Quality Improvement and Safety in Healthcare: Reflections on essential frameworks to guide applied scholarship that promotes transformation and innovation

The publication of the inaugural issue of the Journal of Nursing and Interprofessional Leadership in Quality and Safety (JONILQS) is a unique milestone that is the culmination of visionary leadership, scholarly effort, and keen attention to the many tasks necessary to launch a journal. The University of Texas Health Science Center at Houston’s School of Nursing launches this journal to address the focus on quality and safety initiatives and research that helps to make the health care we provide safer and better. This journal seeks to highlight practical work from the field that will change things for the better for the patients and health care systems we serve

New Journal, Same Ongoing Challenge: Advancing Policies that Promote the Health and Well-Being of Children and Families

The publication of the inaugural issue of the Journal of Applied Research on Children is a notable milestone for its sponsoring organization, CHILDREN AT RISK (www.childrenatrisk.org). With the release of “Volume 1, Number 1,” we as the Co-Editors in Chief would like to take the opportunity to thank the inaugural contributors whose articles follow and to answer the obvious question of “Why publish a new journal?

Avoiding Antiplatelet Reversal in Non-Operative Intracranial Hemorrhages: Functional Outcomes of Guideline-Based Practice

Introduction: Intracranial hemorrhage (ICH) is a common, life-threatening neurological pathology in aging patients, many of whom take antiplatelet medications with potential to worsen the hemorrhage. In the event of ICH, Thomas Jefferson University Hospital (TJUH) follows a protocol modeling the 2016 Neurocritical Care Society (NCS) joint guidelines for antiplatelet medication reversal. We analyzed pre- and post-NCS guideline data from TJUH for outcomes of non-operative ICH patients in order to tease out the potential benefits of this protocol. Methods: This retrospective cohort study took place from January 2016 – Jan. 2018 at a tertiary care center: TJUH. Patients included were ³18 y.o., on antiplatelet therapy who, had CTs available for evaluation of expansion, and did not undergo surgical management. The primary outcomes measured for comparison were both the admission and discharge Glasgow Coma Scores (GCS), admission and discharge modified Rankin Scores (mRS), time to death, hematoma expansion, and in-hospital mortality. T-tests, the Kolmogorov-Smirnov-test, and Chi-Square test for independence were used. Results: For pre- and post-protocol groups, no significant difference existed for GCS or mRS, at admission and discharge. There were no significant findings for in-hospital mortality and hemorrhage expansion. Discussion: TJUH established a protocol in line with the 2016 NCS joint guidelines for managing ICH in patients on antiplatelet therapies. This protocol recommends discontinuing antiplatelet therapy and not transfusing platelets in patients not receiving surgical management. We examined the protocol efficacy have found no significant differences in the pre- and post-protocol groups, indicating patient outcomes may be equivalent

Scientific Proceedings of the Texas Children’s Hospital’s 17th Session of the Advanced Quality Improvement and Patient Safety Program

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required for each QI project. The graduation ceremony is modeled after a day-long scientific meeting and each team presents a poster as well as a brief oral presentation using Power Point slides describing their project work. At the 17th AQI graduation session held on 2/9/2018, 16 teams presented their projects of which 10 submitted their posters for inclusion in this proceedings piece

Scientific Proceedings of the Texas Children’s Hospital’s 16th Session of the Advanced Quality Improvement and Patient Safety Program

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use the IHI ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required for each QI project. The graduation ceremony is modeled after a day-long scientific meeting and each team presents a poster as well as a brief oral presentation using Power Point slides describing their project work. At the 16th AQI graduation session held on 9/15/2017, 16 teams presented their projects, of which 8 submitted their posters for inclusion in this proceedings piece