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Search results for "Hospitals"

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Journal Article > Commentary

Standardized competencies for parenteral nutrition prescribing: The American Society for Parenteral and Enteral Nutrition Model.

Guenter P, Boullata JI, Ayers P, et al; Parenteral Nutrition Safety Task Force, American Society for Parenteral and Enteral Nutrition. Nutr Clin Pract. 2015;30:570-576.

Parenteral nutrition has the potential to result in patient harm if administered or prepared incorrectly. This commentary builds on a set of overarching recommendations to define competencies that enable the safe prescribing and delivery of parenteral nutrition. The model is designed to help organizations apply the suggestions in their particular care environments.

Journal Article > Study

Policies and practices related to the role of board certification and recertification of pediatricians in hospital privileging.

Freed GL, Uren RL, Hudson EJ, Lakhani I, Wheeler JRC, Stockman JA III; Research Advisory Committee of the American Board of Pediatrics. JAMA. 2006;295:905-912.

The investigators surveyed 200 hospitals and discovered a wide range of policies and practices with respect to requirements for board certification in obtaining or maintaining hospital privileges. Nearly 75% of hospitals carried no requirement for certification at initial privileging, though 70% did require it in the future. The authors discuss the lack of standardization in this process, the current views on recertification as a mechanism to ensure standards for physicians, and how these systems are certain to be pressured by an ongoing emphasis on patient safety and quality. Accompanying the article is an editorial (link below) that discusses the broader certification issue, calling for greater collaboration among hospitals, health plans, and physicians to improve quality by using clinical data as part of the certification process. A past related study discussed the role of board certification and its relation to the quality movement.

Journal Article > Study

Leapfrog Hospital Safety Score, Magnet designation, and healthcare-associated infections in United States hospitals.

Pakyz AL, Wang H, Ozcan YA, Edmond MB, Vogus TJ. J Patient Saf. 2017 Apr 27; [Epub ahead of print].

Health care–associated infections (HAIs) are a preventable safety problem. This cross-sectional study looked at hospital factors related to HAI incidence. Investigators explored whether the Leapfrog Hospital Safety Score, a composite safety score calculated from publicly reported measures, is associated with HAIs. They also examined the incidence of HAIs in hospitals with Magnet status, conferred by a nurses' trade association in recognition of a positive nursing work environment. Lower Leapfrog safety scores were associated with more Clostridium difficile infections but no differences in other HAIs, and Magnet status was associated with lower rates of methicillin-resistant Staphylococcus aureus infection but worse than expected performance on C. difficile infections. These mixed results do not indicate a strong or consistent relationship between global measures of safety and quality and specific adverse events. A past PSNet interview with Leah Binder, President and CEO of The Leapfrog Group, discussed the development of the Hospital Safety Score.

Journal Article > Study

Unannounced versus announced hospital surveys: a nationwide cluster-randomized controlled trial.

Ehlers LH, Simonsen KB, Jensen MB, Rasmussen GS, Olesen AV. Int J Qual Health Care. 2017;29:406-411.

Hospital accreditation surveys are critical to identifying and ameliorating safety risks. This trial in Denmark randomized hospitals to receive either announced or unannounced hospital accreditation surveys. Investigators found no differences in adherence to performance indicators among hospitals who received unannounced compared to planned survey visits. They conclude that unannounced visits are no more likely to detect quality concerns.

Journal Article > Study

Patient mortality during unannounced accreditation surveys at US hospitals.

  • Classic

Barnett ML, Olenski AR, Jena AB. JAMA Intern Med. 2017;177:693-700.

Prior research has demonstrated that hospital accreditation by The Joint Commission is associated with improved hospital performance on certain quality of care measures. However, it has not been established whether the survey periods themselves are associated with a change in patient outcomes. Researchers analyzed Medicare admissions at 1984 hospitals surveyed by The Joint Commission between 2008 and 2012 from 3 weeks prior to a survey up to 3 weeks afterward. They compared patient outcomes between survey periods and the surrounding weeks. For the primary outcome—30-day mortality—patients admitted to the hospital during survey periods had significantly lower mortality than those admitted during nonsurvey weeks. The authors conclude that heightened vigilance during survey weeks and resultant changes in practice may explain this finding. This interpretation captured much attention and calls for making heightened vigilance a year-round phenomenon. The study reported detectable reductions in mortality essentially as soon as the survey week begins and reverts to previsit levels when it ends. It seems unlikely that hospitals across the country can increase the numbers of personnel available for patient care and that the teams would work so well together nearly instantaneously. By contrast, it seems plausible that hospitals could cancel or postpone risky elective procedures on a dime, and immediately resume scheduling such procedures after the week ends. Since emergent care continues as usual, there is no increase in avoidable mortality, but the postponement of elective procedures means that some deaths are averted. A past PSNet interview with the president of The Joint Commission discussed his role in the organization.

Legislation/Regulation

Summary of Proposed Changes to ACGME Common Program Requirements Section VI.

Accreditation Council for Graduate Medical Education.

Implementation of resident duty hours, meant to address fatigue in health care, has long been a subject of patient safety discussions. This website provides a summary of proposed changes to the current ACGME residency Common Program Requirements that shape working hours, offers rationale for the revisions.

Legislation/Regulation > Government Resource

Medicare and Medicaid Programs; Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care; Proposed Rule.

Centers for Medicare & Medicaid Services. Fed Regist. 2016;81:39447-39480.

This proposed rule suggests updates to the government requirements hospitals must comply with to participate in Medicare and Medicaid. Changes include emphasis on the role of leadership engagement and safety culture as ways to generate improvements in areas such as reducing hospital-acquired infections and readmissions. Comments on the proposed rule are due August 15, 2016.

Perspectives on Safety > Perspective

Becoming a Certified Professional in Patient Safety—A Pharmacist's Perspective

with commentary by Zahra Khudeira, PharmD, Certification in Patient Safety, June 2016

In this piece, a pharmacist highlights the importance of earning patient safety certification.

Perspectives on Safety > Perspective

Becoming a Certified Professional in Patient Safety—A Registered Nurse's Perspective

with commentary by Karen Frank, DNP, RN, MSHA, Certification in Patient Safety, June 2016

This piece offers a nurse's viewpoint on the benefits of acquiring certification in patient safety.

Perspectives on Safety > Interview

In Conversation With… Gregg S. Meyer, MD, MSc

Certification in Patient Safety, June 2016

Dr. Meyer is Chief Clinical Officer of Partners Healthcare System, the large Boston-based system that includes Massachusetts General and Brigham and Women's Hospitals. We spoke with him about training and certification in patient safety.

Journal Article > Review

Competencies for patient safety and quality improvement: a synthesis of recommendations in influential position papers.

Moran KM, Harris IB, Valenta AL. Jt Comm J Qual Patient Saf. 2016;42:162-169.

Standard competencies of knowledge, skills, and attitudes for patient safety and quality improvement are needed to advance progress. Analyzing 22 position papers from various organizations, this review found little agreement regarding core competencies required. The authors advocate for international efforts to reach a consensus on existing competencies that apply across health professions.

Book/Report

Summit on Certification and Diagnostic Accuracy Report.

Chicago, IL: American Board of Medical Specialties; 2016.

In response to the 2015 Improving Diagnosis in Health Care report, the National Patient Safety Foundation and American Board of Medical Specialties convened a multidisciplinary panel of patient safety experts to determine safety challenges in the diagnostic process as a way to inform recommendations for improving diagnosis. Their consensus focused on educational, assessment, and cultural aspects of the process.

Journal Article > Commentary

On patient safety: when are we too old to operate?

Lee MJ. Clin Orthop Relat Res. 2016;474:895-898.

High-risk industries often have mandatory requirements to determine if a practitioner can safely provide certain services. This commentary offers insights from a physician regarding the potential for a mandated retirement age for surgeons and describes efforts to address whether aging physicians can still practice safely, including a mandated skill assessment screening and a comprehensive neurocognitive testing program.

Journal Article > Study

Variations by state in physician disciplinary actions by US medical licensure boards.

Harris JA, Byhoff E. BMJ Qual Saf. BMJ Qual Saf 2017;26:200-208.

State medical boards play a critical role in physician oversight. This study found significant variation in the rate of disciplinary actions from state to state. This suggests a need for standardization across states in disciplining physicians for unprofessional or unsafe conduct.

Book/Report

America's Hospitals: Improving Quality and Safety—The Joint Commission's Annual Report 2015.

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Oakbrook Terrace, IL: The Joint Commission; November 2015.

The annual report from The Joint Commission, which accredits hospitals in the United States, serves as a snapshot for quality reporting. This year's report reflects an expansion in the number of quality measures used. About one-third of participating hospitals performed at 95% or above for all accountability measures. The report also found that quality of care has improved over time for myocardial infarction, pneumonia, surgery, pediatric asthma, venous thromboembolism, stroke, immunization, perinatal care, and inpatient psychiatry. New measurements of tobacco and substance abuse care reveal potential for improvement. This report underscores both the power of performance measurement and reporting to drive progress. It also demonstrates that patient safety issues such as medication safety and diagnosis remain under-emphasized in the accreditation and performance measurement sphere.

Newspaper/Magazine Article

When should surgeons stop operating?

Whitehead N. National Public Radio. June 18, 2015.

The competency of surgeons as they age has been debated as a risk to patient safety. This news article describes concerns about the aging population of surgeons in the United States and an American Medical Association effort to develop guidelines to assess skills of older physicians.

Newspaper/Magazine Article

Robotic-assisted surgery: focus on training and credentialing.

Dubeck D. PA-PSRS Patient Saf Advis. September 2014;11:93-101.

Research has documented a substantial learning curve for surgeons as they develop skills to use robotic technologies. Drawing from data submitted to the Pennsylvania Patient Safety Authority, this article analyzes the 722 safety events involving robotic-assisted surgery reported since 2005—approximately 75% of these incidents did not result in harm but 10 patient deaths were recorded—and discusses the challenges introduced as robotic-assisted surgery becomes accepted as standard surgical practice.

Journal Article > Commentary

Development of a professionalism committee approach to address unprofessional medical staff behavior at an academic medical center.

Speck RM, Foster JJ, Mulhern VA, Burke SV, Sullivan PG, Fleisher LA. Jt Comm J Qual Patient Saf. 2014;40:161-167.

Unprofessional behavior can hinder patient safety and create a disruptive work environment for other staff. The Joint Commission requires that organizations have clear processes for detecting and reporting unacceptable behaviors. This commentary describes the development and experience of a Professionalism Committee at the University of Pennsylvania Health System. The committee chair serves as the first point of contact for any behavioral concerns. In this system, the committee chair is a trained psychiatrist, which the authors argue is an important aspect of the program since it allows for early identification of behavioral health issues that could contribute to unprofessionalism. The article includes the specific problems addressed and the referral outcomes of 79 cases over 2 years, along with 3 illustrative case vignettes. A prior AHRQ WebM&M commentary focused on the importance of professionalism in patient safety, and an AHRQ WebM&M perspective reviewed strategies to identify and manage problem behaviors.

Web Resource > Multi-use Website

Clinical Learning Environment Review (CLER) Program.

Chicago, IL: Accreditation Council for Graduate Medical Education, 2014.

Many graduate medical education programs have instituted patient safety didactics or online courses to meet accreditation standards, but these are likely insufficient in the face of real-world practices commonly witnessed by trainees in clinical settings. Recognizing the importance of this hidden curriculum on shaping trainees' behaviors, the Accreditation Council for Graduate Medical Education (ACGME) created the Clinical Learning Environment Review (CLER) program to evaluate teaching institutions in six focus areas: patient safety, quality improvement, transitions in care, supervision, duty hours, and professionalism. During 2013, the ACGME visited more than 100 teaching hospitals in the United States as part of this program. According to ACGME leaders, the early findings show an overall lack of trainee engagement in the systems-based practices. Available on the Web site, the CLER Pathways to Excellence report describes discoveries from the first year of the program and provides a guide for teaching institutions to create clinical environments that support patient safety training and practices.

Book/Report

VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events.

Draper D. Washington, DC: United States Government Accountability Office; December 3, 2013. Publication GAO-14-55.

Evaluation of provider behavior can identify problems that affect patient safety. This report analyzed data and expert interviews from four Veterans Affairs medical centers to identify weaknesses in peer review processes. Investigators found inconsistent adherence to peer review policy elements, such as timely review performance and peer review trigger development, and make recommendations to drive actions that address these issues.

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