Demonstrating the value of postgraduate fellowships for physicians in quality improvement and patient safety

2019 ◽  
Vol 29 (8) ◽  
pp. 645-654 ◽  
Author(s):  
Jennifer S Myers ◽  
Meghan Brooks Lane-Fall ◽  
Angela Ross Perfetti ◽  
Kate Humphrey ◽  
Luke Sato ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Goal Attainment ◽  
Clinical Care ◽  
Individual Interviews ◽  
Academic Medical ◽  
Fellowship Programme ◽  
Institutional Impact ◽  
Training Programmes ◽  
The Impact

BackgroundAcademic fellowships in quality improvement (QI) and patient safety (PS) have emerged as one strategy to fill a need for physicians who possess this expertise. The authors aimed to characterise the impact of two such programmes on the graduates and their value to the institutions in which they are housed.MethodsIn 2018, a qualitative study of two US QIPS postgraduate fellowship programmes was conducted. Graduates’ demographics and titles were collected from programme files,while perspectives of the graduates and their institutional mentors were collected through individual interviews and analysed using thematic analysis.ResultsTwenty-eight out of 31 graduates (90%) and 16 out of 17 (94%) mentors participated in the study across both institutions. At a median of 3 years (IQR 2–4) postgraduation, QIPS fellowship programme graduates’ effort distribution was: 50% clinical care (IQR 30–61.8), 48% QIPS administration (IQR 20–60), 28% QIPS research (IQR 17.5–50) and 15% education (7.1–30.4). 68% of graduates were hired in the health system where they trained. Graduates described learning the requisite hard and soft skills to succeed in QIPS roles. Mentors described the impact of the programme on patient outcomes and increasing the acceptability of the field within academic medicine culture.ConclusionGraduates from two QIPS fellowship programmes and their mentors perceive programmatic benefits related to individual career goal attainment and institutional impact. The results and conceptual framework presented here may be useful to other academic medical centres seeking to develop fellowships for advanced physician training programmes in QIPS.

Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

2021 ◽  
pp. 019459982110133
Author(s):  
Ellen S. Deutsch ◽  
Sonya Malekzadeh ◽  
Cecelia E. Schmalbach
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Control Charts ◽  
Neck Surgery ◽  
Resident Training ◽  
Statistical Process ◽  
Ensure Patient Safety ◽  
Statistical Process Control Charts ◽  
The Individual ◽  
The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

scholarly journals The impact of an innovative curriculum to introduce patient safety and quality improvement content

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kelly T. Gleason ◽  
Brigit VanGraafeiland ◽  
Yvonne Commodore-Mensah ◽  
Jo Walrath ◽  
Susan Immelt ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Innovative Curriculum ◽  
The Impact

Resident and RN perceptions of the impact of a medical emergency team on education and patient safety in an academic medical center*

2009 ◽  
Vol 37 (12) ◽  
pp. 3091-3096 ◽  
Author(s):  
Babak Sarani ◽  
Seema Sonnad ◽  
Meredith R. Bergey ◽  
Joanne Phillips ◽  
Mary Kate Fitzpatrick ◽  
...  
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team ◽  
Academic Medical ◽  
The Impact

scholarly journals Are educational or quality improvement interventions delivered at the induction or orientation of junior doctors effective?

2014 ◽  
Vol 3 (5) ◽  
pp. 14
Author(s):  
Luke McMenamin ◽  
Natalie Blencowe ◽  
Damian Roland
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Health Care Professionals ◽  
Group Intervention ◽  
Junior Doctors ◽  
Or Education ◽  
Implementation Quality ◽  
Objective Outcomes ◽  
The Uk ◽  
The Impact

There has been significant media scrutiny in the UK of the period when doctors change over into new jobs, with a number of reports highlighting increased mortality. Starting work in a new hospital confers a potential patient safety risk and induction programmes are therefore designed to familiarise doctors with local policies. Little is known about using this time as an opportunity to improve patient outcomes or change practice. The aim was to review interventions which may aid hospital trusts during induction and a strategy to direct future educational and implementation research. A review of Medline, Embase, Cochrane, Scopus and ERIC databases with key terms (induction or orientation, junior doctor or intern, intervention or education or implementation, quality improvement or patient safety or outcome) extracted relevant abstracts. Articles of relevance were analysed and coded as to the type of patient or doctor group, intervention and outcome. Only seven studies were found which generally reported perceived benefits rather than objective outcomes. A significant opportunity to improve evidence based practice and patient safety is being missed by not thoroughly evaluating the impact of induction and orientation of health care professionals.

scholarly journals Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

2015 ◽  
Vol 3 (3) ◽  
pp. 1-304 ◽  
Author(s):  
Jill Maben ◽  
Peter Griffiths ◽  
Clarissa Penfold ◽  
Michael Simon ◽  
Elena Pizzo ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Experience ◽  
Clinical Care ◽  
Temporary Increase ◽  
Infection Rates ◽  
Hospital Design ◽  
Single Room ◽  
Working Practices ◽  
The Impact

BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

A multicenter quality improvement initiative on the impact of pharmacists’ postdischarge follow-up to reduce medication-related acute care episodes

2020 ◽  
Vol 77 (12) ◽  
pp. 938-942
Author(s):  
Lydia Noh ◽  
Kristina Heimerl ◽  
Rita Shane
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Acute Care ◽  
Academic Medical Centers ◽  
Quality Improvement Initiative ◽  
Medical Centers ◽  
Academic Medical ◽  
Risk Patients ◽  
The Impact

Abstract Purpose This multicenter quality improvement initiative aims to measure and quantify pharmacists’ impact on reducing medication-related acute care episodes (MACEs) for high-risk patients at an increased risk for readmission due to drug-related problems (DRPs). Methods This was a prospective, multicenter quality improvement initiative conducted at 9 academic medical centers. Each participant implemented a standardized methodology for evaluating MACE likelihood to demonstrate the impact of pharmacist postdischarge follow-up (PDFU). The primary outcome was MACEs prevented, and the secondary outcome was DRPs identified and resolved by pharmacists. During PDFU, pharmacists were responsible for identification and resolution of DRPs, and cases were reviewed by physicians to confirm whether potential MACEs were prevented. Results A total of 840 patients were contacted by 9 participating academic medical centers during a 6-week data collection period. Of these, 328 cases were identified as MACEs prevented during PDFU by pharmacists, and physician reviewers confirmed that pharmacist identification of DRPs during PDFU prevented 27.9% of readmissions. Pharmacist identified 959 DRPs, 2.8% (27) of which were identified as potentially life threatening. Potentially serious or significant DRPs made up 56.6% (543) of the DRPs, and 40.6% (389) were identified as having a low capacity for harm. Conclusion The results demonstrate that PDFU of high-risk patients reduces DRPs and prevents MACEs based on physician confirmation. Implementation of MACE methodology provides health-system pharmacy departments the ability to demonstrate pharmacists’ value in transitions of care and assist in expanding pharmacist services.

Abstract TP303: Institutional Stroke Quality Improvement and Impact on Vascular Neurology Fellows Practice Patterns

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
John Lynch ◽  
Richard Benson ◽  
Amie Hsia ◽  
Richard Leigh ◽  
Zurab Nadareishvili ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Practice Patterns ◽  
Clinical Care ◽  
Heart Association ◽  
Stroke Care ◽  
Number Of Patients ◽  
Yearly Average ◽  
Case Logs ◽  
The Impact ◽  
Iv Tpa

Background and objectives: The American Heart Association quality improvement (QI) program Target Stroke is focused on reducing door-to-needle (DTN) time for IV tissue plasminogen activator (tPA) therapy to ≤60 minutes. Multidisciplinary QI procedures similar to the Target Stroke best practices have been shown to improve DTN times at an MRI based program. Whether these strategies improve the performance of trainees is unclear. The objective of this study was to determine the impact of a multidisciplinary QI program on the practice patterns of vascular neurology (VN) fellows at an MRI based stroke program. Methods: Case logs from the NIH Stroke Program VN fellows (N=22) were reviewed from July 2008-July 2015. Data was collected for the following: total patients screened, patients triaged, stroke code proceeds, tPA treated cases, and door to needle time (DTN) for each patient treated including DTN ≤60 minutes. QI processes that included stroke team education and process changes were initiated in 2013 to improve stroke care at two hospitals where VN fellows provide clinical care. We compared VN fellow practice patterns before (2008-12) and after (2013-15) QI implementation. Results: A total of 5093 cases were reviewed for the study. From 2008-15, fellows screened a yearly average of 232 patients, triaged 54% (125) to acute imaging, and treated 7.8% (18) patients each year with IV tPA. VN fellow practice patterns after QI implementation (2013-15) improved for percent treated with IV tPA (5.8% vs. 9.9%, p<0.05), median DTN (83 vs. 71 min.; p<0.05), and percentage treated ≤60 minutes (11% vs. 40%; p<0.05). The mean number of patients screened was slightly higher before 2013 (238 vs. 225), and triage rates were similar (52.4% vs. 55%, p=0.58). Conclusion: The results of this study suggest that an institutional multidisciplinary QI stroke program can improve the practice patterns of VN fellows at an MRI based stroke program.

Impact of Computerized Prescriber Order Entry (CPOE) on Clinical Pharmacy Practice: A Hypothesis-Generating Study

2007 ◽  
Vol 42 (10) ◽  
pp. 931-938 ◽  
Author(s):  
Josephine S. Lai ◽  
Glenn Yokoyama ◽  
Clifton Louie ◽  
Jim Lightwood
Keyword(s):  
Patient Safety ◽  
Pharmacy Practice ◽  
Order Entry ◽  
Advantages And Disadvantages ◽  
Medical Centers ◽  
Academic Medical ◽  
Staffing Requirements ◽  
The Impact ◽  
Pharmacy Leaders ◽  
Computerized Prescriber Order Entry

Since the Institute of Medicine's 1999 landmark report on patient safety, much literature have been published to show the advantages and disadvantages of information systems such as computerized prescriber order entry (CPOE) on improving the delivery of health care. The primary end points of this study were to assess the potential impact of CPOE on patient safety, as well as pharmacy practice and profession—based on the experience and/or opinions of selected pharmacy leaders in California. A qualitative method using multidimensional scaling (MDS), a hypothesis generating tool, was used for data analysis. Most pharmacy leaders held positive opinions regarding the impact of CPOE on the pharmacy practice and the profession, with varying concerns regarding its impact on practice and safety. The MDS analysis showed that leaders from community hospitals held the most optimistic beliefs on CPOE's impact compared with leaders from the academic medical centers and government hospitals whom held concerns over the effect on pharmacy workflow, staffing requirements, and safety. Further studies with more observations should be conducted to assess the impact of CPOE on the pharmacy department.

scholarly journals The impact of accreditation on healthcare quality improvement: a qualitative case study

2016 ◽  
Vol 30 (8) ◽  
pp. 1242-1258 ◽  
Author(s):  
Sara Melo
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Large Scale ◽  
Positive Impact ◽  
Healthcare Quality ◽  
Healthcare Services ◽  
Content Type ◽  
Healthcare Quality Improvement ◽  
The Impact

Purpose Research on accreditation has mostly focused on assessing its impact using large scale quantitative studies, yet little is known on how quality is improved in practice through an accreditation process. Using a case study of an acute teaching hospital in Portugal, the purpose of this paper is to explore the dynamics through which accreditation can lead to an improvement in the quality of healthcare services provided. Design/methodology/approach Data for the case study was collected through 46 in-depth semi-structured interviews with 49 clinical and non-clinical members of staff. Data were analyzed using a framework thematic analysis. Findings Interviewees felt that hospital accreditation contributed to the improvement of healthcare quality in general, and more specifically to patient safety, as it fostered staff reflection, a higher standardization of practices, and a greater focus on quality improvement. However, findings also suggest that the positive impact of accreditation resulted from the approach the hospital adopted in its implementation as well as the fact that several of the procedures and practices required by accreditation were already in place at the hospital, albeit often in an informal way. Research limitations/implications The study was conducted in only one hospital. The design of an accreditation implementation plan tailored to the hospital’s context can significantly contribute to positive outcomes in terms of quality and patient safety improvements. Originality/value This study provides a better understanding of how accreditation can contribute to healthcare quality improvement. It offers important lessons on the factors and processes that potentiate quality improvements through accreditation.

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