A novel system to address adherence barriers in clinical practice decreases allograft rejection for kidney transplant patients
Conclusions
An integrated system to address adherence barriers in the clinic was associated with reduced late-rejection episodes in kidney transplant patients. This approach may help address adherence barriers in other chronic conditions thereby improving health outcomes while reducing cost.
Figure 1Key driver diagram.
Figure 2 Patient days between late rejection episodes.
Figure 3N of 1: Patient data over time. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Varnell, C., Rich, K., Nichols, M., Engelhardt, J., Dahale, D., Huber, J., Ashiki, M., Pai, A., Modi, A., Hooper, D. Tags: Abstracts Source Type: research
Mortality reduction associated with surveillance using an emr-based acuity score at an academic medical center
Conclusions
Enhanced surveillance reduced mortality, and the nursing-based protocols were subsequently implemented throughout the hospital, and are being implemented throughout the 8-hospital system. Implications are that this approach will also aid in improving the general quality of care.
Figure 1Monitoring protocols by clinician role fore patient surveillance at Houston Methodist Hospital "Graphs" below refer to Rothman Index graphs displayed on kiosks (monitors) at each nursing station, and in the EMR.
Figure 2Houston Methodist alert rules and required nursing action. Rothman Index graphs are updated whe...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Walsh, K., Hamlin, S., Askary, B. Tags: Abstracts Source Type: research
Improving patient safety in latin america: a multi-country quality improvement collaborative project to reduce the incidence of clabsi in icus
Conclusions
Evidence-based interventions and multi-country collaborative work contributed to a significant reduction in the incidence of CLABSI in Latin American ICUs.
Figure 1
Figure 2
Figure 3 (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Arrieta, J., Colmenares, M., Delgado, P., Garcia-Elorrio, E., Giuffre, C., Macchiavello, D., Mora, N., Orrego, C., Rodriguez, V. Tags: Abstracts Source Type: research
Reducing time to antibiotics in patients presenting to the emergency department with short bowel syndrome and fever
Conclusions
In patients presenting to the ED with SBS, central access, and fever, time to antibiotics, process variability as reflected in narrower control limits, and LOS were reduced significantly through a formal improvement process.
Figure 1 Mean time to antibiotics – Individual (I) statistical process control chart.
Figure 2ED LOS – Individual (I) statistical process control chart.
Figure 3Key Driver diagram.
Figure 4Pareto chart. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Hudgins, J., Eisenberg, M. Tags: Abstracts Source Type: research
Implementation of a rai-frailty screening across surgical clinics: a quality improvement initiative
Conclusions
RAI-Frailty screening was successfully implemented and sustained in the vascular surgery clinic utilizing audit and feedback and EHR modifications as strategies for change. Based on these findings, this screening initiative is being implemented across surgical clinics. Outcome measures are being evaluated to determine the clinical implications of this screening initiative.
Figure 1
Figure 2 (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Tucker, P., Flink, B., Varley, P., Hall, D., Johanning, J., Clevenger, C., Tomolo, A., Arya, S. Tags: Abstracts Source Type: research
Pilot study of a medication change teaching tool and pharmacist discharge reconciliation on limiting medication errors for heart failure patients
Conclusions
Based on this pilot further study of standard methods for MR including a pharmacist role and medication change teaching tool are warranted for the potential to durably impact outcomes for HF patients at hospital discharge.
Figure 1Make your medication changes picture education tool.
Figure 2Composite percent score for HCAPS communication about medications. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Nicolsen, E., Markle, J., Curran, L., Cooper, J., Bensimhon, D. Tags: Abstracts Source Type: research
Integrated primary care mental health quality improvement intervention
Conclusions
An integrated MH model with same day SW assessments of children with positive MH screens shows promise for improving MH assessments. A referral algorithm directing stepped care assignments facilitated this process. Assess to community-based therapy was rate limiting.
Figure 1Stepped Care model.
Figure 2Compliance with algorithm.
Figure 3Patients with secondary assessments.
Figure 4Patients connected to treatment by 3 months. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Cox, J., Durant, H., Castile, N., Cheek, S., Dowd, K., Carrick, O., Reisinger, E., Markiewicz, M., Caldas, A., Tunick, R. Tags: Abstracts Source Type: research
Mentored implementation of the i-pass handoff program in diverse clinical environments
Conclusions
The I-PASS Handoff program is associated with improved handoff communication in a variety of settings and provider types.
Figure 1Verbal Handoff Assessments: adherence to all 5 mnemonic elements.
Figure 2Written Handoff Assessments: adherence to all 5 mnemonic elements.
Figure 3Verbal Handoff Assessments: quality of patient summaries.
Figure 4Written Handoff Assessments: quality of patient summaries.
Figure 5Verbal Handoff Assessments: quality of contigency plans.
Figure 6Written Handoff Assessments: quality of contigency plans.
Figure 7Verbal Handoff ...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Starmer, A., O'Toole, J., Spector, N., West, D., Sectish, T., Schnipper, J., Srivastava, R., Goldstein, J., Campos, M.-L., Howell, E., Landrigan, C., SHM I-PASS Study Group Tags: Abstracts Source Type: research
Asthma care standardization in a pediatric emergency department: changing to discharge medications in-hand and understanding effects across the care continuum
Conclusions
Using improvement methodology, we increased the proportion of patients seen in the ED/UC who received OCS in-hand at discharge from 2% to 96% without any increase in 7 day returns requiring additional OCS. This practice change within one division had a ripple effect across multiple care sites, including inpatient change to dexamethasone and a standardized process for outpatient follow-up. Future work will focus on standardization of key decisions across ED/UC in collaboration with all key stakeholders.
Figure 1Primary outcome measure.
Figure 2Secondary outcome measure.
Figure 3Balancing ...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Kurowski, E. M., Rinderknecht, A., Caruso, M., Oehler, J., Varadarajan, K., Doughty, L., Gordon, C., Kercsmar, C., Mansour, M., McDowell, K., Simmons, J., Iyer, S. Tags: Abstracts Source Type: research
The impact of a multidisciplinary and multimodal approach on sepsis outcomes in a large community hospital system
Conclusions
Improving sepsis care across a large healthcare system was possible using multidisciplinary and multimodal strategies and resulted in reduced sepsis mortality.
Figure 1Sepsis mortality rates by ICD-9/10 codes.
Figure 2Combined sepsis mortality rates. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Penoyer, D., Cheatham, M., Inderwiesen, P. Tags: Abstracts Source Type: research
Increasing oral health preventive interventions in two primary care pediatric practices
Conclusions
Revision of processes and protocols contributed to increased rates of FV orders, FV billing and OHE completed. We anticipate continued improvement leading to reduced dental caries rates among our patient populations.
Figure 1Oral health education completed during well child visits in Center 1.
Figure 2Oral health education completed during well child visits in Center 2.
Figure 3Fluoride varnish orders completed during well child visits in Center 1.
Figure 4Fluoride varnish orders completed during well child visits in Center 2.
Figure 5Well child visits with fluoride var...
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Cheng, J., Fleck, M., Chase, T., Burgess, J., Faniyan, A., Chan, J., Starmer, A., Ng, M. W. Tags: Abstracts Source Type: research
Pediatric lung transplant index - improvement through measurement
Conclusions
Adding the ability to track performance via a care index has increased the overall care our patients receive and further indices will be rolled out to other service lines in the future. This project shows the importance of measuring performance and can be quickly and easily applied to other transplant hospitals.
Figure 1 (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Feeney, B. Tags: Abstracts Source Type: research
Reliable adherence to best practices that mitigates system-level errors reduces copd readmissions: a system redesign using improvement science
Conclusions
System-level failures and unmet patient needs are modifiable risks for COPD readmissions. Using improvement science to mitigate institution specific system-level failures reduces COPD readmissions.
Figure 1Identified system-level failures.
Figure 2Compliance to care bundle.
Figure 3All-cause readmission rate. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Zafar, M., Panos, R., Warm, E., Alessandrini, E. Tags: Abstracts Source Type: research
Quality improvement practice facilitators in community practices: increasing fluoride varnish application
Conclusions
Practices can benefit from assistance of PFs to effectively implement clinical recommendations.
Figure 1Sample key driver diagram.
Figure 2Fluoride Varnish application. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Toth, C., Hoholik, S., Fetzer, M., Baum, R., Cardamone, S., Gleeson, S. Tags: Abstracts Source Type: research
Digital social network analysis as a strategy for understanding variation in the participation of patients in healthcare quality improvement
Conclusions
SNA is a reliable and relatively unobtrusive method to detect and monitor participation in collaborative work groups. Next, we explore how this approach could inform design and management of improvement efforts that meaningfully involve more patients and their caregivers.
Figure 1
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Figure 3 (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - November 17, 2016 Category: Journals (General) Authors: Provost, S., Gloor, P., Seid, M., Margolis, P. Tags: Abstracts Source Type: research
