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Am J Med Qual 2022 May 18. Epub 2022 May 18.

Department of Medicine, Duke University, Durham, NC.

The authors present a tool to improve gaps in patient safety using the electronic health record. The tool integrates gap identification, passive alerts, and actions into a single interface embedded within clinicians' workflow. The tool was developed to address venous thromboembolism prophylaxis, prevention of hypo- and hyperglycemia, code status documentation, bowel movement frequency, and skilled nursing facility transitions. Read More

Am J Med Qual 2022 May 16. Epub 2022 May 16.

Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD.

Mortality review is one approach to systematically examine delivery of care and identify areas for improvement. Health system leaders sought to ensure hospitals were adapting to the rapidly changing medical guidance for COVID-19 and delivering high-quality care. Thus, all patients with a COVID-19 diagnosis within the 6-hospital system who died between March and July 2020 were reviewed within 72 hours. Read More

Am J Med Qual 2022 May 6. Epub 2022 May 6.

Department of Emergency Medicine, Weill Cornell Medical College, New York, NY.

Am J Med Qual 2022 May-Jun 01;37(3):282-283. Epub 2022 Apr 29.

Am J Med Qual 2022 May-Jun 01;37(3):280-281. Epub 2022 Jan 25.

Health Quality Advisors, Highland Park, IL.

Am J Med Qual 2022 May-Jun 01;37(3):278-279. Epub 2022 Mar 16.

Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC.

Am J Med Qual 2022 May-Jun 01;37(3):276-277. Epub 2022 Apr 4.

Department of Internal Medicine, Stony Brook University Hospital, Stony Brook, NY.

Am J Med Qual 2022 May-Jun 01;37(3S):S1-S129. Epub 2022 May 2.

Vice President, Member Education and Learning, Vizient.

Am J Med Qual 2022 Apr 15. Epub 2022 Apr 15.

College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX.

This research examined trends and severity of alleged injury in malpractice over a 10-year period. An understanding of the severity of patient outcomes is important to gauge improvements in care delivery. Analysis of the National Practitioner Database (NPDB) investigated malpractice payments from 2008 to 2018 by physicians, advanced nurse practitioners, and registered nurses and assessed the relationship of years of practice on the severity of alleged malpractice injury. Read More

Am J Med Qual 2022 Apr 8. Epub 2022 Apr 8.

University of Michigan Medical School, Ann Arbor, MI.

Am J Med Qual 2022 Apr 8. Epub 2022 Apr 8.

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Although most health care occurs in the ambulatory setting, limited research examines how providers and patients think about and enact ambulatory patient safety. This multimethod qualitative study seeks to identify perceived challenges and strategies to improve ambulatory safety from the perspectives of clinicians, staff, and patients. Data included interviews (N = 101), focus groups (N = 65), and observations of safety processes (N = 79) collected from 10 patient-centered medical homes. Read More

Am J Med Qual 2022 Apr 8. Epub 2022 Apr 8.

Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.

Am J Med Qual 2022 Apr 8. Epub 2022 Apr 8.

Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.

Hospital rapid response systems are designed to reduce unmet patient needs and prevent clinical deterioration. Rapid response teams are the principal component of a rapid response system and require teamwork to function optimally; poor communication among team members can result in substandard patient care. The authors describe a process for developing and implementing standardized communication and a teamwork structure for rapid response events (RREs) at a large academic hospital. Read More

Am J Med Qual 2022 Mar 30. Epub 2022 Mar 30.

Department of Quality, WVU Medicine: United Hospital Center, Bridgeport, WV.

A West Virginia regional community hospital incorporated an initial specimen diversion device (ISDD) into conventional blood culture protocol with the objective to bring the hospital-wide blood culture contamination (BCC) rate from a 3.06% preintervention rate to a target performance level below 1%. Emergency department staff, laboratory phlebotomists, and nursing staff on acute-critical care floors were trained on ISDD (Steripath Gen2, Magnolia Medical Technologies, Inc. Read More

Am J Med Qual 2022 Mar 16. Epub 2022 Mar 16.

Department of Medicine, Weill Cornell Medicine, New York, NY.

Despite disproportionately higher rates of morbidity and mortality from COVID-19 among Black and Hispanic adults in the United States, ethnoracial disparities in vaccination rates emerged rapidly. The objective of this quality improvement study was to rapidly develop and implement an equity-focused community outreach intervention that facilitated COVID-19 vaccine appointments. Using the Plan-Do-Study-Act model, this multipronged, primary care-based outreach intervention developed call/recall systems that addressed vaccine hesitancy and facilitated real-time vaccine scheduling. Read More

Am J Med Qual 2022 Mar 17. Epub 2022 Mar 17.

Sidney Kimmel Medical College at Thomas Jefferson University Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Department of Medicine, Division of Internal Medicine, Thomas Jefferson University Department of Radiology, Thomas Jefferson University Division of Cardiology, Thomas Jefferson University.

Individuals eligible for lung cancer screening (LCS) are at risk for atherosclerotic cardiovascular disease (ASCVD) due to smoking history. Coronary artery calcifications (CAC), a common incidental finding on low-dose CT (LDCT) for LCS, is a predictor of cardiovascular events. Despite findings of high ASCVD risk and CAC, a substantial proportion of LCS patients are not prescribed primary preventive statin therapy for ASCVD. Read More

Am J Med Qual 2022 Mar 17. Epub 2022 Mar 17.

The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH Connected Care, Dartmouth Hitchcock Medical Center, Lebanon, NH.

This article shares initial experiences designing and operating a new health care delivery innovation program at a rural academic medical center. The program was designed with the belief that dedicated team member time, senior leadership engagement, deliberate project/team selection, and robust, tailored project support would enable rapid and transformative health care redesign. Three teams were supported in the initial 1-year funding cycle; all 3 teams successfully designed, implemented, and tested new care models for different serious illness populations. Read More

Am J Med Qual 2022 Mar 11. Epub 2022 Mar 11.

Department of Population Health Sciences, Institute for Health Promotion Research, UT Health San Antonio, Joe R. & Teresa Lozano Long School of Medicine, San Antonio, TX Clinical Excellence Division, CHRISTUS Health, San Antonio, TX Department of Medicine, UT Health San Antonio, Joe R. & Teresa Lozano Long School of Medicine, San Antonio, TX Department of Family and Community Medicine, UT Health San Antonio, Joe R. & Teresa Lozano Long School of Medicine, San Antonio, TX.

In 2011, Texas received federal approval of the 1115 Healthcare Transformation waiver, which went to support the Texas Delivery System Reform Incentive Payment Program (DSRIP) incentivizing the transformation of service delivery practices which included expanded coverage of preventive cancer screenings. There is limited evidence that quality improvement initiatives stemming from DSRIP improve cancer screening outcomes for the Medicaid, low-income, and uninsured (MLIU) patient population. The present the results of a quality initiative to improve breast, cervical, and colorectal cancer screening rates for MLIU patients receiving primary care at an academic medical center. Read More

Am J Med Qual 2022 Mar 11. Epub 2022 Mar 11.

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY Frank G. Zarb School of Business, Hofstra University, Hempstead, NY AiD Technologies, Stony Brook, NY.

Accurate determinations of the time of intubation (TOI) are critical for retrospective electronic health record (EHR) data analyses. In a retrospective study, the authors developed and validated an improved query (Ti) to identify TOI across numerous settings in a large health system, using EHR data, during the COVID-19 pandemic. Further, they evaluated the affect of Ti on peri-intubation patient parameters compared to a previous method-ventilator parameters (Tv). Read More

Am J Med Qual 2022 Mar-Apr 01;37(2):189

Humana, Inc, Miramar, FL.

Am J Med Qual 2022 Mar-Apr 01;37(2):166-172

Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

Medical errors harm patients and increase costs. Engaging early clinicians in patient safety (PS) is critical but challenging. We evaluated the impact of a Patient Safety Escape Room (PSER) simulation on intern engagement in PS. Read More

Am J Med Qual 2022 Feb 23. Epub 2022 Feb 23.

University of Maryland Medical Center Midtown Campus, Baltimore, MD American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda.

High-quality and efficient sign-outs are essential to ensure patient safety. To evaluate the impact of a new handoff tool by objective measures of handoff quality and residents' subjective experiences. Internal medicine residents working on a medical ward service completed a handoff clinical evaluation exercise (CEX) questionnaire and an anonymous survey on handoff quality and experiences prior to implementing a new handoff tool and at 2 and 6 weeks after implementation. Read More

Am J Med Qual 2022 Feb 23. Epub 2022 Feb 23.

Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO UCHealth, Aurora, CO Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.

Coronavirus disease 2019 (COVID-19) pandemic has forced providers to rapidly adopt telehealth tools to reduce staff exposure to ill persons, preserve personal protective equipment, and minimize impact of patient surges on facilities. Remote patient monitoring (RPM) can be used to monitor high-risk patients from their homes and open up hospital bed availability. The authors describe a pilot program to evaluate the impact of RPM in postdischarge monitoring of COVID-19 patients. Read More

Am J Med Qual 2022 Jan 25. Epub 2022 Jan 25.

Vizient Inc, Chicago, IL. Froedtert Hospital, Wauwatosa, WI. Sanford Health, Sioux Falls, SD. Rush University, Chicago, IL.

Improving hospital mortality is a key focus of quality and safety efforts at both the local and national level. Structured interventions can assist organizations in determining whether interventional efforts have led to sustained improvement. The PARiHS framework (Promoting Action on Research Implementation in Health Services) can assist organizations in implementing research into practice. Read More

Am J Med Qual 2022 Mar-Apr 01;37(2):185

Department of Surgery, University of Calgary, Calgary, Alberta, Canada Alberta Obesity Centre, Calgary, Alberta, Canada.

Am J Med Qual 2022 Apr 12. Epub 2022 Apr 12.

Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.

Background: During the COVID-19 pandemic, frequently changing guidelines presented challenges to emergency department (ED) clinicians. The authors implemented an electronic health record (EHR)-integrated clinical pathway that could be accessed by clinicians within existing workflows when caring for patients under investigation (PUI) for COVID-19. The objective was to examine the association between clinical pathway utilization and adherence to institutional best practice treatment recommendations for COVID-19. Read More

Am J Med Qual 2022 Jan 11. Epub 2022 Jan 11.

Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL Department of Healthcare Delivery and Population Sciences, University of Massachusetts Medical School-Baystate, Springfield, MA Center for Health and the Social Sciences, University of Chicago, Chicago, IL Harris School of Public Policy, University of Chicago, Chicago, IL.

Coding variation distorts performance/outcome statistics not eliminated by risk adjustment. Among 1596 community-acquired pneumonia patients hospitalized from 1998 to 2012 identified using an evidence-based algorithm, the authors measured the association of principal diagnosis (PD) with 30-day readmission, stratified by Pneumonia Severity Index risk class. The 152 readmitted patients were more ill (Pneumonia Severity Index class V 38. Read More

Am J Med Qual 2022 Mar-Apr 01;37(2):186

Department of Neurology, Northwestern University, Chicago, IL Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI Clinical Informatics, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI Emergency Department, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.

Am J Med Qual 2022 Jan 4. Epub 2022 Jan 4.

Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI Wayne State University School of Medicine, Detroit, MI Division of General Internal Medicine, Department of Internal Medicine, Detroit Medical Center, Detroit, MI Division of General Internal Medicine, Department of Internal Medicine, John D. Dingell Veterans Affairs Medical Center, Detroit, MI.

Objectives: Congestive heart failure (CHF) is the most common cause of 30-day inpatient readmission. Studies have found that early follow-up with primary care physicians (PCP) within 7 days of discharge may improve 30-day readmission rates; however, many have used a multidisciplinary discharge coordination team, which is not a resource at all centers. Here, the authors present a resident-driven quality improvement initiative using a monthly quality and safety award to increase early PCP follow-up for veterans discharged following admissions due to a CHF exacerbation. Read More

Am J Med Qual 2022 Jan-Feb 01;37(1):93