International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Gaining Efficiency and Reducing Cost: The Re-design of a Preoperative Screening Clinic

Purpose: The purpose of this project was to focus on the redesign of the preoperative screening clinic (PSC) at a 410-bed acute care facility. The process change took place at a healthcare facility where surgical volume has been growing annually since 2011, with an average growth rate of 3% per year. The facility has projected business plans to add capacity for 6 operating rooms in the next three years due to the increased growth. The organization needed the ability to support continued surgical growth prior to the development of adding operating rooms. Understanding the current PSC operations with the need to support future growth, was the motivation for the development of this project to redesign the PSC operations. Methods: A literature review was preformed prior to the development of a plan for change in the PSC. This project is based on using an all registered nurse (RN) group to staff the prescreening clinic for patients needing anesthesia services. The intent was to demonstrate reduced day of surgery cancellations. To complete this process, specific nurse assignments with sequential assembly of the medical chart, and patient information was used. Following approved permissions for use, the Prosci's change management methodology, and the ADKAR model were used to guide the change process. Quantitative data was collected over two separate six month time periods, to compare metrics before and after the change. Results: The z-test was used to determine the significance of the changes made in the pre screening clinic. The results suggest that the changes made to the operational design in the pre screening clinic were significant in reducing day of surgery cancellations. Day of surgery cancellation rate for avoidable causes decreased from 15 cases per month to just two from December 2014 to April 2015. Conclusions: The implementation of the project achieved the goal of decreasing day of surgery cancellations. Additional benefits from the changes implemented included reduced patient wait times in the PSC to an average of less than 15 minutes, and an increased number of patient visits per day by 55%. These changes resulted in an increase in patient satisfaction. Data sources: Data was obtained using Epic's electronic software, which included the Cadence scheduling software. Additional software programs that were used to obtain data were the Kronos time keeping software, and Cisco phone reports. Daily schedules were developed by the manager to coordinate nursing assignments. Researched data sources used included; PubMed, Cochrane Collaboration, CINAHL, and Google Scholar. Key words: pre-screening clinic, pre-admission testing, pre-surgical labs, pre-operative anesthesia consultations, set-up and functioning of pre-anesthesia clinic, cost effective preoperative clinic, design of pre-operative clinic, surgery cancellation rate and the pre-operative clinic.Doctor of Anesthesia Practice (DAP)School of Health Professions and Studies: Doctor of Anesthesia PracticeUniversity of Michiganhttps://deepblue.lib.umich.edu/bitstream/2027.42/137960/1/Flint2016.pd

Improving Provider Knowledge on Surgical Site Infection Prevention Using a Surgical Surveillance Education Program

Background: Surgical site infections are a serious adverse outcome following any surgery. Despite the presence of international and standardized hospital guidelines, the prevention of surgical site infections remains a challenge for private practices and ambulatory centers. Currently, most ambulatory centers rely solely on provider reporting for their infection control reports and the education on prevention in these practices is minimal. It is critical that healthcare professionals have appropriate knowledge on surgical site infections, prevention methods and on their role in implementing evidence-based prevention strategies such as a surgical surveillance program. Purpose: The purpose of this quality improvement project (QIP) was to improve healthcare professionals’ knowledge on surgical surveillance and its potential impact on infection prevention in private and ambulatory settings. Methods/practice: The findings from the literature helped guide this QIP. A test was created to be used in the pre- and post-intervention phases. The test consisted of 4 demographic questions and 10 knowledge questions on current surgical infection prevention practices, surgical surveillance guidelines including telehealth follow ups, and 4 ungraded self-knowledge level questions. Ten participants completed the pre-test, and ten participants completed the educational session and post-test. A 30-minute evidenced-based educational session was conducted at a primary care clinic on indirect surgical surveillance and how it can be utilized in private practice to improve patient outcomes. Conclusion: The findings indicated that the participants lacked the appropriate education and information on what surgical surveillance entails and how it can be utilized in private settings. Findings from the post-test indicated that the educational session did increase the knowledge of the participants on surgical surveilling and how it can directly impact patient outcomes. Post-test scores improved 29% over pre-testing scores following the educational session. Implications for Practice: There is a lack of education and implementation of surgical surveillance guidelines in private practices across the country. Both educational leadership and management should implement the continuous and important education on how to properly utilize surgical surveillance to ensure the best and safest care is being provided to patients

Systematic and continuous collection of patient-reported outcomes and experience in women with cancer undergoing mastectomy and immediate breast reconstruction: a study protocol for the Tuscany Region (Italy)

Introduction: Monitoring how patients feel and what they experience during the care process gives health professionals data to improve the quality of care, and gives health systems information to better design and implement care pathways. To gain new insights about specific gaps and/or strengths in breast cancer care, we measure patient-reported outcomes (PROs) and patient-reported experiences (PREs) for women receiving immediate breast reconstruction (iBR). Methods and analysis: Prospective, multicentre, cohort study with continuous and systematic web-based data collection from women diagnosed with breast cancer, who have an indication for iBR after mastectomy treated at any Breast Unit (BU) in Tuscany Region (Italy). Patients are classified into one of two groups under conditions of routine clinical practice, based on the type of iBR planned (implant and autologous reconstruction). Patient-reported information are obtained prior to and after surgery (at 3-month and 12-month follow-up). We estimate that there are around 700 annual eligible patients.Descriptive analyses are used to assess trends in PROs over time and differences between types of iBR in PROs and PREs. Additionally, econometric models are used to analyse patient and BU characteristics associated with outcomes and experiences. PREs are evaluated to assess aspects of integrated care along the care pathway. Ethics and dissemination: The study has been reviewed and obtained a nihil obstat from the Tuscan Ethics Committees of the three Area Vasta in 2017. Dissemination of results will be via periodic report, journal articles and conference presentations

An Educational Module Explaining the Utilization of Airway Ultrasonography as Standard of Care for Preoperative Airway Assessment

Background: One of the most life-threatening complications during anesthesia is an unrecognized difficult airway. Difficult airway patients are more prone to intraoperative complications including airway edema, periods of hypoxia, and trauma to the airway. Failure to oxygenate due to an unpredicted difficult airway can result in permanent organ damage. Standardizing the method in which providers classify airways preoperatively including handheld ultrasonography could help decrease the incidence of unpredicted difficult intubations. This quality improvement project assessed whether anesthesia providers would benefit from an educational module on ultrasound parameters to differentiate difficult versus easy intubations to increase ultrasound airway anatomy knowledge, skill, and predictive abilities. There were three participants, all are certified registered nurse anesthetists (CRNAs). The project involved a pretest, PowerPoint presentation, and posttest. Based on the results, an educational module on airway assessment utilizing ultrasound parameters compared to no ultrasound parameters increases knowledge in ultrasound airway anatomy, skill, and predictive ability in detecting a difficult versus easy intubation

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

International Profiles of Health Care Systems, 2015

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

International Profiles of Health Care Systems, 2013

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers healthinsurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Data standards for transcatheter aortic valve implantation: the European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart)

Funding: European Society of Cardiology.publishersversionepub_ahead_of_prin