Patient Chief Complaint and Otolaryngology Referral Rationale: Discordance and Opportunities for Quality Improvement

2021 ◽  
pp. 000348942110528
Author(s):  
Scott E. Mann ◽  
Shelby White ◽  
Laurel C. Officer ◽  
Laylaa Ramos ◽  
Scott Hirsch ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Safety Net ◽  
Chief Complaint ◽  
Medical Systems ◽  
Contributing Factors ◽  
Time Intervals ◽  
Patient Dissatisfaction ◽  
Patient Questionnaires ◽  
Electronic Referral ◽  
Patients Experience

Objective: As medical systems focus on patient satisfaction as an important care outcome, specialty clinics are tasked with continued improvement of patients’ experience. When patient expectations for a consultation differ from that of the specialty provider, dissatisfaction with the experience can occur. One source of differing expectations is discordance between the patient’s chief complaint and the clinical rationale for the consultation as requested by the referring provider. We sought to better understand when this discordance occurs, as well as factors contributing to this disorientation of patient and provider expectations in a safety net otolaryngology practice. Methods: A retrospective observational study was performed and records were examined from new patient consultations. Patient questionnaires, including self-reported chief concerns, were compared with the electronic referral documentation. A difference between the patient’s Chief Complaint (CC) and Referral Reason (RR) was defined as CC-RR Discordance. Medical records, pre-consultation patient communication, and scheduling data were also reviewed to evaluate contributing factors. Results: Of the 1155 consultations examined, 952 were included in the analysis. A CC-RR Discordance was found in 175 (18.4%) of new-patient encounters, including 117 (12.3%) that were unable to articulate a CC (unsure of the reason for the appointment), and 58 (6.1%) that stated a CC that was different than the RR. The rate of CC-RR Discordance was higher in patients with female sex ( P < .05), older age ( P < .001), and longer time intervals between referral and appointment ( P < .05). Lack of communication with the patient (instructions or referral notification) by the referring provider was not associated with CC-RR Discordance. Conclusions: Discordance between patient CC and the rationale for a consultation is common in this safety-net otolaryngology practice and may be an important source of patient dissatisfaction. Future opportunities for quality improvement include pre-consultation communication between the specialist and the patient and reducing time intervals between referral and appointment.

THE CLINICAL IMPLICATIONS OF HEMOGLOBIN STRUCTURE

PEDIATRICS ◽  
1963 ◽  
Vol 31 (5) ◽  
pp. 780-785
Author(s):  
Park S. Gerald
Keyword(s):  
Incidental Finding ◽  
Chief Complaint ◽  
Clinical Implications ◽  
Dominant Inheritance ◽  
Successful Completion ◽  
Contributing Factors ◽  
Peripheral Neuritis ◽  
Paternal Aunt ◽  
The Many ◽  
And Training

I FEEL DEEPLY HONORED to be named as one of the recipients of the 1962 Mead Johnson Awards for research in pediatrics. I am grateful for this opportunity to express my indebtedness and gratitude to the many who have aided me, and especially to my sponsor, Dr. Louis K. Diamond. His unwavering confidence and unselfish support were major contributing factors toward the successful completion of these research efforts. Lack of time prevents me from giving an adequate list of those other teachers and associates who contributed significantly toward my research efforts and training, but time can never be so short as to prevent me from mentioning my stimulating and energetic co-worker, Dr. Mary Efron. I have saved to the last, mention of my wife, as she has so often cheerfully been the vital silent partner of experiments that seemed always to last "just a little longer" than I expected. In order to make this a coherent presentation, I am going to dwell solely upon the "Hb M diseases." This group of hemoglobinopathies is characterized by the presence of cyanosis in several generations of a given family, being transmitted as if determined by the presence of a single abnormal gene (i.e., "dominant" inheritance). In the first family of this disorder that came to our attention, the cyanosis was an incidental finding in a child whose chief complaint was an obscure peripheral neuritis. There seemed to be little relation between the peripheral neuritis and the cyanosis, since the child's brother, father, paternal aunt and other relatives also were cyanotic (Fig. 1), although lacking any neuritis.

The Swiss Cheese Conference: Integrating and Aligning Quality Improvement Education With Hospital Patient Safety Initiatives

2019 ◽  
Vol 34 (6) ◽  
pp. 590-595
Author(s):  
Matthew S. Durstenfeld ◽  
Scott Statman ◽  
Andrew Dikman ◽  
Anahita Fallahi ◽  
Cindy Fang ◽  
...  
Keyword(s):  
Medical Education ◽  
Patient Safety ◽  
Quality Improvement ◽  
Graduate Medical Education ◽  
Hospital Patient ◽  
Swiss Cheese ◽  
Contributing Factors ◽  
Specific Patient ◽  
Safety Issues ◽  
Graduate Medical

The Accreditation Council for Graduate Medical Education requires integration of quality improvement and patient safety education into graduate medical education (GME). The authors created a novel “Swiss Cheese Conference” to bridge the gap between GME and hospital patient safety initiatives. Residents investigate a specific patient safety event and lead a monthly multidisciplinary conference about the case. Resident presenters introduce the Swiss cheese model, present the case and their findings, and teach a patient safety topic. In groups, participants identify contributing factors and discuss how to prevent similar events. Presenters and stakeholders immediately huddle to identify next steps. The Swiss Cheese Conference has increased participants’ comfort analyzing safety issues from a systems perspective, utilizing the electronic reporting system, and launching patient safety initiatives. The Swiss Cheese Conference is a successful multidisciplinary model that engages GME trainees by integrating resident-led, case-based quality improvement education with creation of patient safety initiatives.

scholarly journals Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi: A Cochrane review

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Maria Ordonez ◽  
Eu Chang Hwang ◽  
Michael Borofsky ◽  
Caitlin J. Bakker ◽  
Shreyas Gandhi ◽  
...  
Keyword(s):  
Stent Placement ◽  
Cochrane Review ◽  
Stone Disease ◽  
Ureteral Stent ◽  
Ureteral Stricture ◽  
Time Intervals ◽  
Comprehensive Search ◽  
Publication Language ◽  
Post Hoc ◽  
Patients Experience

Introduction: We aimed to assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. Methods: We performed a comprehensive search with no restrictions on publication language or status up to February 1, 2019. We only included randomized trials. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the certainty of the evidence according to GRADE. Results: We included 23 studies with 2656 randomized patients. Primary outcomes: It is uncertain whether stenting reduces the number of unplanned return visits (very low CoE). Pain on the day of surgery is probably similar (mean difference [MD] 0.32; 95% confidence interval (CI) -0.13‒0.78; moderate CoE). Pain on postoperative days 1‒3 may show little to no difference (SMD 0.25; 95% CI -0.32‒0.82; low CoE). It is uncertain whether stented patients experience more pain on postoperative days 4‒30 (very low CoE). Stenting may result in little to no difference in the need for secondary interventions (relative risk [RR] 1.15; 95% CI 0.39‒3.33; low CoE). Secondary outcomes: We are uncertain whether stenting reduces the need for narcotics and reduces ureteral stricture rates up to 90 days (very low CoE). Rates of hospital admission may be slightly reduced (RR 0.70; 95% CI 0.32‒1.55; low CoE). This review was limited to patients in whom ureteroscopy was deemed ‘uncomplicated.’ In addition, time intervals for the grouping for the reported degree of pain were established post hoc. The CoE for most outcomes was rated as low or very low for methodological reasons. Conclusions: Findings of this review illustrate the tradeoffs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease.

Multi-institution quality improvement in supportive oncology: Results of the Coleman Supportive Oncology Collaborative (CSOC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6606-6606
Author(s):  
Paramjeet Khosla ◽  
Julia Rachel Trosman ◽  
Betty Roggenkamp ◽  
Teresa Lillis ◽  
Joanna Martin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Delivery ◽  
Safety Net ◽  
Training Methods ◽  
Institute Of Medicine ◽  
Quality Improvements ◽  
Exact Test ◽  
Oncology Care ◽  
Supportive Oncology ◽  
Oncology Practice

6606 Background: The Institute of Medicine and Commission on Cancer recommend systematic delivery of supportive oncology care for cancer patients. The CSOC is focused on quality improvement (QI) of supportive care across Chicago cancer centers (Weldon ASCO ’17). Supportive oncology includes distress, practical, family, physical, nutrition, pain, fatigue and care concerns. To support QI, cross-institution teams developed unique, relevant tools, methods, care delivery processes, patient handouts and online training. Methods: Ten centers (5 academic, 1 VA, 1 public, 2 safety net, 1 community) implemented supportive oncology screening and care delivery quality improvements. Centers collected data for relevant Quality Oncology Practice Initiative (QOPI) metrics. Analyses used simple frequencies and Fishers exact test. Results: Five of six QOPI measures were improved at statistically significant levels from 2014 to 2017, p < .00001. Improvements are more modest in 2016 & 2017 as 4 of the centers started this QI in 2017. Conclusions: The CSOC achieved significant improvements in supportive oncology screening and identifying and addressing patients’ needs and concerns. Additional work is needed to improve these measures to achieve the best quality of cancer care possible for every patient based on their needs and concerns. [Table: see text]

Emergency department surge and overcrowding: An interdisciplinary solution for an institutional issue.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 242-242 ◽  
Author(s):  
Susan Gaeta ◽  
Toni Edwards ◽  
Sorayah Bourenane ◽  
Carmen E. Gonzalez ◽  
Karen McFarland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Action Plan ◽  
Cancer Center ◽  
Contributing Factors ◽  
Improvement Project ◽  
Safety Risks ◽  
Ed Overcrowding ◽  
Systematic Solution ◽  
Md Anderson

242 Background: Emergency Department (ED) surges at MD Anderson Cancer Center (MDACC) lead to overcrowding, safety risks, privacy concerns, staff burnout, and adverse events associated with delays in care, including death. In 2015, the ED Interdisciplinary Quality & Safety Committee (EDIQSC) at MDACC was developed to review and address safety events. We report on the preliminary results of a quality improvement project with a long-term goal of developing a systematic solution of proactively responding to ED surge and overcrowding (EDSO). Methods: First, EDIQSC reviewed the current literature regarding EDSO. Subsequently an ED Surge and ED Overcrowding Committee (EDSOC) was established to identify solutions to address patient safety risks and improve patient experience in the ED. Results: Literature review showed that NEDOCS (Weiss, SJ et al) was the best scoring tool to calculate ED Overcrowding levels. EDSOC’s weekly meetings facilitated by the Office of Performance Improvement (OPI) explored factors related to EDSO via FMEA a quality improvement tool that proactively evaluate process associated risks. In addition, the following immediate solutions were implemented in the ED: daily status reporting by ED to institutional leaders, a “fast-track” care area implementation, senior executive rounding during ED Surge, electronic medical record (EMR) configuration for high census accommodation, continuous ED Nursing Leadership unit needs assessment, and prioritization of needs based on hospital throughput. Additional interventions in current development include a real-time EMR dashboard accurately reflecting ED capacity, and a NEDOCS guided interdisciplinary operational action plan. Conclusions: ED Surge & Overcrowding is a complex issue with various external and internal contributing factors that cannot be solved with one approach. It is a dynamic, interdisciplinary system that requires vigilant planning, assessment of downstream change effects, stakeholder agility and continuous risk anticipation. EDSOC continues these efforts in an attempt to develop and implement a comprehensive, interdisciplinary tool to direct institutional operations during times of ED Surge & Overcrowding.

Characteristics of Primary Care Safety-Net Providers and Their Quality Improvement Attitudes and Activities

2012 ◽  
Vol 28 (2) ◽  
pp. 151-159 ◽  
Author(s):  
Lenny López ◽  
Catherine M. DesRoches ◽  
Christine Vogeli ◽  
Richard W. Grant ◽  
Lisa I. Iezzoni ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Safety Net ◽  
Safety Net Providers

scholarly journals Improving Respiratory Rate Accuracy in the Hospital: A Quality Improvement Initiative

2019 ◽  
Vol 14 (11) ◽  
pp. 673-677 ◽  
Author(s):  
Neil Keshvani ◽  
Kimberly Berger ◽  
Arjun Gupta ◽  
Sheila DePaola ◽  
Oanh Kieu Nguyen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Respiratory Rate ◽  
Low Cost ◽  
Blood Pressure Measurement ◽  
Vital Signs ◽  
Safety Net ◽  
Adverse Outcomes ◽  
Quality Improvement Initiative ◽  
Safety Net Hospital ◽  
Automated Blood Pressure Measurement

Respiratory rate (RR) is a predictor of adverse outcomes. However, RRs are inaccurately measured in the hospital. We conducted a quality improvement (QI) initiative using plan-do-study-act methodology on one inpatient unit of a safety-net hospital to improve RR accuracy. We added time-keeping devices to vital sign carts and retrained patient-care assistants on a newly modified workflow that included concomitant RR measurement during automated blood pressure measurement. The median RR was 18 (interquartile range [IQR] 18-20) preintervention versus 14 (IQR 15-20) postintervention. RR accuracy, defined as ±2 breaths of gold-standard measurements, increased from 36% preintervention to 58% postintervention (P < .01). The median time for vital signs decreased from 2:36 minutes (IQR, 2:04-3:20) to 1:55 minutes (IQR, 1:40-2:22; P < .01). The intervention was associated with a 7.8% reduced incidence of tachypnea-specific systemic inflammatory response syndrome (SIRS = 2 points with RR > 20; 95% CI, –13.5% to –2.2%). Our interdisciplinary, low-cost, low-tech QI initiative improved the accuracy and efficiency of RR measurement.

scholarly journals Exploring Unobserved Heterogeneity in Cyclists’ Occupying Motorized Vehicle Lane Behaviors at Different Bike Facility Configurations

2022 ◽  
Vol 19 (2) ◽  
pp. 792
Author(s):  
Lei Zhang ◽  
Shengrui Zhang ◽  
Bei Zhou ◽  
Yan Huang ◽  
Dan Zhao ◽  
...  
Keyword(s):  
Road Traffic ◽  
Unobserved Heterogeneity ◽  
Random Parameter ◽  
Contributing Factors ◽  
Time Intervals ◽  
Recording Time ◽  
Heterogeneous Effects ◽  
Lane Width ◽  
Random Parameter Logit ◽  
Working Day

Cyclists occupying motorized vehicle lanes disrupt road traffic order and increase collisions. Exploring the contributing factors could help develop countermeasures to regulate such behaviors. The purpose of this study is to explore the intrinsic features influencing the behavior of cyclists in occupying motorized vehicle lanes at different bicycle facilities. We investigated a total of 34,631 cycling behavior samples in the urban area of Pingdingshan, China. A Bayesian random parameter logit model was used to account for the unobserved heterogeneous effects. The experimental results of all bike facilities demonstrate that the bike type, dividing strip type, bike lane width, temporary on-street parking, and whether it is a working day significantly affect cyclists’ occupying motorized vehicle lane behaviors. Factors associated with unobserved heterogeneity are age, barriers dividing strip, vehicle lane numbers, bike volume, vehicle volume, and daily recording time intervals. Comparing the estimated model of five type bike lane facilities across different dividing strips, we find that cyclists have a significantly different occupying probability and the heterogeneity factors of the various bike facilities also have their focus. When the non-motorized road conditions become more open, the cyclist behavior becomes more random and the heterogeneity factors become broader.

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