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Search results for "Book/Report"
- General Internal Medicine
Oakbrook Terrace, IL: The Joint Commission; September 2010.
In the fifth report on the quality of care provided by hospitals in the United States, The Joint Commission shifts its focus to performance on accountability measures—evidence-based, easily measurable metrics that are strongly linked to patient outcomes and have minimal potential for harm. By these metrics, the overall quality of care has improved since 2007 for patients undergoing surgery, and for patients hospitalized with myocardial infarctions, pneumonia, and asthma (in children). Dr. Mark Chassin, the president of the Joint Commission, discussed the organization's approach to improving patient safety and quality in a 2009 AHRQ WebM&M perspective.
Portland, OR: Oregon Patient Safety Commission.
This annual publication provides data and analysis of adverse events voluntarily reported to the Oregon Patient Safety Commission. The review of 2015 data discussed the 704 events submitted from the 4 types health care settings involved and found that medication errors, invasive procedure incidents, care delays, and falls were the most frequent problems.
Reed K, May R. Golden, CO: Health Grades, Inc; 2010.
This report analyzed Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator data from 2006–2008 to identify pediatric patient safety incidence rates.
Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals.
Oakbrook Terrace, IL: The Joint Commission; 2010.
This report reveals how hospitals can improve communication, cultural competency, and patient-centeredness to enhance patient experience of care.
Lucado J, Paez K, Andrews R, Steiner C. HCUP Statistical Brief #94. Rockville, MD: Agency for Healthcare Research and Quality; August 2010.
McHugh M, Garman A, McAlearney A, Song P, Harrison M. Chicago, IL: Health Research & Educational Trust; June 2010.
This publication describes human resources strategies to improve quality of care.
London, UK: Health Policy & Economic Research Unit, British Medical Association Scotland; May 2010.
This report summarizes findings from a survey querying physicians about United Kingdom National Health Service whistleblowing policies.
Rockville, MD: Agency for Healthcare Research and Quality.
In this annual publication, AHRQ reviews the results of the National Healthcare Quality Report and National Healthcare Disparities Report. Providing a 5-year update on the National Quality Strategy, this report highlights that a wide range of quality measures have shown improvement in quality, access, and cost.
Golden, CO: HealthGrades, Inc.; March 2010.
This report, the latest in an annual series, uses the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) to estimate the incidence of preventable patient safety events, estimate the attributable morbidity and mortality from such events, and identify hospitals with lower rates of PSIs. It is important to note that prior research has questioned the validity of using PSIs for hospital comparison purposes.
Salt Lake City, UT: Utah Department of Health, Utah Hospitals & Health Systems Association, and HealthInsight; March 10, 2010.
This brief provides information on 101 sentinel events reported to the state of Utah in 2009. The report also includes background on efforts to address such incidents.
Levinson DR. Washington, DC: US Department of Health and Human Services, Office of the Inspector General; March 2010. Report No. OEI-06-08-00221.
This report examined five methods of identifying adverse events that harmed hospitalized patients. Findings note that physician and nurse reviews were highly effective in discovering problems but that incident reports were not as useful. The document provides numerous recommendations to improve screening for adverse events.
Ryan K, Levit K, Davis PH. HCUP Statistical Brief #87. Rockville, MD: Agency for Healthcare Research and Quality; March 2010.
Using data from the Healthcare Cost and Utilization Project, this report analyzed characteristics of weekend hospital stays and found that patients experienced delays in receiving care compared with patients admitted during the week.
Sorra J, Famolaro T, Dyer N, Nelson D, Khanna K. Rockville, MD: Agency for Healthcare Research and Quality; March 2010. AHRQ Publication No. 10-0026.
The Hospital Survey on Patient Safety Culture, a validated tool for measurement of safety culture developed by the Agency for Healthcare Research and Quality (AHRQ), was initially released in 2004. AHRQ has released database reports yearly since 2007 that present benchmarking data for safety culture across different regions, hospital types, hospital size, respondent work areas, and staff positions. This edition presents data from more than 300,000 respondents and greater than 800 hospitals nationwide, and also includes data on changes in safety culture perception over time for a subset of hospitals. Notable findings include widespread concern about a persistent culture of individual blame when errors occur, and concern about the safety of handoffs.
Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out.
Pronovost P, Vohr E. New York, NY: Hudson Street Press; 2010. ISBN: 9781594630644.
Over the past decade, Johns Hopkins intensivist Dr. Peter Pronovost has emerged as the world's most influential patient safety researcher. In this book, written with Eric Vohr, Pronovost describes how his work was inspired by two deaths from medical mistakes: of young Josie King at Johns Hopkins Hospital (chronicled by her mother Sorrel in another book) and of his own father. The meat of the volume is a detailed chronicle of Pronovost's journey from neophyte faculty member to internationally acclaimed researcher and change agent. In earnest and plainspoken prose, he describes the inside story of interventions and studies that have transformed the safety world: the Comprehensive Unit-Based Safety Program (CUSP), the use of ICU goal cards, and most importantly, the use of checklists to reduce central line infections in more than 100 Michigan ICUs, a story also recently described by Dr. Atul Gawande in The Checklist Manifesto. Dr. Pronovost was the subject of an AHRQ WebM&M interview in 2005.
Cambridge, MA: Institute for Healthcare Improvement; February 2010.
This manual offers practical advice on how to plan for and implement care team rounds that involve a variety of health care providers.
Osei-Anto A, Joshi M, Audet AJ, Berman A, Jencks SF. New York, NY: The Commonwealth Fund, The John Hartford Foundation, Health Research and Educational Trust; January 25, 2010.
This guide introduces strategies for hospital managers to prevent avoidable readmissions.
Oakbrook Terrace, IL: The Joint Commission; January 2010.
America's hospitals continued to improve the quality of care they provide for myocardial infarction, congestive heart failure, pneumonia, and surgical care, according to the newest report from The Joint Commission. Compared to the prior report published in 2007, hospitals increased their provision of evidence-based treatments across all four disease processes. In particular, significant improvements were achieved in use of measures to prevent surgical site infections. While the prior report provided data on adherence to the National Patient Safety Goals, these measures were not discussed in the current report.
An In Depth Investigation into Causes of Prescribing Errors by Foundation Trainees in Relation to Their Medical Education—EQUIP Study.
Dornan T, Ashcroft D, Heathfield H, et al. London: General Medical Council; 2009.
This report analyzed the causes and rates of prescribing errors in the National Health Service and found that educational level had little impact on medication errors and that many were intercepted before reaching patients. The authors suggest that a standardized national prescription chart could help prevent errors.
Schyve PM. San Diego, CA: Governance Institute; 2009.
This white paper provides comprehensive information on leadership standards for health care organizations and explains topics including leadership structure, hospital culture, and system performance.
Dr Foster Intelligence Unit. London, UK: Imperial College London; 2009.
This consumer-focused report ranked the 148 hospital trusts in the United Kingdom National Health Service (NHS) on patient safety, clinical effectiveness, and patient experiences and found wide variation in the scores.