Minimally invasive innovations enhance procedural technology. However, healthcare quality demands addressing mental and physical workloads. This study analyzes flow disruptions uncovering specialty-specific patterns and systemic weaknesses, to enhance quality, processes, and patient safety.

In 2022, our pediatric and women's medical center observed a 166.67% increase in central line bloodstream infections (CLABSIs) in the pediatric population. A quality-focused group was initiated to implement changes to reduce CLABSIs.

Workplace violence (WPV) is a significant concern in healthcare settings and indicates the need for accurate reporting to plan and implement effective interventions. This article presents the results of a quality improvement (QI) initiative implemented at a large academic health sciences center to improve the reporting of WPV events.

The Institute for Safe Medication Practices and The Joint Commission recommend the implementation of bidirectional smart infusion pump interoperability with the electronic health record (EHR) to improve medication safety. However, there are barriers associated with implementation of this process.

Quality assessment organizations leverage numerous patient safety measures to evaluate hospital performance, resulting in significant financial, administrative, and operational burdens on health systems. Low-intensity approaches that allow for reliable risk stratification of patients can reduce the required investment. The Braden score is a routinely performed bedside nursing evaluation validated to assess risk for hospital-acquired pressure injury. We hypothesized that the tool can be used to evaluate risk for other hospital-related adverse outcomes, including mortality, catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI). We found that abnormal Braden scores have significant association with numerous adverse outcome measures, including mortality, CLABSI, CAUTI, and iatrogenic hypoglycemia. Because of its frequency of reevaluation, we have found preliminary evidence that leveraging this tool can reduce harm by quickly identifying the most at-risk patients for various types of iatrogenic harm. We conclude that in the face of increasing automation and technical applications, for example, artificial intelligence-driven tools, highly reliable clinician bedside physical examination and evaluation can still have significant, low-cost, and high-value impact in improving patient safety.

Atrial fibrillation is the most common sustained arrhythmia with a variable presentation ranging from asymptomatic incidental diagnosis by physical examination or electrocardiogram screening, to severely symptomatic requiring emergent treatment. The variation in care represents an opportunity to build a comprehensive center of excellence within a hospital system. We present our experience building the Swedish Comprehensive AFib Network and a dedicated AFib clinic at a large quaternary urban medical center. We focused on patient and referral engagement, standardized protocols to promote best practices, data collection to improve quality of care, and broad evaluation of a single but multidisciplinary disease process. We hope this can offer insight into how other programs can be started for atrial fibrillation or other disease-focused clinics. We report our experience in the first 2 years, having evaluated over 700 new patients, and demonstrated an improvement in the rate of anticoagulation usage and a reduction in hospitalizations among patients included in our program.

Evidence-based guidelines recommend statins as first-line therapy to reduce the risk of cardiovascular events in patients with cardiovascular disease and/or diabetes. The Centers for Medicare and Medicaid Services assess compliance with these guidelines through performance and process quality measures.

Loneliness and social isolation are serious problems that can impose negative consequences on individual well-being. Research suggests that loneliness can lead to an increased risk of depression, anxiety, and other health issues. Meritus Health, recognizing that loneliness is an issue within its community, has set a goal to comprehensively eradicate loneliness. As part of this effort, Meritus implemented the Care Caller program in November of 2021 through which a volunteer is paired up with a patient from our institution who has indicated that they are lonely. Each duo then finds a weekly cadence to share in 15- to 30-minute phone calls to facilitate meaningful social interaction. As of July 2023, the program has 500 participants enrolled with 47 volunteers and 2 full-time employees, and over 350 people are called weekly. In the last fiscal year, over 75,000 minutes have been spent on the phone between care callers and participants with promising results. Of the 172 participants who have been in the program for 4+ months, 166 have indicated that they felt less lonely, yielding a success rate of 97%. Meritus Health continues to further this program by increasing the number of care callers and utilization of Plan-Do-Study-Act rapid improvement.

At our 710-bed academic medical center, nine (9) patients sustained injuries during nasogastric (NG) tube insertion attempts over a 16-month period (March 2021-July 2022). No injuries were reported during the comparable period before these events. This increase in reported events prompted an in-depth analysis to determine the root causes and implement a process improvement plan.

Careful preoperative patient preparation for orthopedic foot and ankle surgery can help manage postoperative expectations and avoid suboptimal outcomes. Our quality improvement initiative aimed to reduce emergency department (ED) visits within 30 days postsurgery by enhancing preoperative education.

Prosthetic joint infection (PJI) after total hip and knee arthroplasty (TJA) is a major cause of morbidity in orthopedics. Fully specified quality measures for PJI diagnosis are lacking. We aimed to specify and evaluate electronic clinical quality measures (eCQM) across different healthcare institutions.

With growing recognition of the influence that social risks, such as food insecurity and housing instability, have on individual and population health, social risk screening and social care interventions have proliferated across the health system. Social needs intervention research on screening and referral in specialty care is limited, despite evidence that social needs influence access to and outcomes of surgical and specialty care.

This study develops a hospital quality index to analyze state-level variations in hospital quality in the United States from 2013 to 2021, using data from 3,000 hospitals from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare data set.

Despite the importance of early detection of diabetic retinopathy, many diabetic patients fail to receive the recommended screening. The objective of this quality-improvement initiative was to increase diabetic retinopathy screening through a partnership between primary care and ophthalmology, where primary care clinic staff may schedule patients directly for screening appointments at point of referral. To our knowledge, this intervention is the first described to use an interspecialty partnership to increase screening. We implemented the intervention at a resident-run primary care clinic with a medically underserved patient population. The pilot intervention took place over a 6-month time frame. The completion rate of diabetic retinopathy screening examinations was compared before and after intervention and was found to increase in a statistically significant manner from 34.7% to 40.5% ( p = .01). The no-show rate did improve from 66.7% preintervention to 46.0% postintervention; however, this change was not statistically significant ( p = .44). During this pilot, the intervention was able to increase diabetic retinopathy screening completion rate; however, further efforts should be aimed at addressing no-shows. Overall, this initiative was a positive step toward the goal of every diabetic patient undergoing the appropriate screening examinations.

Since 2011, hospitals in the United States have used the Total Harm Rate as a metric to address and enhance patient safety by mitigating harmful events. However, upon evaluation, it was concluded that this tool had lost its validity and was not widely used as an effective measure to prevent harm to patients. There are no similar comparative data in the literature to which we can compare our results with others. The Quality Management Performance Improvement team began to develop a composite safety score that would be used to reflect the environment of patient safety and promote improvement opportunities.

Risk of stroke is greater in patients with atrial fibrillation. Anticoagulation is effective at decreasing risk, yet 40-50% of eligible patients are not prescribed anticoagulation and seem to have a concerning gap in care quality. This quality improvement initiative implemented a pharmacist-led approach to identify, verify, and close apparent anticoagulation treatment gaps.

Gather insights into healthcare organization (HCO) preparedness for new 21st Century Cures Act information blocking disincentives and challenges in achieving greater accuracy /interoperability of patient identity/data.

To reduce the rate of central line-associated bloodstream infections (CLABSI) in the M Health Fairview Neonatal Intensive Care Unit (NICU) from 2.15 infections per 1,000 central line days to less than one per 1,000 line days using process evaluation.

Lung cancer ranks as the third most prevalent cancer in the United States. The use of low-dose computed tomography (LDCT) screening significantly reduces mortality from this disease. Unfortunately, Texas lags in completing lung cancer screening (LCS) for high-risk patients, ranking 48th among all states. It is crucial to implement quality improvement (QI) initiatives in Texas. In collaboration with the American Cancer Society, the primary care center (PCC) at our institution led a multidisciplinary QI project aimed at enhancing LCS through LDCT for eligible PCC patients.

Patient throughput issues are of significant concern for U.S. hospitals and have serious implications for patient care quality and safety as well as hospital finances. In 2021, leaders of a community hospital commissioned a quality improvement team to address a bottleneck of patients in the emergency department (ED). The bottleneck was causing significant increases in the number of hours patients were held in the ED because of a lack of available inpatient beds. The team used the DMAIC improvement framework to analyze patient flow challenges across the hospital, design an evidence-based set of interventions, and measure improvements. Analysis revealed problems with communication breakdowns and workflow silos, discharge predictability, readiness of patients for discharge, timeliness of discharges, and lack of standardization in patient hand-offs and documentation processes. Addressing these issues resulted in patient throughput improvements including a reduction of greater than 75% in monthly ED hold hours after implementation.