This document discusses processes that have been implemented at a rural hospital with 1200 births per year to improve obstetric patient safety and outcomes. Some of the key processes discussed include establishing a team approach involving all hospital personnel, conducting regular simulations to improve communication and adherence to protocols, implementing mentorship programs for nurses and managers, standardizing communication using SBAR, leveraging electronic medical records and data to monitor quality and outcomes, and promoting a culture of accountability and professionalism. The goal of these initiatives is to reduce errors, minimize harm, and improve outcomes through multidisciplinary collaboration and a systems-based approach. While changing healthcare culture and achieving measurable outcomes can be challenging, continuous monitoring and refinement of processes may help advance safety and quality of
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides 3 key points:
1) The PCMH model emphasizes primary care-led, coordinated, and comprehensive care centered around the patient. It aims to improve access, outcomes and reduce costs through care coordination and an emphasis on prevention.
2) Studies show PCMH interventions can reduce hospital and ER use by over 30% each and lower total costs by 9% while maintaining or improving outcomes.
3) Successful PCMH models require health IT and data sharing to facilitate care coordination, population health management, and quality improvement. They also rely on payment reforms that appropriately recognize the added value of the medical
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
This document provides an overview of transitions of care, including definitions, models, and best practices. It describes transitions as the movement of patients between healthcare settings or providers. Poor transitions can lead to adverse outcomes for patients and increased costs. Several evidence-based models are described that aim to improve transitions through elements like medication reconciliation, discharge planning, and post-discharge follow up. These models have demonstrated reductions in readmissions and healthcare utilization. The document provides resources for additional information on improving the quality of patient transitions.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
The Beryl Institute 2013 State of the Patient Experience Benchmarking StudyEngagingPatients
This document summarizes the key findings of a survey of over 1,000 US hospitals regarding their efforts to improve the patient experience. It finds that while patient experience remains a top priority, hospitals feel somewhat less positive about their progress than two years ago. Most hospitals now have a formal definition and structure for patient experience. Leadership support and HCAHPS scores are the top factors driving patient experience work. Hospitals continue focusing on communication, noise reduction, and discharge processes to improve patient experience.
Can we solve the adult primary care shortage without more physicians? CHC Connecticut
Tom Bodenheimer,of the Center for Excellence in Primary Care at UCSF Dep’t of Family and Community Medicine talks about addressing the primary care shortage at the 2014 Weitzman Symposium
The Kansas Healthcare Collaborative worked with over 50 Kansas birthing hospitals from 2012-2014 to reduce non-medically indicated early elective deliveries (EED) before 39 weeks gestation. Through collaborative efforts and adopting evidence-based practices, hospitals reduced EED by 70.5%, exceeding the initial goal of 40%. Analysis of birth certificate data found potential disparities in EED rates between racial/ethnic groups and primary languages, suggesting hospitals should consider these factors in quality improvement efforts to further reduce EED.
Patients and their loved ones often hold critical knowledge that informs diagnosis. This toolkit from the Institute of Medicine offers patients, families and clinicians guidance on how they can collaborate to improve diagnosis.
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
Kaiser Permanente developed a bundled approach to improve care transitions called the Transition Care Journey. The bundle includes risk stratification, a dedicated phone number for post-discharge questions, standardized discharge summaries, medication management, and follow-up appointments and calls. Implementation of the bundle in Northwest Kaiser led to reductions in readmission rates, medication list errors, and time to primary care follow-up. It also improved communication between hospitalists, primary care physicians, and specialists. The bundled approach is being spread to other Kaiser regions nationally.
The document discusses Project ECHO and its mission to expand access to specialty healthcare for common and complex diseases in rural and underserved areas. Project ECHO uses teleconferencing and case-based learning to train primary care clinicians to treat and manage conditions like hepatitis C. An evaluation showed primary care clinicians trained through Project ECHO achieved similar treatment outcomes for hepatitis C as specialists at a university medical center, improving access to care for rural and minority populations.
Patient engagement is evolving to include a composite of practices that impact patient behaviors and health. Contemporary models of patient engagement include the HIMSS 5 phases of patient engagement and the Regional Primary Care Coalition's 6 dimensions of patient engagement. Meaningful Use Phase 3 identifies key priorities around patient access to health records and secure messaging. Barriers to patient engagement include defining engagement and integrating diverse engagement tools and technologies.
This infographic from The Beryl Institute presents key findings from its study, the "State of Patient Experience 2015: A Global Perspective on the Patient Experience Movement," which engaged over 1,500 respondents in 50 countries, sharing challenges and opportunities in addressing the patient experience across all healthcare settings.
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
The Kaiser Permanente Homeless Navigator Pilot Program in Woodland Hills, California connects homeless patients with community resources to help them find housing and other services, placing over 576 homeless patients in shelters and programs since 2012. The program uses a team approach involving medical, social work, and community staff. It has been successful in transforming lives and ending homelessness for many patients.
SlideShare now has a player specifically designed for infographics. Upload your infographics now and see them take off! Need advice on creating infographics? This presentation includes tips for producing stand-out infographics. Read more about the new SlideShare infographics player here: http://wp.me/p24NNG-2ay
This infographic was designed by Column Five: http://columnfivemedia.com/
This document provides tips to avoid common mistakes in PowerPoint presentation design. It identifies the top 5 mistakes as including putting too much information on slides, not using enough visuals, using poor quality or unreadable visuals, having messy slides with poor spacing and alignment, and not properly preparing and practicing the presentation. The document encourages presenters to use fewer words per slide, high quality images and charts, consistent formatting, and to spend significant time crafting an engaging narrative and rehearsing their presentation. It emphasizes that an attractive design is not as important as being an effective storyteller.
No need to wonder how the best on SlideShare do it. The Masters of SlideShare provides storytelling, design, customization and promotion tips from 13 experts of the form. Learn what it takes to master this type of content marketing yourself.
10 Ways to Win at SlideShare SEO & Presentation OptimizationOneupweb
Thank you, SlideShare, for teaching us that PowerPoint presentations don't have to be a total bore. But in order to tap SlideShare's 60 million global users, you must optimize. Here are 10 quick tips to make your next presentation highly engaging, shareable and well worth the effort.
For more content marketing tips: http://www.oneupweb.com/blog/
This document provides tips for getting more engagement from content published on SlideShare. It recommends beginning with a clear content marketing strategy that identifies target audiences. Content should be optimized for SlideShare by using compelling visuals, headlines, and calls to action. Analytics and search engine optimization techniques can help increase views and shares. SlideShare features like lead generation and access settings help maximize results.
A Guide to SlideShare Analytics - Excerpts from Hubspot's Step by Step Guide ...SlideShare
This document provides a summary of the analytics available through SlideShare for monitoring the performance of presentations. It outlines the key metrics that can be viewed such as total views, actions, and traffic sources over different time periods. The analytics help users identify topics and presentation styles that resonate best with audiences based on view and engagement numbers. They also allow users to calculate important metrics like view-to-contact conversion rates. Regular review of the analytics insights helps users improve future presentations and marketing strategies.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
How to Make Awesome SlideShares: Tips & TricksSlideShare
Turbocharge your online presence with SlideShare. We provide the best tips and tricks for succeeding on SlideShare. Get ideas for what to upload, tips for designing your deck and more.
discusion 1As I mentioned in my introduction, I manage two OBGYN p.docxowenhall46084
discusion 1
As I mentioned in my introduction, I manage two OBGYN practices at the University of Kentucky. One of those practices is located in Rowan County, in a small town called Morehead, KY. In the community, our clinic is one of only two OBGYN practices.
In addition, many of the surrounding rural counties are without OBGYN physicians. Therefore, many of our patients make a lengthy commute to see one of our providers. Fortunately, Morehead does have a hospital that is equipped with labor and deliver services. The next closest hospital or OBGYN high risk specialist is over an hour’s drive away on the main UK campus in Lexington, KY. Recognizing the lack of services, and the difficulty of travel for our patients, we started offering telehealth in 2013 to expand access of care and improve the quality of care for our high risk OB patients with the Blue Angels program.
All patients who are considered as having a high risk pregnancy are offered a telehealth consult with a high risk OBGYN specialist from Lexington via telehealth with the Blue Angels program. This consultation occurs during the patient’s routine ultrasound. The exam room is equipped with a large 55 inch monitor that allows the physician to see both the patient and the ultrasound that is being performed by the sonographer, in real time. This allows the provider and the patient to communicate as if they were face to face in an office visit.
From 2015-2016, 1,863 patients participated in the Blue Angels program - a 62% growth in patient volume from the previous year. Deliveries and NICU referrals from the area to Lexington grew almost 40% from 2013-2016.
The set up cost for telehealth was minimal in comparison to the progress and benefits being made in our high risk patients.
According to the document “The Role of Telehealth in an Evolving Health Care Environment”, telehealth allows rural areas to increase quality of care and patient volumes, reduce emergency department visits and hospital readmissions, and offer specialty care at a lower cost, not to mention saving the patients time, money, and traveling to Lexington.
Other methods of web-based communication tools have also proven to help manage complex health care needs by providing virtual access to multiple specialty providers. In a pilot study, researchers developed the “Loop”, a secure online communication tool that allowed patients to communicate with multiple members of a health care team. The study proved the “Loop” to be successful in providing effective medical team collaboration with patients. Similar in design and access, patient portals allow for patients to get medical information, appointments, and prescriptions all in the click of a computer. In the article “Patient Web Portals, Disease Management, and Primary Prevention”, the authors state that web portals have been shown to increase patient adherence to medical regimens, and have improved the overall efficiency and quality of health care.
Patient-centered .
Patient-centered medical home initiatives in several states have shown promising results in improving access to care, quality, and cost control for Medicaid patients. Oklahoma saw a $29 per patient annual reduction in Medicaid costs from 2008-2010 alongside increased use of preventive care. Colorado expanded Medicaid access from 20% to 96% of pediatricians at lower costs. Vermont saw 21-22% decreases in inpatient care use and costs from 2008-2010 alongside 31-36% drops in ER use and related costs. Washington state's acute care spending was 18% below average with 35% fewer inpatient stays per beneficiary. Overall, these initiatives demonstrate that the patient-centered medical home model can positively impact Medicaid programs.
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides examples of organizations that have implemented PCMH initiatives to improve care coordination, access, costs and outcomes. Key points include:
- PCMH aims to strengthen primary care through care coordination, enhanced access, quality improvement and payment reform.
- Studies show PCMH can reduce costs by decreasing ER visits and hospital days while improving outcomes.
- Several large employers, the Department of Defense, and state governments have adopted PCMH models for the populations they insure.
- Successful PCMH models integrate primary care, specialists, hospitals, and community resources through use of health IT, data sharing and care
Impact Of Improved Documentation On An Academic Neurosurgical PracticeAntoinette Williams
This document discusses the impact of an educational intervention on documentation accuracy at an academic neurosurgery department. The intervention provided training to physicians on properly documenting patient comorbidities. After the intervention, measures of case complexity including severity of illness, risk of mortality, and case mix index all significantly increased, reflecting more accurate documentation. As a result, the average margin per discharge improved by 42.2%, showing the financial impact of improved documentation. The study demonstrates that targeted training can meaningfully improve documentation quality and its effects on quality metrics and revenue.
Many healthcare financial decisions have a direct effect on nursin.docxalfredacavx97
Many healthcare financial decisions have a direct effect on nursing practice and patient care delivery. What are the ethical implications of these financial decisions? Discuss and explain two specific ways to involve nursing staff in financial planning.
Peer 1 Response:
Lauren Van Hemelrijck posted
The ethical implications of financial decisions that have a direct effect on nursing practice consist of the reduction in available money that is spent on staffing in order to ensure there are appropriate ratios at all times as well as cutting costs related to specific equipment and or tools needed to perform our jobs. Specific nurse to patient ratios have been implemented in some places however, it is not currently the norm regardless of numerous studies that have been conducted and shown that the higher the ratio the worse a patient's outcome. Although facilities will save a substantial amount of money when they cut down on staff, which is why they often choose to do so, an immoral and unethical act in and of itself, the end result effects the patients in often times very negative ways. If patients are having poor experiences they are either not likely to return because they are afraid the care that they receive will continue to be less than adequate or they will have to return due to complications that could have been prevented had there been an appropriate nurse to patient ratio when they were being cared for. As a study on this very subject has found "there is already a significant amount of empirical evidence showing the relationship between certain individual and organizational characteristics of hospital nursing and patient outcomes. These characteristics include nurses' level of education, patient-to-ratios, percentage of RNs among all nursing staff (skill mix), and the nurse practice environment" (Simonetti, 2019, p. 79).
Often times, more expensive equipment makes our jobs easier because it is more efficient and or effective. If we begin to "cut corners" in these ways it will undoubtedly have a direct impact on how well we are able to perform our jobs in certain situations. This is unethical because equipment could mean the difference between accuracy and efficiency among other things. This then means that it could then make or break a patient's outcome. If safety is compromised it is completely inappropriate to substitute equipment that might be unsafe thus putting the patient at an increased risk for illness or injury. This is not only incredibly unethical, it will have an all around negative impact on the facility's reputation and financial standing in the long run. Nurses should have a say in how money is spent because they are often times the most knowledgeable about all of the above. One article that looks at lifting equipment or lack there of states that "the results indicate that fewer than 12 percent of the responding nurses told us they have a "No Lift Policy". More than 85 perfect of hospitals have some type of.
Lessons Learned for Strengthening Early Infant Diagnosis of HIV ProgramsHFG Project
This document summarizes lessons learned for strengthening early infant diagnosis (EID) of HIV programs in sub-Saharan Africa based on a literature review and the Health Finance and Governance project's work in Kenya. The main challenges identified are patient loss to follow up throughout the EID testing process, long turnaround times between sample collection and result receipt, and failure to initiate antiretroviral therapy for HIV-positive infants. Countries have implemented interventions like community outreach, point-of-care testing, and data dashboards to address these challenges. In Kenya, EID testing costs were measured and turnaround times analyzed, finding an average of 43 days between sample collection and result receipt.
Synopsis: Impact of Health Systems Strengthening on HealthHFG Project
Leaders in low- and middle-income countries (LMICs) require timely and compelling evidence about how to strengthen their health systems to improve the health and well-being of their citizens. Yet, evidence on how to strengthen health system performance to achieve sustainable health improvements at scale, particularly toward Ending Preventable Child and Maternal Deaths (EPCMD), fostering an AIDS-Free Generation (AFG), and Protecting Communities against Infectious Diseases (PCID) is limited. The evidence that does exist is scattered, insufficiently analyzed, and not widely disseminated. Without evidence, decision-makers lack a sound basis for investing scarce health funds in health systems strengthening (HSS) in an environment of competing investment options.
USAID is committed to advancing the evidence base on HSS and this commissioned report clearly demonstrates that HSS can improve health in LMICs.
This report, based on a review of systematic reviews of the effects on health of HSS, presents a significant body of evidence linking HSS interventions to measureable impact on health for vulnerable people in LMICs. Making decisions on who delivers health services and where and how these services are organized is important to achieve priority health goals such as EPCMD, AFG, and PCID. The findings of this report document the value of investing in HSS.
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides examples of how the PCMH approach coordinates care through a team-based approach focused on managing patient populations, uses data to drive decisions and improve outcomes, and shifts care away from episodic visits to proactive health management. Studies show the PCMH approach can reduce costs through lower utilization of emergency rooms, hospitals, and specialty care while improving quality of care and patient outcomes.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
· What is the NDNQIThe National Database of Nursing Quality Ind.docxodiliagilby
· What is the NDNQI?
The National Database of Nursing Quality Indicators (NDNQI®) is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level. Linkages between nurse staffing levels and patient outcomes have already been demonstrated through the use of this database. Currently over 1100 facilities in the United States contribute to this growing database which can now be used to show the economic implications of various levels of nurse staffing.
NDNQI data allows staff nurses and nursing leadership to review and evaluate nursing performance in relation to patient outcomes. Hospitals can use the information to establish organizational goals for improvement at the unit level, and mark progress in improving patient care and the work environment. It can also help your facility avoid costly complications.
· What are nursing-sensitive quality indicators?
Nursing-sensitive indicators identify structures of care and care processes, both of which in turn influence care outcomes. Nursing-sensitive indicators are distinct and specific to nursing, and differ from medical indicators of care quality. For example, one structural nursing indicator is nursing care hours provided per patient day. Nursing outcome indicators are those outcomes most influenced by nursing care.
· Which particular quality indicator did you select to address in your tutorial?
Medication error
· Why is this quality indicator important to monitor?
· Be sure to address the impact of this indicator on quality of care and patient safety.
Medication safety is an important topic because medication errors (MEs) are a common, serious and expensive type of medical error
may cause or lead to inappropriate medication use or patient harm
· Why do new nurses need to be familiar with this particular quality indicator when providing patient care?
The nurse’s role in and ability to change patient safety and quality improvement within health care has implications for both safety and quality processes and nursing, patient, and organizational outcomes. The relationships between organizational systems factors, clinical processes, and patient safety and quality outcomes. It is important to focus on improving and widening the assessment of the impact of patient safety and quality improvements on the incidence of the broad array of errors that can and do occur in nurses’ work environments. For example, leaders and clinicians need to understand the association between an organization’s culture of safety and patient outcomes as well as how nurses can influence executives to lead working environment improvements.
Hello and welcome to the University Hospital Health Care System. My name is Diane Tate. We are so excited to have you on our nursing team. I am here today to help you better understand how our healthcare system uses Nursing Sensitive Quality Indicators – also known as the NDNQI - to en ...
· What is the NDNQIThe National Database of Nursing Quality Ind.docxalinainglis
· What is the NDNQI?
The National Database of Nursing Quality Indicators (NDNQI®) is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level. Linkages between nurse staffing levels and patient outcomes have already been demonstrated through the use of this database. Currently over 1100 facilities in the United States contribute to this growing database which can now be used to show the economic implications of various levels of nurse staffing.
NDNQI data allows staff nurses and nursing leadership to review and evaluate nursing performance in relation to patient outcomes. Hospitals can use the information to establish organizational goals for improvement at the unit level, and mark progress in improving patient care and the work environment. It can also help your facility avoid costly complications.
· What are nursing-sensitive quality indicators?
Nursing-sensitive indicators identify structures of care and care processes, both of which in turn influence care outcomes. Nursing-sensitive indicators are distinct and specific to nursing, and differ from medical indicators of care quality. For example, one structural nursing indicator is nursing care hours provided per patient day. Nursing outcome indicators are those outcomes most influenced by nursing care.
· Which particular quality indicator did you select to address in your tutorial?
Medication error
· Why is this quality indicator important to monitor?
· Be sure to address the impact of this indicator on quality of care and patient safety.
Medication safety is an important topic because medication errors (MEs) are a common, serious and expensive type of medical error
may cause or lead to inappropriate medication use or patient harm
· Why do new nurses need to be familiar with this particular quality indicator when providing patient care?
The nurse’s role in and ability to change patient safety and quality improvement within health care has implications for both safety and quality processes and nursing, patient, and organizational outcomes. The relationships between organizational systems factors, clinical processes, and patient safety and quality outcomes. It is important to focus on improving and widening the assessment of the impact of patient safety and quality improvements on the incidence of the broad array of errors that can and do occur in nurses’ work environments. For example, leaders and clinicians need to understand the association between an organization’s culture of safety and patient outcomes as well as how nurses can influence executives to lead working environment improvements.
Hello and welcome to the University Hospital Health Care System. My name is Diane Tate. We are so excited to have you on our nursing team. I am here today to help you better understand how our healthcare system uses Nursing Sensitive Quality Indicators – also known as the NDNQI - to en.
This study assessed the accuracy and completeness of data related to early infant diagnosis (EID) of HIV in Kisumu County, Kenya. The study reviewed data from 23 health facilities and analyzed records for 130 patients. Several key data elements were found to have incomplete or inaccurate recording, including infant age, date of sample collection, and prevention of mother-to-child transmission prophylaxis. However, infant sex, infant prophylaxis, breastfeeding information, and test results were more completely recorded. While staff appeared dedicated, the findings suggest the data is not fully utilized locally and presents opportunities for improved data management to strengthen the EID program.
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
Here is a professionally written paragraph on the topic with an APA formatted citation:
Alarm fatigue poses a significant patient safety risk in healthcare facilities. When nurses are inundated with a high volume of alarms, some of which are clinically irrelevant, it can lead to desensitization and delays in response to critical alarms (Sendelbach & Jepsen, 2013). Nuisance or false-positive alarms are a key driver of alarm fatigue, as they do not indicate an actual adverse patient condition but still interrupt care providers (Graham & Cvach, 2010). The overuse of alarms has created a "cry wolf effect" wherein nurses start to mistrust clinical alarm systems due to the frequency of irrelevant alerts (Cvach, 2010
Midwifery has provided safe care to over 180,000 Ontarians since 1994. Midwifery care demonstrates excellent clinical outcomes, cost-effectiveness, and high rates of client satisfaction. To further transform Ontario's healthcare system, the document recommends leveraging midwifery's expertise by expanding access to midwifery care, improving coordination and integration of midwifery services, educating the public about birth choices, and making evidence-based decisions to ensure sustainability.
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
This document discusses leadership for patient engagement in the NHS. While the NHS has focused on public consultations and one-off engagement initiatives, true culture change is required to make services patient-centered. Leaders face challenges in shifting beliefs, attitudes, and behaviors away from disease-focused care toward responsive, empowering care centered around patients' needs and preferences. Successful approaches require strategic, system-wide efforts to engage patients in shared decision-making, self-management of long-term conditions, and improving quality by understanding patients' perspectives. Isolated projects are easier than changing mainstream practice to prioritize the patient experience in all interactions and functions.
Drhatemelbitar (1)MEDICAL CASE MANAGEMENTد حاتم البيطارد حاتم البيطار
1. The document discusses issues with the current healthcare system including lack of coordination between institutions, dehumanization of care, and rising costs.
2. It introduces case management as a promising solution, defined as a method that aims for continuity of services and quality clinical outcomes through efficient management of available resources for specific clientele.
3. Case management relies on thorough knowledge of client needs, estimating patient stay lengths, and planning coordinated treatment processes to improve care quality while controlling costs.
Seeking patient feedback an important dimension of quality in cancer careAgility Metrics
1) A patient satisfaction survey was conducted with cancer outpatients to identify areas for improvement. Wait times and contacting healthcare providers by telephone received the lowest satisfaction ratings, despite prior interventions to address wait times.
2) Patients followed by a nurse navigator reported higher satisfaction with wait times than those without a nurse navigator.
3) The survey found overall high satisfaction rates, but identified wait times and telephone contact as ongoing priorities for enhancing the patient experience.
Seeking patient feedback an important dimension of quality in cancer care
OGIJ-02-00020
1. Obstet Gynecol Int J 2015, 2(1): 00020
Obstetrics & Gynecology International Journal
Submit Manuscript | http://medcraveonline.com
Abbreviations
NICU: Neonatal Intensive Care Unit; SWOT: Strength,
Weakness, Opportunities, and Threats; SBAR: Situation,
Background, Assessment and Recommendation; MIS: Medical
Information Systems; EMR: Electronic Medical Record; EMTALA:
Emergency Treatment and Labor Act
Commentary
Over the past 14 years there has been a growing interest
in improving hospital processes for effectiveness, efficiency,
and patient safety [1-4]. The obstetric research is difficult and
complex partly because of the high percentage of physiologically
well patients, mother and neonate [5]. The main intent of the
researcher objective was to improve accuracy, competencies,
and to initiate a collaborative commitment through processes,
which will result in improved outcomes [4,5]. They also strove
to decrease variances, reduce harm, and lessen costs. Continuous
and constant data is needed to benchmark care, which is
episodically provided in silos. As important is that unknown,
amounts of the quality data may be inadequate and programs are
inconsistent. For example, hospitals with low obstetric volumes
appear to have higher postpartum odds of maternal hemorrhage.
Additional data concludes obstetric quality and safety outcomes
vary significantly across rural hospitals by birth volume. It
appears further research is needed to determine if volumes and
geography affect outcomes [6-8]. There is great variation among
hospital’s and the quality indicators [7,9].
Processes To Improve Obstetric Patient Safety And
Outcomes In A Rural Hospital: Are There Unintended
Consequences?
Commentary
Volume 2 Issue 1 - 2015
Robert A Knuppel*
Chief OB/Gyn and Director Perinatal Consultants, Penn
Highlands Healthcare, USA
*Corresponding author: Robert A Knuppel, Chief
OB/Gyn and Director Perinatal Consultants, Penn
Highlands Healthcare, 274 Treasure Lake Dubois, PA,
Tel: 908-812-5240; Email:
Received: November 27, 2014| Published: January 3,
2015
You may ask, what are the outcomes you want to advance?
[10] Improved outcomes take many forms and may result in
unrecognized, unintended consequences. Objectives will depend
on international geography and established public health targets
to reduce maternal and child mortality and morbidity. It is
oftentimes important to notice the differences in definition, such
as rural, urban, quality, and process. Currently in the United
States, most outcomes are targeted by the short-term adverse
effects on the mother, fetus, and neonate.
RegulatorsintheUnitedStates,includingtheJointCommission
and insurance companies, have cited such short-term outcomes
by which they gauge and may publicly report physician and
hospital performance. These include, but are not limited to, read
missions, birth trauma, admissions to the Neonatal Intensive
Care Unit (NICU), vaginal lacerations, episiotomies, elective
near term deliveries, liability claims, financial ramifications, and
cesarean section rates, thus demonstrating a need for expanded
quality measures [10].
In truth, the most valuable maternal and child outcomes
we desire to reduce are delivery of premature babies, child
neurologic dysfunction, maternal mortality and morbidity (50
times more common than mortality). Will altering processes and
standardization improve these outcomes? The long-term adverse
outcomes have a low prevalence and will continue to require
multicenter well-funded studies, large hospital systems or meta-
analysis to provide the appropriate research papers to support
that evidence-based care can be the cause of improved outcomes.
Abstract
There is growing international interest in improving obstetric service processes,
outcomes, and reducing costs. Change in delivery of the healthcare system is universal
due to innovation but predominantly incited by the sociopolitical call to reduce costs.
Most of the literature has been provided by increasing numbers of accomplished
researchers concentrating on obstetric patient safety and outcomes. Several papers
demonstrate similar maternal/neonatal outcomes on rural versus urban populations.
Measuring and improving outcomes has proven to be a difficult task. Processes to
improve patient safety will be discussed from a rural hospital perspective, some of
which have been and can be easily implemented in all hospitals to effect efficiency,
effectiveness, and data to alter the communication (oral and electronic). If you cannot
dynamically measure quality, you cannot improve quality. There are local solutions
to local problems. Perinatal regionalization, telemedicine, and tele-sonography
continue to provide improvements in access to at-risk care. The development of the
TEAM approach cannot be underestimated. It is essential to remove the silos from the
service. Monitoring and infusion of resources to improve population accessibility is in
need of enhancement. Value driven healthcare will be affected by balancing business
and financial needs with improved quality of care.
Keywords
Rural Health; Patient Safety; Obstetrics; Quality; Shared Decision Making
2. Processes To Improve Obstetric Patient Safety And Outcomes In A Rural Hospital: Are There Unintended
Consequences?
Citation: KnuppelRA(2015) ProcessesToImproveObstetricPatientSafetyAndOutcomesInARuralHospital:AreThereUnintendedConsequences?
Obstet Gynecol Int J 2(1): 00020. DOI: 10.15406/ogij.2015.02.00020
Copyright:
2015 Knuppel
2/5
It appears it takes 3-5 years to provide any statistically significant
long-term outcome change based on process alteration in part
due to the low prevalence of the adverse benchmark. It will also
require robust, integrated, and granulated data management
across diverse systems and populations. Recent large studies of
some long and short-term outcomes are disappointing [11,12].
As such, the regulating bodies and benchmark developers
for public dissemination have limited scopes of quality to short-
term outcomes. To be meaningful, these short-term “quality”
measures require greater refinement of data, such as individual
cesarean section rates. Gross rates are not an indicator of quality
of performance unless we know why it was done, the acuity of the
patients, comorbidities, etc. In addition, grading outcomes across
diverse hospitals may not be valid. Furthermore, obstetric care
should be based on shared decision making with evidence based
medicine and the patient.
Shared decision making is becoming more prominent as
a method to improve population health [13] How strong is
the evidence-based medicine and how well does the patient
understand the explanation of the evidence upon which they
will make a shared decision? Can one exist without the other if
we are to improve patient safety? The balance of autonomy and
beneficence is ubiquitous. There are skills needed in informing
and measuring heterogeneity of patient populations. Will the
evaluators of hospital and physician quality insert the variable of
patient diversity with the intent to maintain wellness and patient
compliance into the grading system? How much effect does the
doctor have on patient behavior? [14,15] Until patient population
diversity is incorporated into grading reports of performance,
one questions the true value of the grading system resulting in
improving patient care in the current system.
We all recognize any grading of physicians and hospitals will
alter their behavior, but will it improve the care and outcomes?
The long-term outcomes with strong evidence could be funded by
the same insurers and regulators, but they have generally failed
to do so. Cost factors at all levels can influence the commitment
of resources for safety efforts. The diversity of populations must
be taken into account. Individual human behavior is difficult to
measure when the system performance is evaluated. Systems
to provide home support after delivery need to be improved to
assist in newborn care and maternal compliance for care of their
comorbidities. Targeted “pay for performance” may take into
account the more complex and higher acuity patients that cost
more for proper care.
As “pay for performance” becomes more prevalent and
has a greater effect on reimbursement these rating scores of
“quality” and outcomes will require more scrutiny, validation
and unintended consequences as seen with the electronic fetal
monitoring and the cesarean section rates. Also, the use of
hormone replacement in post-menopausal women and increased
heart attacks should cause us to pause. Approximately 14% of all
US deliveries are in rural hospitals (depending on the definition
of rural) Literature shows that hospitals with less than or equal
to 1200 deliveries provide in-patient care for almost 50% of the
deliveries in the US. According to ACOG, in 2008, only 6.4% of
obstetricians/gynecologists practice in rural settings [16].
I wish to describe processes that we have implemented in a
rural facility housing an NICU with approximately 1200 deliveries
per year. There are no residents or fellows in the healthcare
system. All patients from every socioeconomic background are
seen in the healthcare system or private physician offices and
there are no clinics. The following is a summary of initiatives
we implemented that may assist in improving the obstetrical
services and reduce miscommunication and harm [17,18].
Establish the Team Approach
This includes all personnel (most importantly nurses) in all
processes such as case presentations, protocol development and
approval, educational didactic sessions, input from the NICU,
pediatricians, and anesthesia department. We tried to align
incentives.
Develop a Plan From All Personnel
We began by using the Strength, Weakness, Opportunities,
and Threats (SWOT) business model approach. Hours were
spent meeting with all providers to determine opportunities
to improve care. They proved to be primarily communication
and professionalism. We subsequently distributed to the team
by email timely journal articles and webinars which addressed
improving care for discussion, evaluation, and possible
implementation at our monthly Risk Management and Patient
Safety Meeting attended by all interested providers.
Mission and Vision Statements
I learned as Chair of the Robert Wood Johnson Medical School
Department of OB/GYN near the International Headquarters of
Johnson and Johnson that the mission statement had a genuine
effect with almost all the employees and management for nearly
100 years. The founder of this most successful corporation
established it. Our obstetric mission and vision statements were
established by the TEAM following the SWOT exercise.
Simulations
Improving mishaps in the aviation industry have had a
worldwide impact. They used simulations to effectively reduce
errors, improve communication, and establish strict adherence
to protocols [17]. Videotaping the sessions is an essential
component of the debriefing. We hold these sessions at least
once per month. They address both the common and uncommon
events. A multidisciplinary presence is required in most
simulations. Protocols are followed and corrections in actions are
a learning experience.
Mentoring
It was recognized that the charge nurses were not adequately
trained to provide leadership and manage a group to adhere to
accepted behavior and protocols. This included interactions
with doctors, nurses, and disruptive behaviors. We all realize the
nurses are the first line of care requiring structure and critical
thinking in a system where they know someone has their back.
3. Processes To Improve Obstetric Patient Safety And Outcomes In A Rural Hospital: Are There Unintended
Consequences?
Citation: KnuppelRA(2015) ProcessesToImproveObstetricPatientSafetyAndOutcomesInARuralHospital:AreThereUnintendedConsequences?
Obstet Gynecol Int J 2(1): 00020. DOI: 10.15406/ogij.2015.02.00020
Copyright:
2015 Knuppel
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This is particularly important on night shifts and weekends. Thus,
mandatory mentoring sessions were established for all mangers
and charge nurses no matter their seniority. Often individuals are
put in charge because they are entitled. This applies to physician
management and leaders as well.
Communication
Cascading errors in communication leads to most adverse
events. There needs to be a supportive culture to provide
confidence for each member to express concerns, disagreements
in care, avoid silence, and report disruptive behavior [18,19].
Anger and stress negatively affect judgment. Emphasis was
placed disseminating complete information to the health care
team. Accurate hand-offs are essential to providing proper care
now being taught in medical schools [20].
Laborist
A laborist would assist in maintaining continuity while the
providers remained in their offices until needed [21]. The laborist
also provides adherence to protocols, assistance at surgery,
manages emergencies, and delivers “unattended’ deliveries by
the private obstetrician or nurse midwife.
SBAR
The situation, background, assessment, and recommendation
(SBAR) was implemented to assist in standardizing
communication, however most doctors want to quickly get to the
gist of the issues. SBAR was used by most but not all as a method
of standardized communication for over 2 years after it was
implemented.
Process Improvement and Medical Information
Systems (MIS) Data Management
Hospitals cannot improve quality if they cannot measure
quality and collaborate with the both the Process Improvement
department and MIS. Granulation of accurate data with a timely
feedback loop is essential as we move to improve overall care.
Electronic medical record (EMR) data is in the nascent stages.
It is sometimes incomplete or inaccurate, but it has allowed us
to share timely healthcare information as never before. This
detail allows us to move forward in more accurate and precise
evaluation of performance. Furthermore, we can determine
adverse or enhanced outcomes based on processes providing
proper outcomes to assess provider performance. The EMR needs
to be constantly customized to provider needs including placing
pediatric, newborn, anesthesia, and NICU information for timely
sharing to avoid errors in missed diagnosis or preparing for care
of all patients. Moreover, new reports discuss errors in EMR
documentation attributing 20% of one system’s liability claims.
Clearly, if the information is invalid then it should be corrected.
If we find the quality measures unsatisfactory we should demand
forbettermorejustifiableandrealdatathatimprovesourpractice
of medicine. The system requires a feedback loop to address
areas for timely improvement. Community wide compatible
infrastructure will assist in reducing lack of information arriving
to the point of care in a timely fashion. It is becoming more
evident that poor care or documentation in the outpatient setting
is compounding errors in the hospital.
Cultural Change
This is the most challenging and most rewarding impact that
leadership can attain in efforts to improve safer care. It takes time
and is built on the first-adopters to accept the change. They must
buy in to the TEAM approach, professionalism, critical thinking,
andthemissionandvisionstatements.Thefirst-adoptersareyour
core. They understand reciprocation and are motived by a desire
to provide collaborative improvement for excellence. Change in
healthcare is difficult to achieve and the desire for quick action
is always sought. Expectations need to be modified, but their
desires must not be assuaged. It takes constant and consistent
steps by leadership to monitor communication and action if
realistic and positive impact can be achieved. Accountability must
be aggressively pursued. If accountability is not pursued then
disappointed personnel pervade the culture and negatively affect
implementation of positive change. The leaders should bring the
personnel’s limbic system to the forefront. Provide them with a
platform to express what makes them enjoy their job and what is
the most rewarding experience. We need to appeal to the limbic
system to incite positive emotions, which are just as important
as the fact-loaded precortex. Inspiring value in each person’s
personal role is both enriching and enhances performance.
Professional behavior must be constantly encouraged. It
requires training to properly manage unprofessional behavior
(disruptive), which is a Joint Commission sentinel event [18,19].
Product Line
This is another example of utilizing business models that
have proven effective for decades, such as Japanese engineers
introduced into automobile manufacturing. Integrating
the multidisciplinary, diverse patient flow provides many
advantages. It improves communication, openly discusses system
accountability, examines waste, and should bring efficiency
geared to the patient’s desires and good outcomes. The product
line provides information and measured feedback to distributed
management. The “perinatal” and “product” flow is currently
counter intuitive as the prenatal care moves to in hospital care
and the newborn and mothers are generally placed in silos of care.
Finally, infant and child evaluations are lost to almost all previous
providers. All these silos provide individual information that in
a feedback loop will enable us to target the areas for improved
value and reduced harm. Hospital administrators and directors
of services must participate to provide plans and resources to
add value to the service line.
Perinatal Regionalization
Regionalization is placing the patients in appropriate care
facilities [22-27]. It should emphasize identifying high risk
pregnancies. Risk- appropriate care and levels of services are
usually defined and sometimes funded adequately by the state or
country. Having directed the maternal segment in the developing
Florida RPICC in the 1980s the goal was to direct the most at
risk neonates (very low birth weight=<1500gms) deliver at
4. Processes To Improve Obstetric Patient Safety And Outcomes In A Rural Hospital: Are There Unintended
Consequences?
Citation: KnuppelRA(2015) ProcessesToImproveObstetricPatientSafetyAndOutcomesInARuralHospital:AreThereUnintendedConsequences?
Obstet Gynecol Int J 2(1): 00020. DOI: 10.15406/ogij.2015.02.00020
Copyright:
2015 Knuppel
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subspecialty perinatal centers. The program was, in my opinion,
based on the fact the maternal transport takes precedent to
the neonatal transport to improve outcomes (inborn versus
outborn). Last year our rural hospital accepted 40 maternal
transports and 72 neonatal transports. It appears the message
of better morbidity and mortality when neonates are born at the
regional center has not been universally implemented or transfer
can be negatively affected by weather, geography or emergent
intervention required before transport is safely accomplished.
Our catchment region is a radius of 100miles and transport by
helicopter or ambulance. We have provided outreach consults
and education to our surrounding communities. Transfer and
referral services are available 24/7 supported by the obstetric
nursing station and the maternal fetal medicine or neonatologist’s
cellphones. It is important to standardize the mechanism for
transfer of accurate information. We have developed an internal
system that works well. The referring physician/institution
takes responsibility for the transfer and making the correct
determination if the transfer should occur and assuring the
receiving center agrees. The Emergency Treatment and Labor
Act (EMTALA) laws are in effect to avoid “dumping “patients
and regulating the use of appropriate care at the transferring
and receiving hospital. Geography and logistics play important
roles in facilitating transfers. Weather and availability of people
to drive an ambulance are issues we face in a rural hospital: it
can take up to two hours to get an ambulance crew assembled.
In addition, if fetal or neonatal surgery is indicated we preferably
direct the patient to a full-care University hospital or transport
from our hospital. A decrease in Medicaid funding of NICU care in
this state places these programs at risk.
Telemedicine and tele-sonography have been used in states
with large rural populations such as Arkansas [28,29]. This is a
growing trend, both internationally and in the United States.
Itprovidesanopportunitytohaveimmediateaccesstoremote
patients and healthcare providers. Cost, as in all improvements
in quality, is a barrier. Most large scale systems have required
outside grant funding; we have found it currently too costly to
incorporate. But as we continue to view improvements of new
technologies using pc-pc transfer of information the cost will
decrease. Unfortunately, we still need objective side-by side
comparisons with onsite sonography versus remote. Federal or
state funding may assist in improving patient accessibility to
remote experts and improve care for the poor and geographically
remote patients enhancing population health.
This is only a descriptive commentary providing selected
processes others in healthcare system research have described.
We began our cultural change by including the entire healthcare
team in building confidence in their opportunities, critical
thinking, and timely information transfer. These processes
require time to improve positive attitudes with constant
vigilance and when possible utilize protocols and targeted data
mining to determine their effects on selected outcomes. Data is
management and must be dynamic and replace the entrenched
static monitoring. Too often managers only use a fire truck to
put out fires in a post de facto response. The circular truck often
runs out of water: thus, proactive management and leadership
is more effective.. Accurate data and ranking and priorities
work well to alter behavior. The short-term outcomes can be
analyzed in smaller healthcare systems like ours. Long-term
outcomes will require large and prolonged studies and/or meta-
analysis. Successful following of protocols have been rewarded
in cooperative ventures with the liability carriers reducing
premiums.
The cultural change and the collaborative commitment to
excellence calls for more providers to accept progressive and
creative alternatives founded on high grade evidence. Review of
future articles by experts that perform research on patient safety
processes and outcomes is part of leadership and to adopt proven
effective ideas and evidence based processes and outcomes.
Much of this evidence and selected processes can be used in
smaller services. Always be conscious that the changes take time.
Constant vigilance and leadership are important: dispose of the
“hit and run” consultant. First impactful steps from the existing
literature would be to institute steroids given to all mothers
with babies at risk of delivery before 32 weeks, protocols and
simulations for hypertension, massive maternal hemorrhage, and
preparation for at-risk mothers to deliver at regional centers. The
lack of patient accessibility to proper healthcare in rural areas
remains a major obstacle and deterrent to improving health in
rural healthcare systems and beyond the scope of this paper.
Overall the external factors are calling for rapid change due to
cost, growing provider shortage and inexperience. We continue
to review strong evidence based protocols and implement them
while maintaining a careful analysis in search of unintended
consequences. We must not forget that the performance and
cost of the healthcare system is a multi-stakeholder problem
with causality related to insurance companies, government
regulations, defensive medicine and patients. It is not only the
causality of patient safety related to hospitals and physicians
[30].
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Citation: KnuppelRA(2015) ProcessesToImproveObstetricPatientSafetyAndOutcomesInARuralHospital:AreThereUnintendedConsequences?
Obstet Gynecol Int J 2(1): 00020. DOI: 10.15406/ogij.2015.02.00020
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2015 Knuppel
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