scholarly journals Healthcare Quality Improvement Analytics: An Example Using Computerized Provider Order Entry

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1187
Author(s):  
Jungwon Cho ◽  
Sangmi Shin ◽  
Youngmi Jeong ◽  
Eunsook Lee ◽  
Soyeon Ahn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Control Chart ◽  
Healthcare Professionals ◽  
Segmented Regression ◽  
Long Term Effects ◽  
Order Entry ◽  
Post Intervention ◽  
Computerized Provider Order Entry ◽  
Healthcare Settings ◽  
The Impact

Evaluation of sustainability after quality improvement (QI) projects in healthcare settings is an essential part of monitoring and future QI planning. With limitations in adopting quasi-experimental study design in real-world practice, healthcare professionals find it challenging to present the sustained effect of QI changes effectively. To provide quantitative methodological approaches for demonstrating the sustainability of QI projects for healthcare professionals, we conducted data analyses based on a QI project to improve the computerized provider order entry system to reduce patients’ dosing frequencies in Korea. Data were collected for 5 years: 24-month pre-intervention, 12-month intervention, and 24-month post-intervention. Then, analytic approaches including control chart, Analysis of Variance (ANOVA), and segmented regression were performed. The control chart intuitively displayed how the outcomes changed over the entire period, and ANOVA was used to test whether the outcomes differed between groups. Last, segmented regression analysis was conducted to evaluate longitudinal effects of interventions over time. We found that the impact of QI projects in healthcare settings should be initiated following the Plan–Do–Study–Act cycle and evaluated long-term effects while widening the scope of QI evaluation with sustainability. This study can serve as a guide for healthcare professionals to use a number of statistical methodologies in their QI evaluations.

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

scholarly journals CPOE in Non-Surgical Versus Surgical Specialties: A Qualitative Comparison of Clinical Contexts in the Medication Process

2010 ◽  
Vol 4 (1) ◽  
pp. 206-213 ◽  
Author(s):  
Zahra Niazkhani ◽  
Habibollah Pirnejad ◽  
Antoinette de Bont ◽  
Jos Aarts
Keyword(s):  
Information Needs ◽  
Order Entry ◽  
Clinical Context ◽  
Qualitative Comparison ◽  
Computerized Provider Order Entry ◽  
Medication Process ◽  
Positive Attitudes ◽  
Perceived Impact ◽  
The Impact

Background: Computerized provider order entry (CPOE) systems are implemented in various clinical contexts of a hospital. To identify the role of the clinical context in CPOE use, we compared the impact of a CPOE system on the medication process in both non-surgical and surgical specialties. Methods: We conducted a qualitative study of surgical and non-surgical specialties in a 1237-bed, academic hospital in the Netherlands. We interviewed the clinical end users of a computerized medication order entry system in both specialty types and analyzed the interview transcripts to elicit qualitative differences between the clinical contexts, clinicians’ attitudes, and specialty-specific requirements. Results: Our study showed that the differences in clinical contexts between non-surgical and surgical specialties resulted in a disparity between clinicians’ requirements when using CPOE. Non-surgical specialties had a greater medication workload, greater and more diverse information needs to be supported in a timely manner by the system, and thus more intensive interaction with the CPOE system. In turn these factors collectively influenced the perceived impact of the CPOE system on the clinicians’ practice. The non-surgical clinicians expressed less positive attitudes compared to the surgical clinicians, who perceived their interaction with the system to be less intensive and less problematic. Conclusion: Our study shows that clinicians’ different attitudes towards the system and the perceived impact of the system were largely grounded in the clinical context of the units. The study suggests that not merely the CPOE system, the technology itself, influences the perceptions of its users and workflow-related outcomes. The interplay between technology and clinical context of the implementation environment also matters. System design and redesigning efforts should take account of different units’ specific requirements in their particular clinical contexts.

scholarly journals Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tessa Scheffers-van Schayck ◽  
Bethany Hipple Walters ◽  
Roy Otten ◽  
Marloes Kleinjan
Keyword(s):  
Smoking Cessation ◽  
The Netherlands ◽  
Healthcare Professionals ◽  
Counseling Program ◽  
Smoking Cessation Counseling ◽  
Healthcare Settings ◽  
Quit Smoking ◽  
Child Healthcare ◽  
Referral Tool ◽  
The Impact

Abstract Background Recently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool. Methods Child healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data. Results The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service. Conclusions Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.

Abstract WP266: EMS/Hospital Combined Education Decreased Primary Stroke Center Bypass

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason P Stopyra ◽  
Myron Waddell ◽  
Emily B Parks
Keyword(s):  
North Carolina ◽  
Quality Improvement ◽  
Service Area ◽  
Education Intervention ◽  
Post Intervention ◽  
Intervention Phase ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Impact

Introduction: Historically, community hospitals have had few options for meaningful treatment of patients presenting with acute stroke. As expertise grows in the administration of thrombolytics, primary stroke centers (PSC) fulfill an important role in the reduction of morbidity and mortality related to stroke. It is important for the PSC to partner with Emergency Medical Services (EMS) to change historical perceptions of the quality of PSC care. Education may improve teamwork and increase awareness of the PSC, thereby increasing their utilization in EMS disposition decisions. Objective: The objective of this study is to report the impact of an education intervention on PSC bypass decisions. Methods: The electronic patient care record database from a North Carolina county EMS system was queried as a quality improvement analysis from January 1, 2012 to February 28, 2016. This included 19 months prior to the education intervention, the year during the education intervention, and 19 months after the education intervention. All primary patient transports with Stroke/CVA, or suspected TIA as the primary or secondary impression were included. Interfacility transports were excluded. The recorded call location was determined to either be inside or outside the PSC service area. The hospital the patient was transported to was also recorded. Results: During the pre-intervention phase 222 patients were identified, 48 of which originated in the PSC service area. Of those 48 patients, 16 bypassed the PSC (33.3%). In the post-intervention phase, 94 of 269 total patients were in PSC service area. Only 12 bypasses occurred (12.8%) which is a reduction of 61.7% in PSC bypass compared to the pre-intervention phase. Conclusion: The period following a combined hospital/EMS educational intervention showed significant reduction in PSC bypass.

scholarly journals Impact of a Pharmacist-Driven Protocol to Improve Drug Allergy Documentation at a University Hospital

2013 ◽  
Vol 48 (4) ◽  
pp. 302-307 ◽  
Author(s):  
Christopher Burrell ◽  
Candy Tsourounis ◽  
David Quan ◽  
Vicki Jue ◽  
Eunice Tam ◽  
...  
Keyword(s):  
Drug Allergy ◽  
Age Groups ◽  
Substantial Improvement ◽  
University Hospital ◽  
Order Entry ◽  
Post Intervention ◽  
Pediatric Services ◽  
Physician Order Entry ◽  
The Impact

Background An internal evaluation of the inpatient pharmacy order entry database ( WORx) at a university hospital revealed that the nature of the reaction was documented for only 47% of patients with reported drug allergies/intolerance. Insufficient documentation of drug allergy/intolerance may result in administration of drugs that should not be prescribed. Similarly, valuable agents that should be used may not be prescribed due to an unnecessary fear of adverse drug reaction. More complete description of drug allergy/intolerance may result in more correct prescribing of medications. Objective Evaluate the impact of a pharmacist-driven protocol on the quality of drug allergy/intolerance documentation. Methods Four pre-intervention evaluations were conducted every 2 weeks documenting the completeness of drug allergy/intolerance information in the pharmacy order entry database. One week following the implementation of a pharmacist-driven protocol intended to improve the completeness of drug allergy/intolerance information, a series of 4 postintervention evaluations was repeated. Proportional analysis of pre- and postinterventional data was performed to evaluate the effectiveness of the intervention. Results A total of 1,686 allergies from 2,174 patients were reviewed pre and post intervention. The frequency of complete drug allergy/intolerance documentation pre intervention was 52% to 62%. Following implementation of the hospitalwide, pharmacist-driven protocol, this rate increased to 60% to 76%. Pediatric services demonstrated the most substantial improvement, increasing from 53% to 79% to 67% to 93%. Blank reaction fields decreased by 10% in both age groups. Conclusion A pharmacy-driven initiative intended to improve the completeness of drug allergy/intolerance documentation was associated with modest success. Other mechanisms, including electronic health record systems with computerized physician order entry and decision support, are needed to improve the completeness of drug allergy/intolerance information.

scholarly journals The impact of computerized provider order entry on emergency department flow

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Andrew Gray ◽  
Christopher M.B. Fernandes ◽  
Kristine Van Aarsen ◽  
Melanie Columbus
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Wait Time ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

scholarly journals A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

2015 ◽  
Vol 5 (1) ◽  
pp. 41 ◽  
Author(s):  
Ssebuufu Robinson ◽  
Victor Pawelzik ◽  
Abraham Megentta ◽  
Oswald Benimana ◽  
Damascene Mazimpaka ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Problem Solving ◽  
Length Of Stay ◽  
Work Group ◽  
Surgical Patients ◽  
P Value ◽  
Post Intervention ◽  
Quality Of Surgery ◽  
The Impact

Objective: While several studies have focused on improving the quality of surgery, less attention has been paid to reducing pre-operative delays in care. We undertook a hospital quality improvement (QI) effort to reduce pre-operative delays in a teaching hospital in Rwanda. Without a coordinated admission schedule, many surgical patients arriving at the hospital for admissions were turned away because of unavailable beds. For those admitted for surgery, the pre-operative waits were long.Methods: A pre- and post-intervention study was conducted to examine the impact of a QI effort on two metrics: 1) pre-operative length-of-stay (LOS) for elective surgical patients, and 2) the number of elective surgical patients who were turned away on the scheduled admission date. Intervention: A multi-disciplinary work group utilized a Strategic Problem Solving Approach and implemented a centralized patient wait list and new schedule process utilizing the existing resources available at the hospital.Results: The percentage of elective surgical patients with a pre-operative LOS of more than two days was significantly lower in the post-intervention compared with the pre-intervention period (80% versus 26.8%, p-value < .001). The percentage of scheduled patients who were turned away due unavailable inpatient beds significantly decreased from 63.4% to 5.3%, p-value < .001.Conclusions: By following a methodical strategic problem solving approach, the pre-operative LOS was reduced, elective surgical patients turned away due to unavailable beds was decreased at very low financial cost.

Analyzing Visual Search Techniques using Eye Tracking for a Computerized Provider Order Entry (CPOE) Task

2017 ◽  
Vol 61 (1) ◽  
pp. 691-695
Author(s):  
Kylie M. Gomes ◽  
Sara L. Riggs
Keyword(s):  
Visual Search ◽  
Eye Tracking ◽  
Search Strategy ◽  
Healthcare Professionals ◽  
Alternative Methods ◽  
Order Entry ◽  
Patient Identification ◽  
Computerized Provider Order Entry ◽  
Search Patterns ◽  
Tracking Technology

A challenge with current Computerized Provider Order Entry (CPOE) systems includes patient identification errors, i.e. when an incorrect patient’s record is referenced. These types of errors can lead to patient safety issues such as administrating medication to the incorrect patient. Eye tracking technology can provide insights into the visual search patterns of healthcare professionals and shed light on how patient identification errors occur. This study investigates whether there are differences in visual search metrics, response time, and accuracy when searching for a patient by two identifiers – name or date of birth – from a list of patients with similar names. The findings revealed there was no effect of search strategy on speed or accuracy; however, there was an effect on fixation duration and number of fixations within specific areas of interest. Across both search strategies, there were more fixations on names. This demonstrates the importance of a patient’s name regardless of search strategy and is an important consideration to take into account if multiple patients share the same name. This study shows that eye tracking technology can be used to investigate the visual search patterns employed during patient identification and provide insights as to how patient identification errors occur. It also demonstrates a need to develop alternative methods to prevent patient identification errors apart from relying on healthcare professionals to verify patient identity.

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