103 research outputs found

    Early Discharge Planning to Improve Throughput

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    Early discharge planning can improve the safety and outcomes of hospitalized patients. The aim of the multidisciplinary team early discharge rounds was to manage patient flow by removing discharge barriers to reduce the length of stay in the medical/surgical unit. The overall goal of the process improvement project was to make inpatient beds available to admit patients from the emergency department, reducing long ED boarding, and decrease the hours of diversion. The PICOT question for this project was: in the Veteran population (P) in the VA medical/surgical unit, early discharge planning with an interdisciplinary team (I) compared to regular discharge rounds alone (C) will improve patient flow and will result in decreased emergency room medical diversion or prolonged ED boarding (O) within 10 weeks (T). The early discharge planning had a significant impact on the medical/surgical unit in helping to decrease the ED medical diversion. Although the mean length of stay from 2022 to 2023 was not significantly changed, the early discharge intervention for the 10-week period on the medical/surgical unit concurred simultaneously with a decreased in diversion hours in the emergency department by 72 hours from the 2022 to 2023 time frames

    Leadership in medical ward rounds

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    Leadership in Medical Ward Rounds: Abstract Medical ward rounds are an under researched area. The medical post take ward round has been cited as being a source of anxiety for new consultants. The non-technical skills involved may well be those that new consultants feel underprepared for in contrast to clinical skills. Ward rounds historically have been a principal vehicle for teaching junior doctors. There have been many changes in how junior doctors work which has potentially impacted their training and preparation towards being a consultant. The overarching aims of this thesis are firstly to expand our current understanding of the incorporation of training into medical ward rounds, and secondly to translate this understanding into an instrument that evaluates senior trainees or consultants skills in leading a ward round. Ultimately, improved training and assessment of the ward round process should enhance patient safety and effectiveness of care on medical wards. This thesis incorporates a narrative review on training and ward rounds. There is also a literature review on non-technical skills tools used in hospital medicine, how they were developed and their psychometric evaluation. The second review of non-technical skills tools leads to a choice of tool on which to base the development of a ward round leadership tool. The review on training and ward rounds, provides background to the thesis but also some of the findings are used for the instrument development. A post take ward round simulation was developed alongside the ward round leadership tool, which serves 2 purposes. One is to develop a training program by which to train senior medical registrars to lead post take ward rounds, and secondly, it is used to psychometrically evaluate the developed medical ward round leadership tool. There is also a chapter reporting an interview study of medical consultants and patients about training and post take ward rounds. The findings from this chapter feed directly into the tool and simulation development. The development of the simulation and tool are described and evaluated in detail. The tool is evaluated in terms of reliability and validity.Open Acces

    A Standardized Electronic Handover Report for Anesthesia Providers

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    Background: Despite numerous studies and agencies recommending the standardization of handovers to improve the quality and safety of patient care, intraoperative anesthesia handovers have remained unstandardized at many institutions. Objectives: The purposes of this study were to 1) develop the preliminary Anesthesia Handover Report (AHR) and evaluate its accessibility, layout, and content using feedback from an Expert Sampling Group; 2) create the finalized AHR and evaluate the impact it had on the perceived quality of handover among anesthesia providers; and 3) to assess the uptake of the finalized AHR. Methods: This study was implemented at NorthShore University Health System (NSUHS), Evanston, Highland Park and Glenbrook locations. In Phase 1, an Expert Sampling Group of ten experienced anesthesia providers evaluated the preliminary AHR for its accessibility, layout and content using the Expert Sampling Group Questionnaire. In Phase 2, using feedback from this questionnaire, the finalized AHR was created and all 140 anesthesia providers at the three study locations were invited to utilize and evaluate the AHR during intraoperative anesthesia handover, additionally, during Phase 3 the use of the AHR was queried every two weeks for the duration of Phase 2 to assess uptake. Results: Five anesthesia providers completed the Expert Sampling Group Questionnaire in Phase 1. Changes made to the preliminary AHR in response to feedback from the Expert Sampling Group Questionnaire included the removal of redundant information, more appropriate layout of information in the sidebar, the addition of total drug dose given in the medications panel, an additional hyperlink to anesthesia nerve block reports, and corrections to wrong information being pulled into the AHR. During Phase 2, 21 anesthesia providers completed the Anesthesia Handover Survey. The overall mean Likert score for handover conduct was 3.72 with a SD of .475 (minimum 2, maximum 4), this indicated that overall the majority of the respondents perceived that the AHR improved the conduct component of handover. The overall mean Likert score for teamwork was 3.76, with a SD of .432 (minimum 3, maximum 4), which indicated that respondents felt the AHR improved teamwork during handover. Lastly, the mean Likert score for the handover quality was 3.64 with a SD of .611 (minimum 1, maximum 4), this indicated respondents felt the AHR improved overall handover quality. Results of Phase 3 indicated the uptake did not increase as expected over the six-week monitoring window, but rather peaked during week four and quickly dropped off thereafter. The mean number of times the “Anesthesia Handoff” event button was clicked each week was 3.17. Conclusions: Use of the AHR improved the perceived conduct, teamwork, and quality of intraoperative anesthesia handovers. The use of the AHR did not improve over time. Overall, use of the AHR improved the perceived quality of anesthesia handovers. Future studies should be done to determine if use of the AHR would result in the standardization of anesthesia handovers

    Optimising cardiac services using routinely collected data and discrete event simulation

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    Background: The current practice of managing hospital resources, including beds, is very much driven by measuring past or expected utilisation of resources. This practice, however, doesn’t reflect variability among patients. Consequently, managers and clinicians cannot make fully informed decisions based upon these measures which are considered inadequate in planning and managing complex systems. Aim: to analyse how variation related to patient conditions and adverse events affect resource utilisation and operational performance. Methods: Data pertaining to cardiac patients (cardiothoracic and cardiology, n=2241) were collected from two major hospitals in Oman. Factors influential to resource utilisation were assessed using logistic regressions. Other analysis related to classifying patients based on their resource utilisation was carried out using decision tree to assist in predicting hospital stay. Finally, discrete event simulation modelling was used to evaluate how patient factors and postoperative complications are affecting operational performance. Results: 26.5% of the patients experienced prolonged Length of Stay (LOS) in intensive care units and 30% in the ward. Patients with prolonged postoperative LOS had 60% of the total patient days. Some of the factors that explained the largest amount of variance in resource use following cardiac procedure included body mass index, type of surgery, Cardiopulmonary Bypass (CPB) use, non-elective surgery, number of complications, blood transfusion, chronic heart failure, and previous angioplasty. Allocating resources based on patient expected LOS has resulted in a reduction of surgery cancellations and waiting times while overall throughput has increased. Complications had a significant effect on perioperative operational performance such as surgery cancellations. The effect was profound when complications occurred in the intensive care unit where a limited capacity was observed. Based on the simulation model, eliminating some complications can enlarge patient population. Conclusion: Integrating influential factors into resource planning through simulation modelling is an effective way to estimate and manage hospital capacity.Open Acces

    Impact of early stage lean management implementation on patient safety culture in acute care hospital units

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    Abstract Healthcare is under intense pressure to reduce waste, provide better value at lower cost and eliminate preventable harm. Lean is a term used to describe operational improvement methods to eliminate waste and do more with less(1). Early application of Lean in healthcare focused on implementing Lean tools to achieve reduction in lead-time and cost in specific units or departments. Lean in healthcare has evolved over the past 15 years beyond implementation of tools alone to include implementation of Lean Management Systems. Methods A structured literature review of peer reviewed articles on Lean Management in healthcare, published between 2000 and 2017, was conducted. The relationship between early stage Lean Management implementation and safety culture assessment at an acute care hospital was explored using difference in difference analysis of 2015 and 2017 scores. Face-to-face interviews with nurse managers involved in early stage implementation of Lean Management in an acute care hospital were conducted between July and September 2018. Key results Articles reporting on Lean Management implementation in healthcare suffer from weak pre-post designs lacking statistical analysis limiting understanding of the true impact of Lean Management implementation. In this study, analysis of the perceptions of local management, perceptions of senior management, and safety organizing scale questions of the safety culture assessment using the Difference in Difference approach showed no statistical difference for units exposed to early stage Lean Management compared to those not exposed. Interviews of nurse managers revealed that introduction of the Lean management system, particularly the True North room, provided clarity on what was important to the organization. All nurse managers interviewed were well acquainted with True North noting alignment of unit metrics to organizational goals. Interviews also revealed tension between the executive level need for standardization of huddle boards and staff engagement. Nurse managers emphasized that, while unit huddle board metrics must align with organizational goals, they must also be meaningful to front line staff to achieve desired improvement. Conclusions Longer exposure times to Lean Management systems, stronger study designs, and rigorous statistical analysis are needed to evaluate the effectiveness of Lean Management implementation in healthcare

    Mobile Device and App Use in Pharmacy: A Multi-University Study

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    Patient Safety and Quality: An Evidence-Based Handbook for Nurses

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    Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

    Textbook of Patient Safety and Clinical Risk Management

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    Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems. The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties
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