scholarly journals The business case for hospital-based Behavioral Screening and Intervention

2015 ◽  
Vol 4 (6) ◽  
pp. 95
Author(s):  
Richard L Brown
Keyword(s):  
Hospital Admissions ◽  
Business Case ◽  
Adverse Outcomes ◽  
Coordination Of Care ◽  
Behavioral Screening ◽  
Value Based Purchasing ◽  
Potential Benefits ◽  
Improvement Programs ◽  
Quality Improvement Programs ◽  
Hospital Revenues

Under the Affordable Care Act, hospitals are challenged to avoid growing penalties for adverse outcomes, including readmissions, and to adapt to value-based purchasing, where parent organizations will ultimately regard hospital revenues as costs. Hospitals are responding by implementing quality improvement programs, strengthening coordination of care around and after discharge, and enhancing chronic disease management, but many hospitals continue to suffer penalties. An additional response could be to systematically conduct screening and intervention for “upstream” behavioral risks and disorders – smoking, unhealthy drinking and depression – which are associated with admissions, inferior medical and surgical outcomes, readmissions, and ample costs. By increasing smoking quit rates, reducing binge drinking and enhancing depression outcomes, Behavioral Screening and Intervention (BSI) could improve outcomes for various chronic diseases, prevent acute disease and injury, decrease hospital admissions and readmissions, avert surgical complications, and improve hospitals’ bottom lines. This article discusses how hospitals could implement BSI and potential benefits, barriers and limitations.

scholarly journals The Challenging but Imperative Path to Monoclonal Antibody Use Against COVID-19 for a Small Overseas Military Hospital

2021 ◽  
Author(s):  
Spencer Shirk ◽  
Danielle Kerr ◽  
Crystal Saraceni ◽  
Garret Hand ◽  
Michael Terrenzi ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Hospital Admissions ◽  
Adverse Outcomes ◽  
Lessons Learned ◽  
Military Hospital ◽  
Clinical Criteria ◽  
Fda Approval ◽  
Life Saving ◽  
Set Up ◽  
Naval Hospital

ABSTRACT Upon the U.S. FDA approval in early November for a monoclonal antibody proven to potentially mitigate adverse outcomes from coronavirus disease 2019 (COVID-19) infections, our small overseas community hospital U.S. Naval Hospital Rota, Spain (USNH Rota) requested and received a limited number of doses. Concurrently, our host nation, which previously had reported the highest number of daily deaths from COVID-19, was deep within a second wave of infections, increasing hospital admissions, near intensive care unit capacity, and deaths. As USNH Rota was not normally equipped for the complex infusion center required to effectively deliver the monoclonal antibody, we coordinated a multi-directorate and multidisciplinary effort in order to set up an infusion room that could be dedicated to help with our fight against COVID. Identifying a physician team lead, with subject matter experts from nursing, pharmacy, facilities, and enlisted corpsmen, our team carefully ensured that all requisite steps were set up in advance in order to be able to identify the appropriate patients proactively and treat them safely with the infusion that has been clinically proven to decrease hospital admissions and mortality. Additional benefits included the establishment of an additional negative pressure room near our emergency room for both COVID-19 patients and, when needed, the monoclonal antibody infusion. In mid-January, a COVID-19-positive patient meeting the clinical criteria for monoclonal antibody infusion was safely administered this potentially life-saving medication, a first for small overseas hospitals. Here, we describe the preparation, challenges, obstacles, lessons learned, and successful outcomes toward effectively using the monoclonal antibody overseas.

Addressing Communication Breakdowns during Emergency Care Transitions of Older Adults: Evaluation of a Standardized Inter-Facility Health Care Communication Form

2021 ◽  
pp. 1-11
Author(s):  
Patrick McLane ◽  
Kaitlyn Tate ◽  
R. Colin Reid ◽  
Brian H. Rowe ◽  
Carole Estabrooks ◽  
...  
Keyword(s):  
Older Persons ◽  
Chart Review ◽  
Care Transitions ◽  
Unintended Consequences ◽  
Term Care ◽  
Usual Practice ◽  
Improvement Programs ◽  
Quality Improvement Programs ◽  
Communication Breakdowns

Abstract Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.

Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand

2007 ◽  
Vol 28 (7) ◽  
pp. 791-798 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Kanokporn Thongphubeth ◽  
Sirinaj Sirinvaravong ◽  
Danai Kitkangvan ◽  
Chananart Yuekyen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Urinary Catheterization ◽  
Urinary Catheters ◽  
Improvement Program ◽  
Improvement Programs ◽  
Intervention Team ◽  
Quality Improvement Programs

Objective.To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.Methods.A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.Results.A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).Conclusions.This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.

scholarly journals The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

2020 ◽  
Author(s):  
Anne Griffin ◽  
Aoife O´Neill ◽  
Margaret O´Connor ◽  
Damien Ryan ◽  
Audrey Tierney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Ability ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Secondary Analysis ◽  
Adverse Outcomes ◽  
Nutrition Status

Abstract BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from baseline to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. At 6-months, a reported further decline in functional ability was more likely among those who were malnourished compared to those who had normal nutritional status. ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to long-term care at 30 days. Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

scholarly journals BIAYA KUALITAS DAN KOMPQNENNYA PADA BAD AN USAHA PERAIH ISO 9000 DI KAWASAN INDUSTRI SIER DAN PIER

2005 ◽  
Vol 4 (1) ◽  
Author(s):  
Stefanus Budy Widjaja Subali ◽  
Yie Ke Feliana
Keyword(s):  
Quality Improvement ◽  
Iso 9000 ◽  
Cost Driver ◽  
Quality Costs ◽  
Activity Cost ◽  
Improvement Programs ◽  
Quality Improvement Programs

Quality has become an important competitive dimension for all organization. Recently, -the emphasis on quality has shifted from a source of strategic advantage to a compepetive necessity As the companies implement quality-improvement programs,one of those is. ISO 9000, a need arises to monitor and report on the progress of these programs. Managers r need to know about the quality costs and the component of quality costs. The component of quality costs include prevention, appraisal, internal failure and external failure costs. This article describes how the companies that were awarded ISO 9000 define the quality costs, what items to be included in the each component of quality costs and how the composition of each component of quality activity cost driver is.

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