de Qualidade/organização & administração , Telemedicina/organização & administração , Humanos , Pandemias , Satisfação do Paciente , Autorização Prévia
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