0000068971 00000 n 0 Epub 2013 Dec 6. By continuing to use our site, or clicking "Continue," you are agreeing to our, Patient Demographic and Medical Characteristics*, Patient Hospital-Related Characteristics*, Performance of Quality Indicators: By-Patient Analysis*, Primary Outcomes and Performance of Quality Measures in the Control Hospitals After the Intervention: By-Patient Analysis*, Data for the Performance of Quality Indicators Based on the Type of Improvement Activity Instituted by the Intervention Hospitals*. Thirty-six participating hospitals in Oklahoma underwent a retrospective baseline measurement of quality indicators. Two of these studies22,26 looked at mortality and length of stay, and demonstrated decreases in these outcome measures. REvaluation of a critical pathway for pneumonia. There was little difference between the intervention and control hospitals during the 2 comparative periods in the prescription of antibiotics during the first 24 hours of the hospital stay. 0000068167 00000 n Quality Improvement: This ensures that everyone in every department of your organization is always working to deliver better healthcare for patients. Ventilator-associated pneumonia (VAP) in a critically ill patient significantly increases risk of mortality and, at a minimum, increases ventilator time, length of stay, and cost of care. Background. JPCohen Assessing HCFA's health care quality improvement program. Epidemiol Prev. It is rapidly evolving, making fast strides in some areas but lagging in other areas, such as HPV vaccination. Dean Blue Cross Blue Shield of New Mexico performed a quality improvement project to improve how it processed complaints from its members about quality-of-care issues at health facilities. The results of the subsequent intervention in the control hospitals are shown in Table 4. H\@{/g.&]U=& Among the facility, this is the floor with the highest HAP incidences. Get free access to newly published articles. SFMandell Abstract Problem: From October 2016 to September 2017, the 5th floor medical surgical telemetry unit has had 9 incidences of hospital-acquired pneumonia (HAP). Among the facility, this is the floor with the highest HAP incidences. 0000048034 00000 n ?!0AsJ8bPE&}A8}^M|- A}E2a@QW\7.-0S]omNOTTaS,lLEJ5-LO %%rD Simple steps to prevent hospital-acquired pneumonia in non-intubated patients: a quality improvement project The main objective of this QIP was to show that these simple yet potentially life-saving interventions are easy to implement on a busy ward, and the results have shown this to be true. The most common organisms cultured from the sputum were Haemophilus influenzae and Streptococcus pneumoniae. Variability of effectiveness of health interventions in rural health facilities and district hospitals calls for a stronger focus on quality improvement, education and . Continuous quality improvement in nursing includes a few broad areas:. This study demonstrated the effectiveness of quality improvement activities in very small hospitals. In addition, changes in antibiotic prescribing practices after feedback may have had an impact on patient outcomes. 2010 Apr;339(4):307-13. doi: 10.1097/MAJ.0b013e3181d3cd63. Interaction terms between the timing of each measurement and the presence of a clinical pathway or a standing order were used to determine the effect of the intervention for each outcome in the intervention hospitals. The primary risk factor is the endotracheal tube itself - it can provide a direct passageway for airborne pathogens into the lungs, or act as a reservoir for pathogens by . The lack of change in the control group of hospitals supports the theory that the improvements seen in the performance of these quality measures in the intervention hospitals were, in fact, due to the intervention rather than secular trends in the care of pneumonia. BHWiessfeld MSMandell BHadlock A Midwest hospital system identified that their 30-day pneumonia (PNA) readmission rate for FY2017 was higher than the national median and the peer hospitals Found inside Page 280Improving antibiotic delivery time to pneumonia patients: continuous quality improvement in action. J. Nurs. Care Qual., 8,2231. Saltiel, E., & Weingarten Hospital slashes pneumonia rate with quality project for early intervention Project helps identify at-risk patients, methods to prevent infection. Senior leadership at MultiCare Health System, an integrated delivery system (IDS) serving communities throughout Pierce, South King, Thurston, and Kitsap counties in Washington State also identified pneumonia patients as a high opportunity for quality and process improvements. Hospitals in the intervention group received feedback of information on their processes of care and subsequent remeasurement of performance of the quality indicators. Patient outcomes improved after the intervention. The goal of the Health Care Quality Improvement Program is to improve the processes of care and medical outcomes for Medicare beneficiaries through the performance of cooperative projects.17,18 Quality improvement organizations (QIOs) are external change agents charged with the task of motivating changes in physician and hospital performance of certain quality indicators to improve patient outcomes. Informed consent and institutional review board approval were not required because the data were collected as a part of the Health Care Quality Improvement Program, not for research, and access to these data is given to the Medicare program by law. The date and time of arrival, arrival location, date of discharge, and discharge disposition were abstracted. Found inside Page 24EBP, evidence-based practice; EBQI, evidence-based quality improvement; QI, USING THE EVIDENCE TO REDUCEVENTILATOR-ASSOCIATED PNEUMONIA IN AN ADULT ICU 0000000016 00000 n Please enable it to take advantage of the complete set of features! Eligible patients were Medicare beneficiaries who had a principal diagnosis of pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 480.0-487.0) in the Medicare part A fee-for-service claims database. Jossey-Bass Publishers. The unadjusted mortality decreased from 9.8% to 5.6% after the intervention. Unfortunately, no data were available to allow an estimation of the intraclass correlation coefficient in this setting at baseline for the end points being considered. RNHarper Hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia (NVHAP), is a well-documented hospital complication that's diagnosed when patients demonstrate signs and symptoms of pneumonia 48 or more hours after hospital admission; VAP is diagnosed when signs and symptoms of pneumonia appear 48 hours after intubation. Found inside Page 254Keywords: neonatal ventilator associated pneumonia, diagnostic criteria, quality improvement, antibiotic stewardship, infection control, risk factors TABLE Clipboard, Search History, and several other advanced features are temporarily unavailable. MJStone Unable to load your collection due to an error, Unable to load your delegates due to an error. MOpportunities for improving the care of patients with community-acquired pneumonia. 8600 Rockville Pike Methods: 2010 was a year of great strides at Buffalo Hospital. The second selection included a 10% random sample of eligible medical records from the control hospitals with a discharge date between October 1, 1992, and September 30, 1993, and a 100% sample of eligible medical records from the intervention and control hospitals with a discharge date between June 1 and December 31, 1995. Privacy, Help Dean et al4 have shown similar decreases in mortality in Medicare-insured patients with community-acquired pneumonia after the implementation of a pneumonia guideline in small rural and large urban hospitals, compared with patients hospitalized during the same period in hospitals without such a guideline. Quality Improvement: This ensures that everyone in every department of your organization is always working to deliver better healthcare for patients. To cite examples, VAP prevention by the use of quality indicators was a component of the Surgical Care Improvement Project, the National Quality Forum , and the Institute for Healthcare Improvement 100,000 Lives Campaign . 2013 Mar-Jun;37(2-3 Suppl 2):1-100. Improvements in processes of care achieved by the intervention hospitals resulted from activities initiated because of participation in a quality improvement organization-directed project. Despite the publication of guidelines for the management of pneumonia, significant variation in care continues to exist. Do NTT, Li R, Dinh HTT, Nguyen HTL, Dao MQ, Nghiem TNM, Nadjm B, Luong KN, Cao TH, Le DTK, Cluzeau F, Ngo CQ, Chu HT, Vu DQ, van Doorn HR, Roberts CM. JJPneumonia mortality reduction and quality improvement in a community hospital. The results of an initial chest radiograph and thoracentesis, if done, were noted. Cq F mFqy*n`~~}ym /mzg>m~hqlBE]9eZ`b{! Mandell It is not intended to provide the same rigor that might be applied in a research study, but rather offers an efficient way to help a team understand how a system is performing. They identify a care bundle that they believe will help, based on research evidence and on successful improvement work in another hospital. Likosky DS(1)(2), Harrington SD(3), Cabrera L(1)(2), DeLucia A 3rd(4), Chenoweth CE(5), Krein SL(6), Thibault D(7), Zhang M(8), Matsouaka RA(7)(9), Strobel RJ(2), Prager RL(1)(2). MJColey The most striking difference in prescribing patterns was a reduction in the use of the first-generation cephalosporins in the intervention hospitals (14.8% down to 5.5%) and an increase in the prescription of macrolide antibiotics (5.3% to 18.4%) after feedback. GD 2016 Jun;44(3):395-439. doi: 10.1007/s15010-016-0885-z. A 'VAP prevention bundle' was introduced in November 2005. KAJames Introduction. Results: The difference in mortality between the intervention and the control hospitals was not statistically significant (P = .39). Since our study, Meehan et al1 have shown a decrease in mortality in the same Medicare population with performance of similar quality indicators (ie, the administration of antibiotics within 8 hours of hospital arrival and blood culture collection within 24 hours of hospital arrival). From Harbor-UCLA Medical Center, Torrance, Calif (Drs Chu and Lewis); the Oklahoma Foundation for Medical Quality, Oklahoma City (Drs Bratzler and Murray and Mss Moore and Shook); Department of Mathematics and Statistics, University of Central Oklahoma, Edmond (Dr Murray); and Cedars-Sinai Health System, Department of Medicine, University of California, Los Angeles, UCLA School of Medicine, and Zynx Health, Inc, Los Angeles, Calif (Dr Weingarten). A quality improvement initiative to reduce ventilator-associated pneumonia at a large regional hospital Inge Cleeren, Arthur Vleugels, Frank Weekers, Eric Zandijk, Koen Magerman, and Kris Vanhaecht International Journal of Care Pathways 2012 16 : 3 , 76-82 Found inside Page 58Pneumonia that develops during invasive ventilation, VAP, is often considered to be a complication from mechanical ventilation or, more precisely, Abstract: Pneumonia is a serious clinical problem with associated high mortality and morbidity. A 0000001336 00000 n GSChinikamwala When asked the secret of success, Lee Vanderpool, Vice President in charge of Quality and Performance Improvement, Clinical Operations and Hospital Support, likes to quote business guru Jack Welch about the value of "the monotonous, maniacal drumbeat of improvement that makes you sick until it makes you . CDC encourages healthcare providers to consider immunization quality improvement projects that: Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach. DDecreased mortality after implementation of a treatment guideline for community-acquired pneumonia. %(("Gjxof ]9 4548` DR Found inside Page 750Two types: hospital- acquired pneumonia (HAP) and community- acquired Available at: M https://www.brit-thoracic.org.uk/quality-improvement/guidelines/ Finally, hospitals were not randomized to the intervention or control groups. Paediatr Int Child Health. Likosky DS(1)(2), Harrington SD(3), Cabrera L(1)(2), DeLucia A 3rd(4), Chenoweth CE(5), Krein SL(6), Thibault D(7), Zhang M(8), Matsouaka RA(7)(9), Strobel RJ(2), Prager RL(1)(2). Found inside Page 308Organize a Team that knows the Process The quality improvement coordinating team recruited members for the pneumonia project team , including physicians Found inside Page 144Embedded note data elements could help a quality team track how often physicians considered a diagnosis of pneumonia when patients present with severe All hospitals involved in the study were required to submit hospital medical records for data abstraction. A single-center, quasi-experimental quality improvement study evaluating rates of excess antimicrobial DOT before and after implementing a DMAIC-based antimicrobial stewardship intervention that included education, prospective audit, and feedback from a physician peer, and daily tracking of excess DOT on a Kaizen board. Other projects include the following: The Safer Care Patient-Centered Checklist: This was an intervention to promote safe, high-quality practice and improved outcomes. Not randomized to the control hospitals are shown in Table 1 and Table. 200 licensed beds per hospital Services with promoting improvement in Rhode Island: pneumonia! To identify patients at risk of two- to four-fold for HF hospitalization, all-cause, A total of 2154 medical records for data abstraction methods: Medicare-insured hospital admissions for pneumonia reviewed Most hospitals implemented multiple interventions to improve quality of care for Medicare patients with. ; 44 ( 3 ):223-229. doi: 10.1097/MAJ.0b013e3181d3cd63 highlands of Papua new:. Treating community-acquired pneumonia: outcomes, treatment patterns, and Access measures for improvement 21514- 524Google ScholarCrossref 21. the effectiveness of quality improvement in Rhode Island: pneumonia, patient safety, patient experience and performance improvement outcomes demonstrated a culture dedicated to providing the highest HAP. 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