Patient-Centered Strategies for HCAHPS ImprovementEngagingPatients
This document discusses strategies for improving patient experience scores on the HCAHPS survey through patient-centered care. It notes that HCAHPS performance is becoming increasingly important for hospital reimbursement. The document recommends partnering with patients, creating a healing physical environment, making data meaningful to staff, focusing on care transitions beyond the hospital, and prioritizing compassionate care. Planetree is introduced as an organization that advocates for these patient-centered approaches and certifies hospitals that meet standards for patient-centered culture and environments.
The document provides an overview of the SAFER patient flow bundle and Red2Green days tools. It summarizes:
- The SAFER bundle focuses on senior review, all patients having clear plans/criteria for discharge, early flow of patients from assessment units before 10am, earlier discharges with 1/3 before midday, and reviewing long stay patients.
- Red2Green days classify patient days as red (not ready for discharge) or green (ready). It aims to have no red days by addressing delays and barriers.
- Evidence shows increased mortality with emergency department overcrowding and delays. Early mobility and discharge can reduce length of stay and improve outcomes while hospitalization risks deconditioning
Strategic priorities in Patient Safety. Philip Hassen. IV International Conference on Patient Safety. (Madrid, Ministry of Health and Consumer Affairs, 2008)
Nursing innovation is a fundamental source of progress for health care systems around the world. And nurses innovate to find new information and better ways of promoting health, preventing disease and better ways of care and cure
This document provides an agenda and materials for an orientation program on safety standards at GAHAR Hospital. It includes sessions on medication management safety standards, operative and invasive procedure safety standards, and environmental safety standards. The objectives are to help participants identify and implement relevant GAHAR standards to minimize safety risks and harm to patients. The document reviews several specific standards for policies, procedures, labeling, documentation, and checklists to ensure correct patient identification, medication reconciliation, and availability of necessary documents and equipment for procedures.
The document discusses rapid response teams (RRTs) which bring critical care expertise to patients whose condition appears to be worsening. It notes that unnecessary deaths still occur in hospitals and RRTs can help address this issue. Data shows that after implementing an RRT at one hospital, cardiac arrests, deaths from cardiac arrest, ICU and hospital stay lengths all decreased. The document provides guidance on setting up an RRT, including engaging leadership, identifying staff roles, establishing alert criteria, training, and evaluating effectiveness. It also discusses tools like the Modified Early Warning Score that can help identify patients needing higher levels of care.
Patient engagement is a critical element of successful transitions of care. Without it, patients are improperly educated about their condition and inadequately prepared to self-manage.
Healthcare organizations need effective and scalable ways of engaging patients post-discharge.
Patient-Centered Strategies for HCAHPS ImprovementEngagingPatients
This document discusses strategies for improving patient experience scores on the HCAHPS survey through patient-centered care. It notes that HCAHPS performance is becoming increasingly important for hospital reimbursement. The document recommends partnering with patients, creating a healing physical environment, making data meaningful to staff, focusing on care transitions beyond the hospital, and prioritizing compassionate care. Planetree is introduced as an organization that advocates for these patient-centered approaches and certifies hospitals that meet standards for patient-centered culture and environments.
The document provides an overview of the SAFER patient flow bundle and Red2Green days tools. It summarizes:
- The SAFER bundle focuses on senior review, all patients having clear plans/criteria for discharge, early flow of patients from assessment units before 10am, earlier discharges with 1/3 before midday, and reviewing long stay patients.
- Red2Green days classify patient days as red (not ready for discharge) or green (ready). It aims to have no red days by addressing delays and barriers.
- Evidence shows increased mortality with emergency department overcrowding and delays. Early mobility and discharge can reduce length of stay and improve outcomes while hospitalization risks deconditioning
Strategic priorities in Patient Safety. Philip Hassen. IV International Conference on Patient Safety. (Madrid, Ministry of Health and Consumer Affairs, 2008)
Nursing innovation is a fundamental source of progress for health care systems around the world. And nurses innovate to find new information and better ways of promoting health, preventing disease and better ways of care and cure
This document provides an agenda and materials for an orientation program on safety standards at GAHAR Hospital. It includes sessions on medication management safety standards, operative and invasive procedure safety standards, and environmental safety standards. The objectives are to help participants identify and implement relevant GAHAR standards to minimize safety risks and harm to patients. The document reviews several specific standards for policies, procedures, labeling, documentation, and checklists to ensure correct patient identification, medication reconciliation, and availability of necessary documents and equipment for procedures.
The document discusses rapid response teams (RRTs) which bring critical care expertise to patients whose condition appears to be worsening. It notes that unnecessary deaths still occur in hospitals and RRTs can help address this issue. Data shows that after implementing an RRT at one hospital, cardiac arrests, deaths from cardiac arrest, ICU and hospital stay lengths all decreased. The document provides guidance on setting up an RRT, including engaging leadership, identifying staff roles, establishing alert criteria, training, and evaluating effectiveness. It also discusses tools like the Modified Early Warning Score that can help identify patients needing higher levels of care.
Patient engagement is a critical element of successful transitions of care. Without it, patients are improperly educated about their condition and inadequately prepared to self-manage.
Healthcare organizations need effective and scalable ways of engaging patients post-discharge.
Improving Healthcare Outcomes: Keep the Triple Aim in MindHealth Catalyst
The battle cry for healthcare organizations throughout the United States? Improve outcomes! However, as organizations begin to measure outcomes they realize not all outcomes are created equal and the question of what constitutes an improvement becomes more challenging. Healthcare leaders would be wise to keep the Triple Aim in mind when creating a strategy for optimizing outcomes. Achieving the appropriate balance among the three dimensions of the Triple Aim is critical to driving real, long-term change in healthcare delivery outcomes.
This document provides an overview and framework for preceptorship programs. It aims to support new staff through orientation and role transitions. Key elements include pairing a new staff member with a preceptor to facilitate learning, develop competencies, and provide feedback. Benefits include increased confidence, job satisfaction, and quality of care for patients. Effective preceptors act as role models, provide constructive feedback, and facilitate problem-solving skills. Upon completion, new staff should be confident and autonomous in delivering high quality care. The framework provides standards and tools to guide preceptorship implementation and monitoring.
The document discusses evidence based nursing practice. It defines nursing research, evidence, evidence based decision making and evidence based practice. Evidence based nursing practice refers to using the best research evidence, clinical expertise and patient preferences in clinical decision making. The evidence based practice movement started in the 1990s to improve care quality. Models like the Stetler model and Iowa model provide frameworks for evidence based practice. Barriers to evidence based practice include lack of time, skills and research access. Guidelines and systematic reviews are sources of best evidence.
This document discusses trends and challenges in nursing education. It notes changing demographics like increasing populations and chronic illnesses. Nursing education must adapt, with more flexible delivery, competency-based curriculums, and use of technology. There are also challenges like lack of qualified faculty, infrastructure issues, and competition for clinical placements. Suggested actions include student-centered learning, technology integration, innovative teaching, and preparing students for future complex care needs through interprofessional education and focus on evidence-based practice.
Rishi Hazarika - ICHOM - IPPOSI PROMs conference Oct 2018ipposi
The document summarizes ICHOM's work defining standard sets of outcomes measures for medical conditions. ICHOM aims to drive value-based healthcare by establishing global standards for outcomes reporting. ICHOM has convened international experts to develop 24 standard sets covering major diseases. Adoption of ICHOM standards is growing, with over 650 organizations and 12 national registries now measuring outcomes. Standardized reporting allows meaningful comparisons of outcomes, costs, and best practices to improve patient care.
To recognize The National Patient Safety Foundation's Patient Safety Awareness Week #PSAW2015 we asked our colleagues in the Harvard medical community to complete this sentence: "Patient safety is..."
Here are some of their responses.
The document discusses quality improvement initiatives for emergency departments. It notes that timely treatment in the emergency department is key to quality care outcomes for patients. It provides examples of quality indicators for conditions like acute myocardial infarction and pneumonia that can be used to measure and improve care. The document advocates for a multidisciplinary team approach, data sharing between hospitals, and engaging medical staff and customers to support quality improvement goals.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
Patient satisfaction is important for hospitals and healthcare providers. It is measured using surveys like HCAHPS which assess patient perceptions of care. High patient satisfaction is important for hospitals as it influences reimbursement and can incentivize improving quality. Nurses play a key role in patient satisfaction through fundamentals like communication, personalized care, and accountability. Hospitals should focus on initiatives that empower nurses and improve organizational culture to boost both patient satisfaction and nurse satisfaction.
This document outlines various hospital protocols and procedures related to patient safety, including ensuring correct patient identification, preventing wrong site/procedure errors, and proper handling of blood products. It discusses the surgical safety checklist that must be performed before procedures, including sign in, time out, and sign out steps. Site marking protocol and exemptions are covered. Risk assessment for venous thromboembolism is also mentioned.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
The Top 7 Outcomes Measures and 3 Measurement EssentialsHealth Catalyst
Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement:
Transparency
Integrated care
Interoperability
Patient safety is a fundamental principle of healthcare. Adverse events can result from problems in various areas of care and improving safety requires a complex, system-wide effort. Ensuring safety involves assessing risks, preventing harm, reporting and analyzing incidents, learning from mistakes, and implementing solutions. Guidelines include proper identification of patients, hand hygiene, medication reconciliation, and fall prevention.
The document discusses patient safety in healthcare. It defines patient safety and identifies common medical errors. The goals are to establish a culture of safety, minimize errors, and implement standardized practices and reporting. A patient safety committee coordinates these efforts by managing risk, establishing reporting procedures, and collecting/analyzing safety data to identify root causes and implement corrective actions. The leadership role is to create an environment that recognizes safety importance and implements a patient safety program.
The document discusses key aspects of quality in healthcare. It defines quality as services that increase the probability of desired health outcomes and follow best practices. There are three aspects of quality - measurable, appreciative, and perceptive. The perception of quality is most influenced by caring staff, physical environment, and physician competence rather than new technology. Quality care positively affects patients and is defined by dimensions like safety, effectiveness, timeliness, efficiency, and equity. Quality management principles center around leadership, data-driven decisions, customer focus, and continuous improvement.
Patient safety involves preventing medical errors and adverse events for patients during healthcare. Some key points covered in the document include:
- Medical errors kill 48,000-98,000 patients per year in the US, costing $18-30 billion annually. Medical error is the third leading cause of death.
- Common causes of errors include poor communication, look-alike medications, improper identification of patients, and failure to follow safety protocols.
- The World Health Organization advocates for practices like explaining procedures during handoffs, checking patient IDs, and improving hand hygiene to prevent infections.
- Hospitals should have safety policies for areas like surgery, laboratories, blood transfusions, and the environment to minimize
Cbahi hospital accreditation guide october 2016Badheeb
The document provides guidance for hospitals on the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) hospital accreditation process. It describes the CBAHI organization and its mission to promote healthcare quality and safety. It also outlines the hospital registration process with CBAHI, the scope and goal of accreditation surveys, how compliance is assessed, accreditation decision rules, and possible accreditation outcomes.
INNOVATION IN NURSING, FUTURICTIC NURSING AND TRANSCULTURAL NURSINGrittikadas7
This document discusses innovation in nursing. It begins by defining innovation and explaining why it is important in nursing due to changes in demographics, healthcare demands, and limited economic resources. The history of innovation in nursing is reviewed from early examples to modern technologies. Areas of innovation are identified as practice, education, care management. New strategies for innovation in nursing practice, education, and care are proposed. Barriers to implementing innovations and the roles of nurses as innovators are also examined.
Patient complaints are inevitable. And when a patient complaint is not effectively managed, unfavorable or harmful consequences can result—noncompliance, dissolving of the patient-physician relationship, litigation, or reduced compensation. Therefore, strong complaint management is a core component for success worth cultivating and honing.
Critical pathway of care,concept mapping by Velveena Mvelveenamaran
Critical pathways of care (CPCs): used as the tools for provision of care in a case management system.
It brings together all the professional groups involved in patient care
to arrive at a consensus about standards of care and expected outcomes for selected patient groups.
Improving hospital discharge time A successful implementation of nurse drive...QualityManagement8
This document describes a study conducted at Lourdes Hospital in India to improve hospital discharge times through a nurse-driven initiative. In the pre-intervention phase, discharge times varied widely between departments and patient satisfaction with discharge timeliness was low. A nurse-led intervention was implemented that standardized the discharge process and assigned dedicated discharge nurses. This resulted in reduced average discharge times across departments from 4.15 to 3.25 hours on average and improved patient satisfaction from 42.6% to 74.6%. The study concluded the intervention successfully improved hospital discharge times and patient experience with the discharge process.
Improving Healthcare Outcomes: Keep the Triple Aim in MindHealth Catalyst
The battle cry for healthcare organizations throughout the United States? Improve outcomes! However, as organizations begin to measure outcomes they realize not all outcomes are created equal and the question of what constitutes an improvement becomes more challenging. Healthcare leaders would be wise to keep the Triple Aim in mind when creating a strategy for optimizing outcomes. Achieving the appropriate balance among the three dimensions of the Triple Aim is critical to driving real, long-term change in healthcare delivery outcomes.
This document provides an overview and framework for preceptorship programs. It aims to support new staff through orientation and role transitions. Key elements include pairing a new staff member with a preceptor to facilitate learning, develop competencies, and provide feedback. Benefits include increased confidence, job satisfaction, and quality of care for patients. Effective preceptors act as role models, provide constructive feedback, and facilitate problem-solving skills. Upon completion, new staff should be confident and autonomous in delivering high quality care. The framework provides standards and tools to guide preceptorship implementation and monitoring.
The document discusses evidence based nursing practice. It defines nursing research, evidence, evidence based decision making and evidence based practice. Evidence based nursing practice refers to using the best research evidence, clinical expertise and patient preferences in clinical decision making. The evidence based practice movement started in the 1990s to improve care quality. Models like the Stetler model and Iowa model provide frameworks for evidence based practice. Barriers to evidence based practice include lack of time, skills and research access. Guidelines and systematic reviews are sources of best evidence.
This document discusses trends and challenges in nursing education. It notes changing demographics like increasing populations and chronic illnesses. Nursing education must adapt, with more flexible delivery, competency-based curriculums, and use of technology. There are also challenges like lack of qualified faculty, infrastructure issues, and competition for clinical placements. Suggested actions include student-centered learning, technology integration, innovative teaching, and preparing students for future complex care needs through interprofessional education and focus on evidence-based practice.
Rishi Hazarika - ICHOM - IPPOSI PROMs conference Oct 2018ipposi
The document summarizes ICHOM's work defining standard sets of outcomes measures for medical conditions. ICHOM aims to drive value-based healthcare by establishing global standards for outcomes reporting. ICHOM has convened international experts to develop 24 standard sets covering major diseases. Adoption of ICHOM standards is growing, with over 650 organizations and 12 national registries now measuring outcomes. Standardized reporting allows meaningful comparisons of outcomes, costs, and best practices to improve patient care.
To recognize The National Patient Safety Foundation's Patient Safety Awareness Week #PSAW2015 we asked our colleagues in the Harvard medical community to complete this sentence: "Patient safety is..."
Here are some of their responses.
The document discusses quality improvement initiatives for emergency departments. It notes that timely treatment in the emergency department is key to quality care outcomes for patients. It provides examples of quality indicators for conditions like acute myocardial infarction and pneumonia that can be used to measure and improve care. The document advocates for a multidisciplinary team approach, data sharing between hospitals, and engaging medical staff and customers to support quality improvement goals.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
Patient satisfaction is important for hospitals and healthcare providers. It is measured using surveys like HCAHPS which assess patient perceptions of care. High patient satisfaction is important for hospitals as it influences reimbursement and can incentivize improving quality. Nurses play a key role in patient satisfaction through fundamentals like communication, personalized care, and accountability. Hospitals should focus on initiatives that empower nurses and improve organizational culture to boost both patient satisfaction and nurse satisfaction.
This document outlines various hospital protocols and procedures related to patient safety, including ensuring correct patient identification, preventing wrong site/procedure errors, and proper handling of blood products. It discusses the surgical safety checklist that must be performed before procedures, including sign in, time out, and sign out steps. Site marking protocol and exemptions are covered. Risk assessment for venous thromboembolism is also mentioned.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
The Top 7 Outcomes Measures and 3 Measurement EssentialsHealth Catalyst
Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement:
Transparency
Integrated care
Interoperability
Patient safety is a fundamental principle of healthcare. Adverse events can result from problems in various areas of care and improving safety requires a complex, system-wide effort. Ensuring safety involves assessing risks, preventing harm, reporting and analyzing incidents, learning from mistakes, and implementing solutions. Guidelines include proper identification of patients, hand hygiene, medication reconciliation, and fall prevention.
The document discusses patient safety in healthcare. It defines patient safety and identifies common medical errors. The goals are to establish a culture of safety, minimize errors, and implement standardized practices and reporting. A patient safety committee coordinates these efforts by managing risk, establishing reporting procedures, and collecting/analyzing safety data to identify root causes and implement corrective actions. The leadership role is to create an environment that recognizes safety importance and implements a patient safety program.
The document discusses key aspects of quality in healthcare. It defines quality as services that increase the probability of desired health outcomes and follow best practices. There are three aspects of quality - measurable, appreciative, and perceptive. The perception of quality is most influenced by caring staff, physical environment, and physician competence rather than new technology. Quality care positively affects patients and is defined by dimensions like safety, effectiveness, timeliness, efficiency, and equity. Quality management principles center around leadership, data-driven decisions, customer focus, and continuous improvement.
Patient safety involves preventing medical errors and adverse events for patients during healthcare. Some key points covered in the document include:
- Medical errors kill 48,000-98,000 patients per year in the US, costing $18-30 billion annually. Medical error is the third leading cause of death.
- Common causes of errors include poor communication, look-alike medications, improper identification of patients, and failure to follow safety protocols.
- The World Health Organization advocates for practices like explaining procedures during handoffs, checking patient IDs, and improving hand hygiene to prevent infections.
- Hospitals should have safety policies for areas like surgery, laboratories, blood transfusions, and the environment to minimize
Cbahi hospital accreditation guide october 2016Badheeb
The document provides guidance for hospitals on the Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) hospital accreditation process. It describes the CBAHI organization and its mission to promote healthcare quality and safety. It also outlines the hospital registration process with CBAHI, the scope and goal of accreditation surveys, how compliance is assessed, accreditation decision rules, and possible accreditation outcomes.
INNOVATION IN NURSING, FUTURICTIC NURSING AND TRANSCULTURAL NURSINGrittikadas7
This document discusses innovation in nursing. It begins by defining innovation and explaining why it is important in nursing due to changes in demographics, healthcare demands, and limited economic resources. The history of innovation in nursing is reviewed from early examples to modern technologies. Areas of innovation are identified as practice, education, care management. New strategies for innovation in nursing practice, education, and care are proposed. Barriers to implementing innovations and the roles of nurses as innovators are also examined.
Patient complaints are inevitable. And when a patient complaint is not effectively managed, unfavorable or harmful consequences can result—noncompliance, dissolving of the patient-physician relationship, litigation, or reduced compensation. Therefore, strong complaint management is a core component for success worth cultivating and honing.
Critical pathway of care,concept mapping by Velveena Mvelveenamaran
Critical pathways of care (CPCs): used as the tools for provision of care in a case management system.
It brings together all the professional groups involved in patient care
to arrive at a consensus about standards of care and expected outcomes for selected patient groups.
Improving hospital discharge time A successful implementation of nurse drive...QualityManagement8
This document describes a study conducted at Lourdes Hospital in India to improve hospital discharge times through a nurse-driven initiative. In the pre-intervention phase, discharge times varied widely between departments and patient satisfaction with discharge timeliness was low. A nurse-led intervention was implemented that standardized the discharge process and assigned dedicated discharge nurses. This resulted in reduced average discharge times across departments from 4.15 to 3.25 hours on average and improved patient satisfaction from 42.6% to 74.6%. The study concluded the intervention successfully improved hospital discharge times and patient experience with the discharge process.
The document outlines the process undertaken by the Blueprint Project Team to define a new blueprint and test specifications for the Medical Council of Canada (MCC) examinations. Key aspects of the process included consultation with subject matter experts, review of reports on current issues in healthcare, and a national survey of physicians, pharmacists, nurses and the public. Based on this information, the team proposed a common blueprint with dimensions of care (e.g. acute, chronic, psychosocial) and physician activities (e.g. assessment, management, communication) to assess core competencies across two decision points - entry into supervised practice and unsupervised practice. The team engaged in consultation with stakeholders to gather feedback on the proposed blueprint and next steps.
7 day services practical tips for achieving consultant review of patients wit...NHS England
Sue Cottle, Programme Lead, 7 Day Services, Sustainable Improvement, NHS England South
Celia Ingham Clark, MBE, Medical Director for Clinical Effectiveness, NHS England
Claire Gorzanski, Head of Clinical Effectiveness, Salisbury NHS Foundation Trust
Sam Burrows, Director of Strategy, NHS Wokingham CCG
This webinar aims to provide you with:
An overview of the updated guidance for the priority clinical standards and timing of the forthcoming self-assessment survey
Practical examples of how commissioners and acute providers are working together to support delivery of timely Consultant assessment (clinical standard 2) – their successes, challenges and opportunities
An opportunity to ask questions of your colleagues and identify key areas of support required
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
This document discusses optimizing patient flow through emergency care by segmenting patients into categories based on length of stay and clinical needs. It advocates using expected date of discharge and clinical criteria for discharge as goals to coordinate care and discharge planning. Key steps include allocating patients early to specialty teams, standardizing care pathways, minimizing handovers, and conducting daily board rounds to focus on constraints and moving patients smoothly through their care. The overall aim is to get patients home safely and faster while improving outcomes.
Measuring Improvement: Using metrics and data to evaluate seven day servicesNHS England
A supporting document from a webinar run by Rhuari Pike, Programme Lead (Seven Day Services, London) on behalf of the NHS England Sustainable Improvement Team.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
MDT round protocol of yekatit 12 Hospital medical college.pdfAshenafiTigabu
This document outlines protocols for multidisciplinary team (MDT) rounds at Yekatit 12 Hospital Medical College. Key points include:
1. MDT rounds involve multiple care team members like doctors, nurses, pharmacists discussing patient care in real-time to coordinate care, establish goals, and plan discharge.
2. MDT rounds are done twice daily at the hospital to review all patients, evaluate new/critical cases, and ensure quality of care.
3. The rounds are led by senior consultants and include evaluating clinical status, nursing care, medication practices, and patient/family engagement.
4. Data from the rounds is documented and used for daily clinical audits to improve departmental
This document discusses quality improvement in critical care. It defines high quality care and describes the components of a critical care system. The document recommends selecting sepsis as a quality improvement project and outlines the steps to take, which include process mapping, setting objectives, pilot testing interventions, measuring outcomes, and continually improving processes. Quality improvement work aims to enhance patient outcomes through systematic and continuous activities.
This document outlines how nurse-led clinics can be established in general practices to manage preventative health and chronic disease care through a team-based approach. It discusses recruiting target patient populations, conducting assessments, developing care plans, involving GPs, using software and templates, billing appropriately, and establishing recall systems. The goals are to expand services, improve outcomes, and utilize nurses' clinical expertise while enhancing practices' competitiveness. Close collaboration between nurses and GPs is emphasized.
Delayed discharges - A patient flow and safety imperativeAnn Marie O'Grady
Presentation details change project to improve patient flow and safety in Beaumont Hospital, Dublin, for patients whose discharge is delayed awaiting a residential nursing home bed
A nursing care plan has five key components: nursing diagnosis, expected outcome, nursing interventions and rationales, and evaluation. It is created through a five-step process: 1) assessment of subjective and objective data, 2) diagnosis, 3) determining outcomes and planning, 4) implementing interventions, and 5) evaluating outcomes. The care plan is updated constantly based on new patient data and aims to help patients achieve measurable goals within a specific timeframe through evidence-based nursing actions.
A nursing care plan has five key components: nursing diagnosis, expected outcome, nursing interventions and rationales, and evaluation. It is created through a five-step process: 1) assessment of subjective and objective data, 2) diagnosis, 3) determining outcomes and planning, 4) implementing interventions, and 5) evaluating outcomes. The care plan is updated constantly based on new patient data and aims to help patients achieve measurable goals within a specific timeframe through evidence-based nursing actions.
Presentation made by Celia Ingham Clark National Director for Reducing Premature Mortality, at Improving access to seven day services. Southampton 25 March 2015
A service improvement focused on frailty using an R&D approach, pop up uni, 3...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
NAC PRA update - 2014 Ottawa ConferenceMedCouncilCan
This document outlines the Pan-Canadian Practice Ready Assessment for IMG Physicians, which aims to establish competency-based standards for provisional licensure in family medicine. It discusses the background and challenges with integrating International Medical Graduates. The Practice Ready Assessment is presented as a process using Miller's pyramid to assess clinical competence through point-in-time and over-time evaluations. Standards are developed in collaboration with various stakeholders and focus on what candidates can do rather than how assessments are implemented. Assessments occur in practice environments over 12 weeks using multi-source feedback from patients and colleagues to determine practice readiness.
This document discusses pragmatic clinical trials. It begins by defining pragmatic trials and explaining how they differ from explanatory trials. Pragmatic trials are designed to assess effectiveness of interventions in real-world settings, while explanatory trials test efficacy under controlled conditions. The document then introduces the PRECIS-2 tool, which is used to evaluate how pragmatic or explanatory a trial is based on 9 domains. It provides examples of pragmatic and explanatory approaches for each domain to help trial designers achieve the right balance. The goal is to generate evidence that is useful for patients, clinicians and policymakers.
The document discusses planning nursing care through establishing priorities, setting goals and expected outcomes, and selecting appropriate nursing interventions. It covers different types of planning including initial, ongoing, and discharge planning. Key aspects of planning discussed include establishing priorities by ranking patient problems, setting goals that are patient-centered and measurable, selecting evidence-based nursing interventions, and documenting the plan of care using systems like standardized plans or concept maps. Effective communication during shift changes and consulting other professionals is also emphasized.
Dr Ayman Ewies - Clinical audit made easyAymanEwies
This document provides an overview of how to conduct a clinical audit. It defines clinical audit as a process used by healthcare professionals to systematically review, evaluate and improve patient care. The document outlines the key components of an audit, including choosing a topic, selecting standards, planning methodology, collecting data, analyzing results, and implementing changes. It emphasizes that the goal of audit is to compare current practices to standards in order to enhance quality of care and patient outcomes.
Similar to Clinical criteria for discharge - ECIST webinar 06 02-20 (P Gordon) (20)
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
1. NHS England and NHS Improvement
A clear plan for every person
• Clinical criteria for discharge
• Criteria led discharge
@PeteGordon68 #homefirst #wherebestnest
2. 2 |2 |
Don’t over complicate things – keep it as
simple as you can
3. 3 |3 |
Start with the patient (the person) and work backwards –
what would we want to know?
Why is a plan so important?
1. Do I know what is wrong with me or what is
being excluded?
2. What is going to happen now, later today and
tomorrow to get me sorted out?
3. What do I need to achieve to get home? ‘Back to
baseline’ is rarely a useful phrase.
4. If my recovery is ideal and there is no
unnecessary waiting, when should I expect to go
home?
5. 5 |
• Home when stable
• Home when mobile
• Start discharge planning
• Home after weekend
• Medically fit for discharge
when back to baseline
• Recheck bloods tomorrow
Common phrases – how clear are they?
10. 10 |10 |
• Mobility e.g. can walk up to 10
metres (exercise tolerance = 25
metres but toilet 10 metres away)
#EndPJparalysis
• Eating and drinking
• Toilet
• What does the person really want
and have the risks been explained
to them and / or their family?
• Plan to assess at home wherever
possible #homefirst
Functional and emotional criteria are
also important
12. 12 |12 |
• Purpose to the patient
• Expectations to the relative
• Consistency for the MDT
• Confidence for the junior Dr
• Continuity for the nurse
• Clarity for integrated discharge
teams, social care and
community colleagues
• Assurance for the trust
Clinical criteria and a clear plan gives
14. 14 |
What is criteria led discharge?
‘Criteria led discharge is a process where the clinical parameters for a
patient’s discharge are clearly defined. They are determined in
accordance with; a care pathway, a clinical protocol (condition specific)
or a bespoke discharge plan.
The consultant leading the care and the multi-professional team
must agree the criteria; these may be standardised for particular
procedures or conditions, however must always be adapted to provide
person centred discharge.
The patient should be actively involved in the process of criteria led
discharge. The patient's discharge can then be facilitated by a
competent member of staff once those the criteria have been met’.
Dr Liz Lees-Deutsch and Jane Robinson, 2018.
16. 16 |
Is criteria led discharge safe?
• YES
• 4 articles Bowen at al, Gotz et al, Webster et al and
Kasthuri et al.
• Complication rates
• Readmissions
• These were dependent upon:
• Process used
• Patient selection (removal/reassessment)
• Attainment of goals
• Patient and carer involvement
Dr Liz Lees-Deutsch
17. 17 |
Does criteria led discharge reduce length of stay?
• YES
• 3 studies where this was primary outcome (surgical). Plus
3 where outcome was an indirect result
• On time – by a specific time
• Reduced delays (46% delay to 5% delay)
• No increase in LOS
• Context specific – not generalisable (always localise the
approach)
Dr Liz Lees-Deutsch
18. 18 |
What are the enablers for criteria led discharge?
• Executive support and policy is needed for criteria led
discharge
• Pre-audit of current process against outcomes measures
e.g. length of stay
• Release of clinical staff time to participate in changes
required
• Establishing a multi-disciplinary steering group (shared
vision)
• Identification of the patient populations that would benefit
• Develop clearly defined criteria & associated process with
documentation. Identify staff training needs (across
professional groups)
Dr Liz Lees-Deutsch
19. 19 |
Key points:
•Implementing criteria-led discharge
requires a review of the whole discharge
process
•Criteria-led discharge should be integrated
with the usual discharge process
•Outcome measures must be in place
before a project starts so effectiveness can
be evaluated
•Implementation should help practitioners to
take charge of the revised discharge
process
•Success will come to those who can show
they can safely adapt elements of their
existing discharge process, with clear robust
discharge criteria
Dr Liz Lees-Deutsch
21. Phase 1
Cambridge J
Phase 2
Cambridge L
Phase 3
Cambridge
M2
Phase 4
King’s C2
We Just Did It
Matrons - Paula Knights and Maria Jenner
December 2019
22. Goals of CLD
• Increased weekend transfers (discharge) of care
• Early decisions leading to smooth discharge
• Reduced length of stay
• Improved patient and staff experience
• Improved communication
• Transparency of discharge plan for MDT
• It supports clinical judgement
23. Being Clear on what CLD is:
Commonly misinterpreted as:
‘the transference of total responsibility for the
discharge decision from doctors to nurses’
Lees L. ‘Making Nurse-Led Discharge Work to Improve Patient Care’
Nursing Times Vol. 100 No. 37 September 2004
24. What did we do?
• Started a conversation
• Four meetings
Initial feedback before the launch
of CLD…
• “It’s another job for us to do” – It’s what we do
already.
• “It’s not about quality” – It’s all about quality.
• “I may miss discharging my patients” – nursing teams
are the last contact.
25. After the initial meetings we…
• Identified key team including junior Drs
• Developed SOP
• Developed CLD forms
• Agreed a launch date of 1 November 2019
• Agreed outcome measures
• Introduced board round stickers
• Formulated the rhythm of the process
26. Rhythm of the Process
• Identification on the board round
• Board round sticker completed by the consultant with
medical or functional criteria documented
• Huddle – CLD form/check list completed
• Matron/Manager Call helpline over weekends
• Follow up contact on Monday
• Review of patients not discharged
27. Story so far
• Positive feedback from MDT including junior doctors
• Steering group (terms of reference)
• Competency framework / training programme including
scenarios e.g. would you discharge this patient?
28. Project Data & Outcomes
• Shows a shift in discharge profile demonstrating
increased Friday and weekend discharges during
November 2019
29. Project Data & Outcomes
21+ spiked at 9 Patients on 22 October, and has
reduced to <5 in recent weeks.
30. THE STORY OF CLD – AVON WARD SWFT
Already doing
‘active specialty
pull’ since 2017
31. Clinicians and Risk
Risk averse culture
No one wants to
take risks
Discharge
when
therapy
happy
Discharge
after review
by doctor
How about shared
responsibility and
shared risks?
What if the
patient falls
at home?
What if the
patient is
readmitted?
32. Team attitudes conducive to CLD
• Flattened hierarchy within the team
• Respectful challenge is the norm and encouraged
• Every member of the team has jobs allocated which
they take responsibility for and jobs are allocated
fairly
• No member of the team leaves until all the jobs are
completed. If you finish your work you help others.
33. How did CLD come about?
• Identified weekend discharges had to wait for
medical review prior to discharge-causing
delays
• Nurses- ‘we can facilitate some discharges if
you tell us exactly what is needed’
• Potential for increase in 4-6 (weekend)
monthly discharges if planned well
34. Aims of CLD
Set criteria and
agree
Nurse / junior
doctor
discharges
No need to
WAIT for
anybody senior
35. • Piloted in September 2018
• Audit after 3 months (September-December
2018)
• Further amendments made based on result
• Action continued
PDSA – testing
36. Process:
Proforma developed for manual data capture of
patients that fit into the CLD audit
CRITERIA LED DISCHARGE - FRIDAY PM HANDOVER AUDIT PROFORMA
DATE:
SISTER/WARDMANAGERINCHARGE:
DOCTORINCHARGE:
PATIENT STICKER
WEEKEND
DISCHARGE
YES /NO BY NURSE BY DOCTOR
REASON FOR NO WEEKEND DISCHARGE
/COMMENTS
Criteria proforma adapted to meet Avon ward needs
Dashboard developed to monitor discharges
This sticker is inserted in medical notes to allow safe discharge once patient is medically stable.
Clinical Criteria for Discharge (CCD) written on (DATE) …………………………/ Aim home on (DATE) …………………………
If the following safe clinical criteria is met, the patient can be discharged home by: NURSE □ DOCTOR □.
If patient deteriorates or the criteria are not met, the patient should be escalated for review by the medical team
1. NEWS: Pulse:…………………………………
2. BP:…………………..………………..
3. RR:…………………..………………..
4. 02 Stats:…………………….……….
Temperature:……………………..
Name of Consultant in charge of care: ____________________________________
Name of Dr planning CCD: PRINT _________________________SIGN ___________________________
Dr / Nurse in charge is signing to
agree that the above criteria is met and patient will be discharged □
or discharge delayed as criteria is not met □
Print Name ________________________ Signature_________________
Date: ___________________Time : __________________________________
37. This sticker is inserted in medical notes to allow safe discharge once patient is medically stable.
Clinical Criteria for Discharge (CCD) written on (DATE) …………………………/ Aim home on (DATE) …………………………
If the following safe clinical criteria is met, the patient can be discharged home by: NURSE □ DOCTOR □.
If patient deteriorates or the criteria are not met, the patient should be escalated for review by the medical team
1. NEWS: Pulse:…………………………………
2. BP:…………………..………………..
3. RR:…………………..………………..
4. 02 Stats:…………………….……….
Temperature:……………………..
Name of Consultant in charge of care: ____________________________________
Name of Dr planning CCD: PRINT _________________________SIGN ___________________________
Dr / Nurse in charge is signing to
agree that the above criteria is met and patient will be discharged □
or discharge delayed as criteria is not met □
Print Name ________________________ Signature_________________
Date: ___________________Time : __________________________________CTMS No:________________________
The stickers have been modified
with time by the team.
38. • Start thinking of patients suitable for CLD on the Thursday
board round (All the team agree, challenged and are aware)
• Firm up the list on the Thursday ward round
• Make sure this is communicated to the patient and family on
Thursday
• TTOs done for those patients between Thursday afternoon
and Friday AM (tasks allocated)
• Check again on Friday board round
The Process…1
39. • Friday PM - CLD stickers with clear criteria put on patient
notes – Nurse Discharge or Medical discharge
• Complexity of the patient decided whether it was the nurse or
doctor and was allocated only after discussion and
acceptance from the team
• Monday morning – review list to check if any patients were
not discharged and why – Education and feedback to the
team
The process …2
40. Challenges/Hesitation - Avon
• Lack of confidence with CLD
• Lack of understanding: why the need to
change what is already working
• We are already doing well-CLD will be extra
work- are we setting ourselves to fail?
• Perhaps try it on a ward with much longer
LOS
41. • Variable confidence within Nurses
• Junior doctors felt it was more work
• Friday handovers – too long – unable to
complete TTOs
• Finding justifications to delay discharge as the
criteria missed slightly
• Long list for ‘Out of hours’ tasks generated by
the junior doctors
Barriers
42. Overcoming Barriers
• Variable confidence within
Nurses
• Junior doctors felt it was
more work
• Friday handovers – too long
– unable to complete TTOs
• Finding justifications to
delay discharge as the
criteria missed slightly
• Long list for ‘Out of hours’
tasks generated by the
junior doctors
• Shared risk
• Checking if confident
before putting the sticker
• Supporting junior doctors
when completing exception
reporting
• Allowing them to peel off
certain handovers when
not needed
• Helping them plan the
weekend work
44. Criteria Led Discharge Audit
(Sept 2018 -Dec 2018) Results
Total no. highlighted for CLD 47
Number of patients discharged using criteria 36 (75%)
Failed d/c due to medical reasons 5 (10%)
Failed d/c due to social reasons* 4 (8.5%)
Failed d/c due to other/unknown** 2 (4.2%)
No. of CLD requiring medical review 13 (28%)
*Mostly POC/NH placement not ready to start
**e.g. Family concern over mobility/Therapy issue
48. 2016/17 2017/18 2018/19 2019/20
Predicted 0 0 0 82
Recorded 73 100 125 62
0
20
40
60
80
100
120
140
160
NumberofWeekendDischargesfortheYear(NB
2019/20=5months)
Avon Weekend Discharges
Active Diabetes
pull and POW
Criteria Led
Discharge
25
49. Avon Total Discharges
2019/20 whole year prediction for total discharges is 1079 pts – a rise of over
20% to previous year
2016/17 2017/18 2018/19 2019/20
Predicted 0 0 0 630
Recorded 605 724 887 449
0
200
400
600
800
1000
1200
TotalNumberofAonDischargesfortheYear(NB
2019/20=5months)
Active Diabetes
pull and POW
Criteria Led
Discharge
163
51. Lessons Learned
CLD is a culture change – it is not about stickers only
CLD is not about weekend discharges only – Once the culture changes it has a
profound effect on week day discharges
CLD is a tool for ‘timely discharge’ and instrumental in LLOS
CLD is not about weekend or weekday discharges only – part of the ‘SAFER patient
flow bundle’
Plan, do, study, act (PDSA) cycles to test an idea by trialling a change on a small scale and assess its impact, building upon the learning from previous cycles in a structured way before whole scale implementation
Junior doctors felt it was more work: The consultants agreed that since it was a new process, they would support them until it was business as usual. So they supported the juniors in ‘exception reporting’ to the educational supervisor if they had to stay back. Once the juniors saw the value to the patients and the support they got, they stopped the reporting. They also learned incorporated it in their day time tasks.
Friday handovers: There is a routine ward handover from the COW of the current week to the COW of the following week on a Friday. The CLD list was initially part of this handover. This long handover kept the juniors from doing the tasks. So the handover was split and the juniors were asked to attend only the CLD handover so the TTOs could be done in a timely way.
Finding justifications to delay discharge as the criteria missed slightly – Monday morning review of the CLD list to educate and empower nurses and doctors to deviate safely from the criteria or escalate if necessary was introduced.
Long list for Out of hours tasks generated by the junior doctors: The consultants took responsibility to challenge the worklist for the weekend teams. The list was minimised by removing unnecessary reviews, blood tests etc. which did not change management. The Out of hours work from the ward was monitored closely.
Junior doctors felt it was more work: The consultants agreed that since it was a new process, they would support them until it was business as usual. So they supported the juniors in ‘exception reporting’ to the educational supervisor if they had to stay back. Once the juniors saw the value to the patients and the support they got, they stopped the reporting. They also learned incorporated it in their day time tasks.
Friday handovers: There is a routine ward handover from the COW of the current week to the COW of the following week on a Friday. The CLD list was initially part of this handover. This long handover kept the juniors from doing the tasks. So the handover was split and the juniors were asked to attend only the CLD handover so the TTOs could be done in a timely way.
Finding justifications to delay discharge as the criteria missed slightly – Monday morning review of the CLD list to educate and empower nurses and doctors to deviate safely from the criteria or escalate if necessary was introduced.
Long list for Out of hours tasks generated by the junior doctors: The consultants took responsibility to challenge the worklist for the weekend teams. The list was minimised by removing unnecessary reviews, blood tests etc. which did not change management. The Out of hours work from the ward was monitored closely.
Junior doctors felt it was more work: The consultants agreed that since it was a new process, they would support them until it was business as usual. So they supported the juniors in ‘exception reporting’ to the educational supervisor if they had to stay back. Once the juniors saw the value to the patients and the support they got, they stopped the reporting. They also learned incorporated it in their day time tasks.
Friday handovers: There is a routine ward handover from the COW of the current week to the COW of the following week on a Friday. The CLD list was initially part of this handover. This long handover kept the juniors from doing the tasks. So the handover was split and the juniors were asked to attend only the CLD handover so the TTOs could be done in a timely way.
Finding justifications to delay discharge as the criteria missed slightly – Monday morning review of the CLD list to educate and empower nurses and doctors to deviate safely from the criteria or escalate if necessary was introduced.
Long list for Out of hours tasks generated by the junior doctors: The consultants took responsibility to challenge the worklist for the weekend teams. The list was minimised by removing unnecessary reviews, blood tests etc. which did not change management. The Out of hours work from the ward was monitored closely.
75% of patients highlighted for discharge went home on the day planned.
28% of these needed a medical review to facilitate their discharge – either planned or unplanned.
Some of these include patients admitted to Avon ward over the weekend (i.e. from Friday afternoon onwards) and therefore were not planned CLD discharges – medical review unavoidable in this circumstance