scholarly journals Application of a Participatory Ergonomic Approach for Scaling Handoff Redesign: A Pilot Feasibility Study

2020 ◽  
Vol 9 (1) ◽  
pp. 283-288
Author(s):  
Louise Gliga ◽  
Isaac Lynch ◽  
Richard Preble ◽  
Philip Greilich
Keyword(s):  
Participatory Design ◽  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Transitions ◽  
Implementation Process ◽  
Scaling Up ◽  
Transitions Of Care ◽  
Modified Delphi ◽  
Best Practice Guidelines

Transitions of care between clinical areas are potentially dangerous events in healthcare. This is especially true in high risk areas, such as between the operating room (OR) and the intensive care unit (ICU). Despite the existence of best practice guidelines for perioperative handoffs, scaling up successful pilots remains a challenge. To more effectively address this limitation, we tested the feasibility of using a participatory ergonomic approach for scaling handoff redesign and implementation in an academic medical center. A multidisciplinary unit-based change team of representatives and influencers was supported by a guidance team of leaders, coaches and subject matter experts through a structured implementation process (plan, engage, execute, reflect). The participatory design incorporated a modified Delphi technique, simulation, and facilitated debriefing to elicit feedback in multiple iterative cycles. The redesigned handoff became the preferred approach by frontline clinicians across the involved disciplines and resulted in a sustained improvement in conformance to unit-determined handoff best practices. The success of this feasibility pilot has led to the support of a diffusion pilot for scaling up handoff redesign within the health system. The study supports further investigation of using a participatory ergonomics approach to engage frontline clinicians and executive leadership to scale complex sociotechnical change, like handoffs and care transitions.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

Abstract W P345: Strength in Numbers: Stroke Coordinators Improving Care Through Collaboration

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kathy Morrison ◽  
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stroke Care ◽  
Direct Care ◽  
Emergency Responders ◽  
Program Manager ◽  
Group Data ◽  
Suspected Stroke ◽  
Host Organization

Background: Stroke care evolution has been remarkable since 2000, when the Brain Attack Coalition published their recommendations for Primary Stroke Centers. For the first time, hospitals had evidence-based standards to improve patient outcomes. Today, many states require emergency responders to take suspected stroke patients only to certified stroke centers. As a result, many hospitals have established the role of stroke coordinator to oversee the myriad facets of stroke care. Coordinators are overwhelmed with the opportunities - and responsibilities - to improve care processes. Method: In 2009, the stroke program manager at a Magnet academic medical center established a regional stroke coordinators’ group. Eight coordinators met and established milestones for success. Information has been shared and nurses have traded services, providing education for each other’s organization. The group of now 28 coordinators meets every other month. Results: Positive outcomes of membership in this dynamic group include a 65% increase in professional membership in American Association of Neuroscience Nurses. In addition, the coordinators report confidence and empowerment to impact change in their own organization that improved care and outcomes. Aggregate group data demonstrates improvement in the following measures: thrombolytic administration 44%; door-to-needle time 16%; & patient education 12%. Nine additional hospitals (from 6 to 17, a 183% increase) have attained Advanced Primary Stroke certification and the host organization achieved Comprehensive Stroke certification. Conclusion: Neuroscience nurses are influential leaders - not just within their own organization. These outcomes demonstrate the mutual benefit of stroke coordinator colleagues working together and sharing best practice strategies. Through multi-organizational collaboration, they have become empowered to establish programs and become experts within their organization, able to guide and improve the care provided by their own direct-care nurses.

Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing

2019 ◽  
Vol 40 (6) ◽  
pp. 668-673 ◽  
Author(s):  
Jasmine R. Marcelin ◽  
Charlotte Brewer ◽  
Micah Beachy ◽  
Elizabeth Lyden ◽  
Tammy Winterboer ◽  
...  
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Poisson Model ◽  
Panel Testing ◽  
Period 2 ◽  
Gastrointestinal Pathogen ◽  
Pathogen Testing ◽  
The Impact

AbstractObjective:To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).Design:We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.Setting:Midwest academic medical center.Participants:Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).Intervention:A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.Results:During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.Conclusions:A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.

Impact of a transitions of care pilot service established by pharmacy residents within an academic medical center

2020 ◽  
Vol 60 (1) ◽  
pp. 87-92.e2 ◽  
Author(s):  
Emily A. O'Reilly ◽  
Amanda K. Kuszmaul ◽  
Andrea M. Carter ◽  
Kayla N. Kreft ◽  
Catherine A. Spencer
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Transitions Of Care ◽  
Academic Medical

Pharmacist Transition-of-Care Services Improve Patient Satisfaction and Decrease Hospital Readmissions

2020 ◽  
pp. 089719002095826
Author(s):  
Katherine L. March ◽  
Michael J. Peters ◽  
Christopher K. Finch ◽  
Lauchland A. Roberts ◽  
Katie M. McLean ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Control Group ◽  
Readmission Rates ◽  
Improve Patient Satisfaction ◽  
Phone Calls ◽  
Improve Patient

Background: Pharmacists ability to directly impact patient satisfaction through increases in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys utilizing transitions-of-care (TOC) services is unclear. Methods: Retrospective analysis of TOC patients from 07/01/2018 to 03/31/2019 was conducted. Intervention (INV) patients received pharmacist medication reconciliation and education prior to discharge and post-discharge telephone follow-up. All other patients served as control group (CON). Primary outcome: Evaluate impact of TOC services on HCAHPS scores for “Communication about Medicines” and “Care Transitions.” Secondary outcomes: 30-day readmissions, quantification of prevented potential safety events, assessment of discharge prescriptions sent to the academic medical center outpatient pharmacy (MOP) for TOC patients. Results: Of 1,728 patients screened, 414 patients met inclusion criteria (INV = 414, CON = 1314). A significant improvement (14.7%; p = <0.0001) in overall medication-related HCAHPS results was seen when comparing pre- vs post-implementation of the TOC service. Statistically significant increases for individual questions “staff told you what the medicine was for” (14.2%; p = 0.018), “staff describe possible effects” (21.2%; p = 0.004), and “understood the purpose of taking medications” (11.4%; p = 0.035) were observed. A non-significant decrease in 30-day readmission rates for the groups was observed (CON 16.4%, INV 13.3%; p = 0.133); however, an unplanned subgroup analysis evaluating impact of discharge phone calls on 30-day readmission rates revealed a significant reduction of 17.3% to 12.4% (p = 0.007). One hundred forty-three medication safety event(s) were potentially prevented by the TOC pharmacist. Lastly, 562 prescriptions were captured at the MOP as a result of the TOC initiative. Conclusions: Pharmacy-based TOC models can improve patient satisfaction, prevent hospital readmissions, and generate revenue.

Who’s in charge? Results from a qualitative study of caregiver perspectives on the care transition process

2018 ◽  
Vol 6 (1) ◽  
pp. 50 ◽  
Author(s):  
Benjamin Shirley ◽  
Nathaniel Erskine ◽  
David D McManus ◽  
Catarina I Kiefe ◽  
Milena Anatchkova ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Care Transitions ◽  
Transition Process ◽  
Care Transition ◽  
Valuable Insight ◽  
Structured Interviews ◽  
Medical Provider ◽  
Factors Affecting ◽  
Health Insurance Status

Background: Care transitions are a topic of increasing interest as researchers and clinicians focus their effects on patient outcomes. Engaging caregivers, who play important roles in care transitions, may yield valuable insight into how care transition processes can be improved. Methods: We conducted semi-structured interviews, focusing on caregivers’ experiences with and perceptions of care transitions, with 11 eligible caregivers whose loved ones had recently experienced an unplanned admission to a single academic medical center. Our research team analyzed the transcripts to identify key themes.Results: Caregivers detailed multiple factors affecting care transitions, including both in-hospital and external elements. Identifying the medical provider in charge of care emerged as a common difficulty. Other areas of interest included receiving discharge information, length of stay, health insurance status, the presence of social support, access to transportation and educational level, among others. Caregivers’ views on the quality of various in-hospital aspects of their own care transition experiences varied.Conclusions: Caregivers re-affirmed the complexity of the care transition process by identifying myriad factors that influence their quality. Taking steps to address these factors may help hospitals to empower and engage caregivers, as well as to improve care transitions overall and better manage the health of their patients.

Redesigning care coordination from the patient’s perspective.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 6-6 ◽  
Author(s):  
Mark Liu ◽  
Aarti Bhardwaj ◽  
Carol Kisswany ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Healthcare Utilization ◽  
Patient Experience ◽  
Medical Center ◽  
Single Point ◽  
Academic Medical Center ◽  
Care Transitions ◽  
Healthcare Providers ◽  
Active Role ◽  
Chemotherapy Administration

6 Background: Cancer patients are frequently admitted to the hospital requiring medical oncologists to take an active role in coordinating with multiple teams. In an effort to redesign care to put patients at the center and address increasing demands on our medical oncologist’s time, we created the Oncology Coordinator (OC) role focused on care setting transitions. We aimed to evaluate whether the OC would improve quality of care and decrease healthcare utilization. Methods: The OCs, are non-clinical and serve as a single point of contact for disease-based teams as patients prepare for elective admissions or discharge from the hospital. The 3 OCs received specialized training in systems and processes in both settings. They coordinate outpatient appointments, prescription delivery, transportation while also providing clinical support. Additionally, they facilitate two interdisciplinary rounds per day across three dedicated oncology units and assist with patients off-unit. We evaluated all patient discharges facilitated by the OCs during 1/1/19-2/29/20 and compared that to non-OC facilitated discharges. Using descriptive statistics, we evaluated the OCs impact on 7- and 30-day readmissions, discharge before noon rate (DBN), average time from admission to chemotherapy start and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Results: We had a total of 2,818 discharges between 1/1/19-2/29/20; 1,032 (36.6%) facilitated by the OCs. For those OC facilitated discharges we observed a 5.07% reduction in 7-day readmissions and 30-day readmissions (2.6%). We observed an overall higher average monthly rate of DBN (4.85%) compared to non-OC facilitated discharges. In addition, the average time from admission to chemotherapy administration decreased by 1 hour 31 minutes (6.8%) for the OC facilitated admissions. In the HCAHPS survey, there were improvements in Discharge Information and Care Transitions on the inpatient units where OCs were most active. Conclusions: At our academic medical center, the OCs have contributed to reduction in readmissions, time from admission to chemotherapy administration as well as improvements in discharges before noon and patient experience. This pilot demonstrates that investment in dedicated lay staff to facilitate admissions and discharges for cancer patients across care settings could lead to meaningful improvements in healthcare utilization, quality and the patient experience. Future work will evaluate the sustainability of this program and evaluate association with healthcare costs.

scholarly journals Treatment Bundle Improves Outcomes in the Management of Candidemia at Large Urban Academic Medical Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S89-S89 ◽  
Author(s):  
Gregory Cook ◽  
Shreena Advani ◽  
Saira Rab ◽  
Sheetal Kandiah ◽  
Manish Patel ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Blood Cultures ◽  
Source Control ◽  
Post Intervention ◽  
The Impact ◽  
Early Source ◽  
Order Set

Abstract Background A candidemia treatment bundle (CTB) may increase adherence to guideline recommended candidemia management and improve patient outcomes. The purpose of this study was to evaluate the impact of a best practice alert (BPA) and order-set on optimizing compliance with all CTB components and patient outcomes. Methods A single center, pre-/post-intervention study was completed at Grady Health System from August 2015 to August 2017. Post-CTB intervention began August 2016. The CTB included a BPA that fires for blood cultures positive for any Candida species to treatment clinicians upon opening the patient’s electronic health record. The BPA included a linked order-set based on treatment recommendations including: infectious diseases (ID) and ophthalmology consultation, repeat blood cultures, empiric echinocandin therapy, early source control, antifungal de-escalation, intravenous to oral (IV to PO) switch, and duration of therapy. The primary outcome of the study was total adherence to the CTB. The secondary outcomes include adherence with the individual components of the CTB, 30-day mortality, and infection-related length of stay (LOS). Results Forty-five patients in the pre-group and 24 patients in the CTB group with candidemia were identified. Twenty-seven patients in the pre-group and 19 patients in the CTB group met inclusion criteria. Total adherence with the CTB occurred in one patient in the pre-group and threepatients in the CTB group (4% vs. 16%, P = 0.29). ID was consulted in 15 patients in the pre-group and 17 patients in the CTB group (56% vs. 89%, P = 0.02). Source control occurred in three and 11 patients, respectively (11% vs. 58% P &lt; 0.01). The bundle components of empiric echinocandin use (81% vs. 100%, P = 0.07), ophthalmology consultation (81% vs. 95%, P = 0.37), and IV to PO switch (22% vs. 32%, P = 0.5) also improved in the CTB group. Repeat cultures and antifungal de-escalation were similar among groups. Thirty-day mortality decreased in the CTB group by 10% (26% vs. 16%, P = 0.48). Median iLOS decreased from 30 days in the pre-group to 17 days in the CTB group (P = 0.05). Conclusion The CTB, with a BPA and linked order-set, improved guideline recommended management of candidemia specifically increasing the rates of ID consultation and early source control. There were quantitative improvements in mortality and iLOS. Disclosures All authors: No reported disclosures.

Implementation of a medication education training program for student pharmacists employed within an academic medical center

2020 ◽  
Vol 77 (3) ◽  
pp. 206-213
Author(s):  
Kisha A Dunkley ◽  
Doneisha Evelyn ◽  
Veronica Timmons ◽  
Tara T Feller
Keyword(s):  
Patient Education ◽  
Training Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Johns Hopkins Hospital ◽  
Adult Inpatient ◽  
Education Training ◽  
Survey Responses

Abstract Purpose To describe the implementation of a student pharmacist medication education training program (the REWARDS Method), to determine if training was effective in preparing employed student pharmacists to provide medication education, and to assess medication education completion rates. Summary Hospital readmissions are often attributable to poor transitions of care (TOC), and medication education prior to discharge may improve TOC. To expand upon existing medication education efforts, the Johns Hopkins Hospital Adult Inpatient Pharmacy (AIP) designed and implemented the REWARDS Method, a training program to prepare employed second- and third-year student pharmacists to provide medication education. The REWARDS Method includes 6 distinct steps, which incorporate student self-directed and pharmacist-facilitated learning. Students were trained to provide patient education targeting 4 classes of high-risk medications (anticoagulants, inhalers, insulin, and naloxone) on multiple inpatient units served by the AIP. A total of 43 hours of pharmacist time was needed to complete training for the 10 employed student pharmacists. A survey was used to assess preparedness for completing medication education. Survey responses indicated that participants were sufficiently to exceedingly prepared to perform medication education. The division’s completion rate for patients requiring education was 79% in 2017, compared to 86% in 2018 (p = 0.006). Conclusion The REWARDS Method is an effective training program that successfully incorporated employed student pharmacists into medication education efforts. Our study demonstrated high rates of students successfully completing training and an increase in the rate of patient education completion.

scholarly journals Building eConsult (Electronic Consults) Capability at an Academic Medical Center to Improve Efficiencies in Delivering Specialty Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110053
Author(s):  
Matthew A. Thompson ◽  
Anne L. Fuhlbrigge ◽  
Duane W. Pearson ◽  
David R. Saxon ◽  
Linda A. Oberst-Walsh ◽  
...  
Keyword(s):  
Delivery System ◽  
System Integration ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Transitions ◽  
Cost Savings ◽  
Models Of Care ◽  
Health Crisis ◽  
Academic Medical ◽  
The Face

As the COVID-19 health crisis continues to reshape healthcare, systems across the country face increasing pressure to adapt their models of care to expand access to care, while also improving efficiency and quality in the face of limited resources. Consequently, many have shown a growing interest and receptivity to the expansion of telehealth models to help meet these demands. Electronic consultations (eConsults) are a telehealth modality that allow for a non-face-to-face asynchronous consultation between a primary care provider (PCP) and a specialist aimed at facilitating specialist input without the need for a patient visit. The aim of this case study is to describe eConsults, how they differ from traditional in person models of care and other models of telemedicine and to review the evidence related to the effectiveness of eConsults by PCPs and clinicians from multiple specialties at the University of Colorado School of Medicine. We have worked to develop an infrastructure, delivery system integration, and care model adaptations that aim to improve delivery system performance by ensuring proper care in appropriate settings and lowering costs through reduced utilization. Lastly, we have increased care coordination, improved collaboration and better care transitions through strengthening of relationships between community-based PCPs and academic medical center-based specialists. This work has resulted in cost savings to patients and positive provider satisfaction.

Sign in / Sign up

Export Citation Format

Share Document