The document describes a study that evaluated the impact of a mobile application called STOP STEMI on door-to-balloon times for patients presenting with STEMI. The study found that after implementing STOP STEMI, which aims to improve coordination of STEMI care, average door-to-balloon times decreased by 22% (from 91 to 71 minutes). A subgroup analysis of Medicare-reportable cases also saw a 22% reduction in door-to-balloon times (from 68 to 53 minutes). The percentage of cases meeting door-to-balloon time benchmarks of under 90 and 60 minutes improved. The study concluded that STOP STEMI reduced door-to-balloon times and improved meeting of benchmarks in patients presenting with STEMI.
This document discusses a quality improvement project aimed at reducing emergency room wait times. A team of 3 nurses will lead the project. They plan to research current best practices for minimizing wait times and improving the patient experience in the ER. Options may include adjustments to staffing, facility layout, or patient flow. The team will evaluate several proposals before testing a new approach. Their goals are to enhance patient satisfaction, safety, and hospital reimbursement by addressing long wait times in the ER.
This document analyzes wait times in hospital emergency departments. It finds that the average wait time has increased from 46.5 minutes in 2003 to 98.7 minutes in 2013 based on data from 54 hospitals. The goal of the project is to reduce wait times by 50% annually to reach a six sigma quality level. Various factors that influence wait times are examined, including patient urgency, hospital location, and ambulance use. Solutions proposed include implementing a breakthrough team system based on lean manufacturing to streamline workflows and potentially increasing doctor staffing levels. The new process aims to reduce the wait time to 30 minutes or less.
The document discusses proposed actions to improve emergency room wait times in Nova Scotia hospitals. It identifies several key issues contributing to long wait times, including a shortage of hospital beds, increased use of emergency rooms by aging patients and alternate level of care (ALC) patients, and government funding cuts. It then proposes several multi-pronged strategies to address wait times by improving patient flow, reducing overcrowding and overuse of emergency rooms, and decreasing the number of ALC patients. Specifically, it suggests implementing triage-driven patient placement, expanding fast-track areas, improving access to diagnostics, and enhancing patient transfers to reduce backlogs in emergency rooms.
The document provides clinical audit tools and data items for monitoring acute kidney injury (AKI). It describes six clinical pathways where AKI care can be audited: acute hospital admission, elective vascular surgery, laboratory, adverse event review, primary care, and renal replacement therapy (RRT). For acute hospital admission, the pathway shows the process from presentation through risk assessment, enacting prevention/care plans, monitoring for AKI resolution or need for RRT, and outcomes of discharge, death, or ongoing RRT dependence. Standards, indicators and specific data items are defined for collecting information across the different pathways to allow comparison of AKI care and outcomes.
This document discusses value stream management in healthcare. It provides an overview of value stream mapping, including creating current state maps to identify waste and future state maps to design improved processes. Key aspects covered include selecting value streams, mapping process and information flows, setting metrics, and developing implementation plans. Maintaining value stream management through a manager, visual controls, and continuous improvement is emphasized.
Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences
Background Hospital contributes significantly tangible and intangible resources on a concurred plan by the scheduling of surgery on the OT list. Postponement decreases efficiency by declining throughput leads to wastage of resources hence burden to the nation. Patients and their family face economic and emotional implication due to the postponement. Postponement rate being a quality indicator controls check mechanism could be developed from the results. Postponement of elective scheduled operations results in inefficient use of the operating room (OR) time on the day of surgery. Inconvenience to patients and families are also caused by postponements. Moreover, the day of surgery (DOS) postponement creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations to an extent of repetition of investigations in some cases causing escalated costs, wastage of time and reduced income. Methodology A cross-sectional study was done in the operation theaters of a tertiary care hospital in which total ten operation theaters of General Surgery Data of scheduled, performed and postponed surgeries was collected from all the operation theater with effect from March 1st to September 30th, 2018. A questionnaire was developed to find out the reasons for the postponement for all hospital’s stakeholders (surgeons, Anesthetist, Nursing Officer) and they were further evaluated time series analysis of scheduling of Operation Theater for moving average technique. Results Total 958 surgeries were scheduled and 772 surgeries performed were and 186 surgeries were postponed with a postponement rate of 19.42% in the cardiac surgery department during the study period. Month-wise postponement Rate exponential smoothing of time series data shows the dynamic of operating suits. To test throughput Postponement rate was plotted the postponed surgeries and on regression analysis is in a perfect linear relationship.
This document discusses a quality improvement project aimed at reducing emergency room wait times. A team of 3 nurses will lead the project. They plan to research current best practices for minimizing wait times and improving the patient experience in the ER. Options may include adjustments to staffing, facility layout, or patient flow. The team will evaluate several proposals before testing a new approach. Their goals are to enhance patient satisfaction, safety, and hospital reimbursement by addressing long wait times in the ER.
This document analyzes wait times in hospital emergency departments. It finds that the average wait time has increased from 46.5 minutes in 2003 to 98.7 minutes in 2013 based on data from 54 hospitals. The goal of the project is to reduce wait times by 50% annually to reach a six sigma quality level. Various factors that influence wait times are examined, including patient urgency, hospital location, and ambulance use. Solutions proposed include implementing a breakthrough team system based on lean manufacturing to streamline workflows and potentially increasing doctor staffing levels. The new process aims to reduce the wait time to 30 minutes or less.
The document discusses proposed actions to improve emergency room wait times in Nova Scotia hospitals. It identifies several key issues contributing to long wait times, including a shortage of hospital beds, increased use of emergency rooms by aging patients and alternate level of care (ALC) patients, and government funding cuts. It then proposes several multi-pronged strategies to address wait times by improving patient flow, reducing overcrowding and overuse of emergency rooms, and decreasing the number of ALC patients. Specifically, it suggests implementing triage-driven patient placement, expanding fast-track areas, improving access to diagnostics, and enhancing patient transfers to reduce backlogs in emergency rooms.
The document provides clinical audit tools and data items for monitoring acute kidney injury (AKI). It describes six clinical pathways where AKI care can be audited: acute hospital admission, elective vascular surgery, laboratory, adverse event review, primary care, and renal replacement therapy (RRT). For acute hospital admission, the pathway shows the process from presentation through risk assessment, enacting prevention/care plans, monitoring for AKI resolution or need for RRT, and outcomes of discharge, death, or ongoing RRT dependence. Standards, indicators and specific data items are defined for collecting information across the different pathways to allow comparison of AKI care and outcomes.
This document discusses value stream management in healthcare. It provides an overview of value stream mapping, including creating current state maps to identify waste and future state maps to design improved processes. Key aspects covered include selecting value streams, mapping process and information flows, setting metrics, and developing implementation plans. Maintaining value stream management through a manager, visual controls, and continuous improvement is emphasized.
Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences
Background Hospital contributes significantly tangible and intangible resources on a concurred plan by the scheduling of surgery on the OT list. Postponement decreases efficiency by declining throughput leads to wastage of resources hence burden to the nation. Patients and their family face economic and emotional implication due to the postponement. Postponement rate being a quality indicator controls check mechanism could be developed from the results. Postponement of elective scheduled operations results in inefficient use of the operating room (OR) time on the day of surgery. Inconvenience to patients and families are also caused by postponements. Moreover, the day of surgery (DOS) postponement creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations to an extent of repetition of investigations in some cases causing escalated costs, wastage of time and reduced income. Methodology A cross-sectional study was done in the operation theaters of a tertiary care hospital in which total ten operation theaters of General Surgery Data of scheduled, performed and postponed surgeries was collected from all the operation theater with effect from March 1st to September 30th, 2018. A questionnaire was developed to find out the reasons for the postponement for all hospital’s stakeholders (surgeons, Anesthetist, Nursing Officer) and they were further evaluated time series analysis of scheduling of Operation Theater for moving average technique. Results Total 958 surgeries were scheduled and 772 surgeries performed were and 186 surgeries were postponed with a postponement rate of 19.42% in the cardiac surgery department during the study period. Month-wise postponement Rate exponential smoothing of time series data shows the dynamic of operating suits. To test throughput Postponement rate was plotted the postponed surgeries and on regression analysis is in a perfect linear relationship.
RQHR developed a strategic approach to improve patient flow based on best practices. Short term initiatives included implementing Allscripts patient flow software, establishing governance structures for patient flow, developing standard work and care planning processes, and leveling demand through surgical targeting. The results were reduced admit no bed numbers, decreased system occupancy and wave times, and closed hallway beds. RQHR's framework was adopted provincially to improve ED waits and flow.
This clinical audit tool provides standards and guidance for auditing the use of ultrasound to determine viable intrauterine pregnancy in cases of ectopic pregnancy and miscarriage. The tool includes clinical audit standards, a data collection form, and an action plan template. It accompanies NICE clinical guideline 154 on the diagnosis and management of ectopic pregnancy and miscarriage. The audit is intended to help services improve their practice in line with recommendations in the guideline.
The document describes a quality improvement project to develop and implement a handover checklist to standardize communication between the Trauma Team Leader and neuro-trauma ICU team when transferring trauma patients. Feedback indicated the checklist reduced information omissions. Metrics showed increased checklist use and no suggested changes after implementation, demonstrating improved handovers and patient safety.
This document provides a toolkit for public hospitals to improve patient access to acute care services. It outlines a process for hospitals to plan improvements, which includes identifying problems, reviewing performance data, engaging clinicians, understanding current systems, determining goals, implementing changes, analyzing results, and communicating changes. The toolkit compiles strategies from various sources that have been shown to improve patient flow, though the evidence level varies. It is intended to help hospitals redesign processes to provide safe, efficient, and timely patient-centered care.
O PTIMISATION B ASED ON S IMULATION : A P ATIENT A DMISSION S CHEDULING ...IJCI JOURNAL
This document summarizes a study that developed an optimization model to schedule patient admissions in a radiology department with the goal of reducing patient wait times. A mathematical model was created to minimize total completion time and total patient waiting time as a multi-objective problem. A multi-stage queuing system was used to represent the patient flow through registration, examination, and checkout. A case study was conducted of a hospital radiology department to collect data and test the optimization model using a multi-objective evolutionary algorithm. The results showed an average 7% reduction in total completion time and 34% reduction in total patient waiting time.
This document outlines a quality improvement project to improve efficiency and patient satisfaction at the emergency room of North Side Hospital. The project aims to decrease length of stay to under 100 minutes, increase patient satisfaction scores to over 75th percentile, and reduce left without being seen rates to under 1%. The document identifies key stakeholders, analyzes current processes and data, and lists interventions to be implemented between July and November 2004 such as new equipment, improved relationships, and enhanced ancillary services. It shows the project achieved significant reductions in length of stay, admissions, and left without being seen rates after initiation.
How to improve patient flow in emergency and ambulatory care, pop up uni, 10a...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
The document is a project report on assessing patient satisfaction at HCG EKO Cancer Center in Kolkata. It includes an introduction, objectives to understand hospital operations and analyze patient satisfaction surveys. It finds that while 760 responses were satisfied, 240 were dissatisfied, identifying issues like lack of housekeeping staff and long wait times. The report provides recommendations to address problems and aims to give insights into improving patient experience.
The document provides an overview of the Joint Commission International (JCI) accreditation process for hospitals. It describes what accreditation is, its benefits, and timeline. The standards are organized around important hospital functions and patient care. During an on-site survey, surveyors use various methods like document review, interviews, patient tracers, and facility tours to evaluate hospitals' compliance with JCI standards. Scoring guidelines are provided to assess standards as fully met, partially met, not met, or not applicable.
The document outlines the steps taken to implement a comprehensive transition of care program for patients with acute venous thromboembolic events (VTE) who present to the emergency department. The program allows for appropriately selected patients to be safely discharged directly from the ED to outpatient care with oral anticoagulation therapy. Key elements of the program include developing standardized order sets, patient education materials, and discharge processes, as well as establishing patient tracking and follow up. An evaluation of outcomes after one year found no patients experienced VTE-related readmissions or complications, and patient satisfaction with the program was high.
This document discusses creating a rapid admit unit to prevent emergency department overcrowding. It defines overcrowding and describes common strategies to address it, such as fast tracks and hallway beds. A rapid admit unit involves creating a separate unit outside the ED to admit patients more quickly. Benefits include reduced boarding times and improved patient safety. The document outlines how to plan and implement a rapid admit unit, including criteria, staffing, supplies, and quality metrics to measure its success in reducing overcrowding.
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
A project was initiated at Lakeland Regional Health to improve patient readiness for surgical cases by ensuring required documents and physician orders were received by noon the day before surgery. The initial patient readiness rate was only 41% but through process changes, the goal of 80% readiness has been consistently met since October 2014. A multidisciplinary team standardized processes, developed technology tools like an electronic tracking board, and held physicians accountable through performance scorecards. As a result, patient safety has increased by reducing delays from missing paperwork.
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
This study investigated the influence of hospital safety climate on patient satisfaction and nursing care quality. Data was collected from nurses and patients at an Egyptian emergency hospital using questionnaires on safety climate, patient satisfaction, and quality of nursing care. The results found that 50% of respondents reported a low safety climate score and only 29.5% of patients were highly satisfied. Nurses reported that the quality of care was low for 69% of patients. A significant relationship was found between safety climate and both patient satisfaction and nursing care quality. The study concluded that improving the hospital safety climate can positively influence patient outcomes like satisfaction and quality of care.
This document discusses the importance of quality control for echocardiography interpretation and summarizes several studies on improving inter-observer reliability and accuracy. The first study found low agreement between experts in assessing diastolic function from the same patient data due to a lack of hierarchy for integrating parameters. A later study developed a consensus strategy to improve grading of aortic regurgitation severity from 70% to over 90% agreement. Another study reduced inter-observer variability in left ventricular ejection fraction measurements from echocardiograms by having readers review their measurements alongside cardiac MRI images. A final study showed quantitative measurements of right ventricular function improved accuracy and agreement compared to qualitative assessments alone. The studies demonstrate the value of quality improvement efforts like developing consensus guidelines
This document outlines a proposal to implement a rapid response team (RRT) at an urban Magnet hospital to improve patient outcomes on medical and surgical units. The purpose is to determine if an RRT can reduce hospital stays, decrease transfers to higher levels of care, and increase patient functionality at discharge. The proposal describes the background on RRTs, significance to nursing practice, literature review on clinical outcomes, relevant nursing theories, and the Iowa Model framework. It provides details on the methodology, team development and training, communication systems, education, documentation, and implementation process including activation protocols and safety huddles. The goal is to activate the RRT for at-risk patients showing signs of respiratory distress, changes in mental status, abnormal
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
This document discusses creating a rapid admit unit to prevent emergency department overcrowding. It defines overcrowding and describes common strategies to address it, such as fast tracks and pulling patients to fill inpatient beds. A rapid admit unit can help by moving admitted patients out of the ED quickly. The document outlines how to plan and implement a rapid admit unit, including criteria for patient inclusion, staffing, equipment needs, and metrics to measure its success in reducing boarding times and left without being seen rates.
Kimberly DeMoss is an experienced operations manager and supervisor with over 15 years of experience in logistics, customer service, warehouse management, and project management. She has held roles in operations management, order fulfillment supervision, inventory control, and quality assurance. DeMoss has a background in process development, training, and people management. She has an Associate's Degree in Business Administration and is pursuing a Bachelor's.
RQHR developed a strategic approach to improve patient flow based on best practices. Short term initiatives included implementing Allscripts patient flow software, establishing governance structures for patient flow, developing standard work and care planning processes, and leveling demand through surgical targeting. The results were reduced admit no bed numbers, decreased system occupancy and wave times, and closed hallway beds. RQHR's framework was adopted provincially to improve ED waits and flow.
This clinical audit tool provides standards and guidance for auditing the use of ultrasound to determine viable intrauterine pregnancy in cases of ectopic pregnancy and miscarriage. The tool includes clinical audit standards, a data collection form, and an action plan template. It accompanies NICE clinical guideline 154 on the diagnosis and management of ectopic pregnancy and miscarriage. The audit is intended to help services improve their practice in line with recommendations in the guideline.
The document describes a quality improvement project to develop and implement a handover checklist to standardize communication between the Trauma Team Leader and neuro-trauma ICU team when transferring trauma patients. Feedback indicated the checklist reduced information omissions. Metrics showed increased checklist use and no suggested changes after implementation, demonstrating improved handovers and patient safety.
This document provides a toolkit for public hospitals to improve patient access to acute care services. It outlines a process for hospitals to plan improvements, which includes identifying problems, reviewing performance data, engaging clinicians, understanding current systems, determining goals, implementing changes, analyzing results, and communicating changes. The toolkit compiles strategies from various sources that have been shown to improve patient flow, though the evidence level varies. It is intended to help hospitals redesign processes to provide safe, efficient, and timely patient-centered care.
O PTIMISATION B ASED ON S IMULATION : A P ATIENT A DMISSION S CHEDULING ...IJCI JOURNAL
This document summarizes a study that developed an optimization model to schedule patient admissions in a radiology department with the goal of reducing patient wait times. A mathematical model was created to minimize total completion time and total patient waiting time as a multi-objective problem. A multi-stage queuing system was used to represent the patient flow through registration, examination, and checkout. A case study was conducted of a hospital radiology department to collect data and test the optimization model using a multi-objective evolutionary algorithm. The results showed an average 7% reduction in total completion time and 34% reduction in total patient waiting time.
This document outlines a quality improvement project to improve efficiency and patient satisfaction at the emergency room of North Side Hospital. The project aims to decrease length of stay to under 100 minutes, increase patient satisfaction scores to over 75th percentile, and reduce left without being seen rates to under 1%. The document identifies key stakeholders, analyzes current processes and data, and lists interventions to be implemented between July and November 2004 such as new equipment, improved relationships, and enhanced ancillary services. It shows the project achieved significant reductions in length of stay, admissions, and left without being seen rates after initiation.
How to improve patient flow in emergency and ambulatory care, pop up uni, 10a...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
The document is a project report on assessing patient satisfaction at HCG EKO Cancer Center in Kolkata. It includes an introduction, objectives to understand hospital operations and analyze patient satisfaction surveys. It finds that while 760 responses were satisfied, 240 were dissatisfied, identifying issues like lack of housekeeping staff and long wait times. The report provides recommendations to address problems and aims to give insights into improving patient experience.
The document provides an overview of the Joint Commission International (JCI) accreditation process for hospitals. It describes what accreditation is, its benefits, and timeline. The standards are organized around important hospital functions and patient care. During an on-site survey, surveyors use various methods like document review, interviews, patient tracers, and facility tours to evaluate hospitals' compliance with JCI standards. Scoring guidelines are provided to assess standards as fully met, partially met, not met, or not applicable.
The document outlines the steps taken to implement a comprehensive transition of care program for patients with acute venous thromboembolic events (VTE) who present to the emergency department. The program allows for appropriately selected patients to be safely discharged directly from the ED to outpatient care with oral anticoagulation therapy. Key elements of the program include developing standardized order sets, patient education materials, and discharge processes, as well as establishing patient tracking and follow up. An evaluation of outcomes after one year found no patients experienced VTE-related readmissions or complications, and patient satisfaction with the program was high.
This document discusses creating a rapid admit unit to prevent emergency department overcrowding. It defines overcrowding and describes common strategies to address it, such as fast tracks and hallway beds. A rapid admit unit involves creating a separate unit outside the ED to admit patients more quickly. Benefits include reduced boarding times and improved patient safety. The document outlines how to plan and implement a rapid admit unit, including criteria, staffing, supplies, and quality metrics to measure its success in reducing overcrowding.
This study aimed to determine the incidence and types of medical errors in ICU patients. The results found that 20% of patients experienced an adverse event, with 45% deemed preventable. A total of 223 serious medical errors occurred, with medications contributing to 78% of errors. The majority of errors were due to slips or lapses in care. The study suggests system-based changes like computerized order entry and barcoding could help reduce medical errors.
A project was initiated at Lakeland Regional Health to improve patient readiness for surgical cases by ensuring required documents and physician orders were received by noon the day before surgery. The initial patient readiness rate was only 41% but through process changes, the goal of 80% readiness has been consistently met since October 2014. A multidisciplinary team standardized processes, developed technology tools like an electronic tracking board, and held physicians accountable through performance scorecards. As a result, patient safety has increased by reducing delays from missing paperwork.
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
This study investigated the influence of hospital safety climate on patient satisfaction and nursing care quality. Data was collected from nurses and patients at an Egyptian emergency hospital using questionnaires on safety climate, patient satisfaction, and quality of nursing care. The results found that 50% of respondents reported a low safety climate score and only 29.5% of patients were highly satisfied. Nurses reported that the quality of care was low for 69% of patients. A significant relationship was found between safety climate and both patient satisfaction and nursing care quality. The study concluded that improving the hospital safety climate can positively influence patient outcomes like satisfaction and quality of care.
This document discusses the importance of quality control for echocardiography interpretation and summarizes several studies on improving inter-observer reliability and accuracy. The first study found low agreement between experts in assessing diastolic function from the same patient data due to a lack of hierarchy for integrating parameters. A later study developed a consensus strategy to improve grading of aortic regurgitation severity from 70% to over 90% agreement. Another study reduced inter-observer variability in left ventricular ejection fraction measurements from echocardiograms by having readers review their measurements alongside cardiac MRI images. A final study showed quantitative measurements of right ventricular function improved accuracy and agreement compared to qualitative assessments alone. The studies demonstrate the value of quality improvement efforts like developing consensus guidelines
This document outlines a proposal to implement a rapid response team (RRT) at an urban Magnet hospital to improve patient outcomes on medical and surgical units. The purpose is to determine if an RRT can reduce hospital stays, decrease transfers to higher levels of care, and increase patient functionality at discharge. The proposal describes the background on RRTs, significance to nursing practice, literature review on clinical outcomes, relevant nursing theories, and the Iowa Model framework. It provides details on the methodology, team development and training, communication systems, education, documentation, and implementation process including activation protocols and safety huddles. The goal is to activate the RRT for at-risk patients showing signs of respiratory distress, changes in mental status, abnormal
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
This document discusses creating a rapid admit unit to prevent emergency department overcrowding. It defines overcrowding and describes common strategies to address it, such as fast tracks and pulling patients to fill inpatient beds. A rapid admit unit can help by moving admitted patients out of the ED quickly. The document outlines how to plan and implement a rapid admit unit, including criteria for patient inclusion, staffing, equipment needs, and metrics to measure its success in reducing boarding times and left without being seen rates.
Kimberly DeMoss is an experienced operations manager and supervisor with over 15 years of experience in logistics, customer service, warehouse management, and project management. She has held roles in operations management, order fulfillment supervision, inventory control, and quality assurance. DeMoss has a background in process development, training, and people management. She has an Associate's Degree in Business Administration and is pursuing a Bachelor's.
1. Cerita ini menceritakan tentang persahabatan antara Lina dan Rika yang mulai retak akibat perebutan pop corn dan berakhir dengan pertengkaran.
2. Mama Rika mencoba mendamaikan pertengkaran tersebut dengan menasehati bahwa marah akan membuat persahabatan hancur.
3. Cerita ini menggambarkan betapa rapuhnya persahabatan yang dapat hancur karena hal sepele.
This document provides a summary of the geography, climate, ethnic groups, history, language, economy and people of the province of Sulu in the Philippines. It notes that Sulu covers an area of 1,600 square kilometers including its main island of Jolo. The climate does not experience typhoons. The economy relies on agriculture including abaca, coconuts and fruits, as well as fishing, seafood like sea turtles and fish, and treasures from the sea like trepang and pearls. The dominant ethnic group are the Tausugs Muslims who were early adopters of Islam in the Philippines and have a close relationship with the sea. Key sites mentioned include the Sulu Sea, the call to prayer,
Kiran Patil is an experienced AS400 programmer seeking a new position. He has over 2 years of experience in analysis, design, development, debugging and testing of RPG/400, CL/400, DB2/400, RPGIV, OS/400, and RPGILE programs. He is proficient in tools like SEU, SDA, PDM, and RLU. Some of his projects include automating account activation for Standard Chartered Bank which involved CL/400, DB2/400, and ILERPG programming. He also worked on a Bancnet DE48 validation project for Standard Chartered Bank Philippines involving RPG ILE, CLP, and RPG programming. Kiran holds a B.
This presentation on Scope of Textile Composite in Aerospace, Automotive, and Energy. It includes the area of application, shortcoming challenge, benefits of using textile composite in following section and how can we develop the following sector by improving textile composite.
This is a study case in all the photosthe SIPOC diagram bel.pdfjkcs20004
This is a study case in all the photos
the SIPOC diagram bellow is incomplete and wrong I need to fix it
Perfect Match TEAM APPLIES n January 2008, the University of Toledo Medical Center
(UTMC) in northwest Ohio collaborated with the University of Toledo's Industrial SIX SIGMA
TO Engineering Department to analyze and improve the preoperational processes for patients
undergoing kidney transplants. Six Sigma was applied to the REDUCE TIME project, and the
following goals were established: IT TAKES TO - Optimize cycle times. QUALIFY PATIENTS
- Enhance customer satisfaction. - Improve efficiencies. FOR KIDNEY - Reduce costs.
TRANSPLANTS - Streamline administrative processes. - Eliminate errors. - Improve protocol
execution and effectiveness. The project's primary metric was the number of days required from
the date a patient was referred to UTMC for a kidney transplant to the date the hospital staff
declared the patient a suitable transplant candidate. The research By Matthew was needed and
the project selected because of an increase in the number of Franchetti and year because of the
increased service area for UTMC. Because of a waiting list of nearly 500 patients, it was
determined a reduced cycle time would save lives. Kyle Bedal, Background and terminology
University of For more than 30 years, UTMC has performed adult and pediatric kidney Toledo
transplants as one of the treatment options for end-stage renal disease. Since UTMC's first
kidney transplant operation in 1972, more than 1,500 kidney transplant operations have been
performed there, with an average patient survival rate of 98% and a graft survival rate of 94%.
The program relies on advanced surgical techniques-including laparoscopic kidney donation,
improved anti-rejection medications and high-quality patient care-to make it one of the most
successful programs in the country. There are a number of steps patients must complete before
receiving a kidney transplant. Generally, the patient must be referred to a medical center and
complete required labs and tests to determine if he or she is suitable. The labs and tests are
usually similar among all transplant centers and among patients. The labs include tuberculosis
(TB) tests, dental clearance, a colonoscopy, chest X-rays, electrocardiography tests, stool
samples, blood work, mammograms, pap smears and diabetes tests. Once the patient fulfills the
requirements, a committee reviews the results and determines whether the patient is a good
candidate. The patient is then allowed to receive a kidney; this is called being "listed," or placed
on the waiting list.
Fil TB EK Often, the time required to complete these health Partnering With Your Transplant
Team, The Patient's Guide screenings is up to nine months. In addition, another to
Transplantation. 2 two years may pass after the patient is listed before a The team deployed the
define, measure, analyze, kidney transplant is performed. improve and control (DMAIC)
approach for this Six It is.
This document describes a proposed model to predict hospital admissions from the emergency department to help reduce overcrowding. It discusses how overcrowding in emergency departments can negatively impact patient care. The proposed model would use machine learning techniques to predict admissions based on patient data from the triage process. This could help allocate hospital resources more efficiently and reduce waiting times in the emergency department. The document reviews several previous studies that developed predictive models using methods like logistic regression, decision trees, and neural networks to forecast admissions based on factors like patient demographics, medical history and symptoms.
A LEAN SIX SIGMA APPROACH TO REDUCE WAITING AND REPORTING TIME IN THE RADIOLO...Joe Andelija
This document summarizes a research paper that used Lean Six Sigma to reduce waiting and reporting times in the radiology department of a tertiary care hospital in Kolkata, India. The researchers mapped the process from patient entry to report generation and identified areas of delay. Root causes of delay were found to be lack of patient preparation and disorganized operations. Recommendations included improving patient orientation to decrease pre-test wait times and streamlining operations to reduce post-test reporting delays. Implementing these changes statistically significantly reduced both pre-test and post-test waiting times.
The document describes a neonatal quality improvement tool used in Switzerland called the Swiss Neonatal Quality Cycle. It collects data on very low birth weight infants to monitor clinical performance and identify areas for quality improvement. The tool fulfills several international recommendations for quality assessment. It uses algorithms to ensure high data quality and generates charts to compare units' performance over time. Analysis of data from 2009-2011 found the mortality rate was similar to other networks, but morbidity rates were better. The tool helps units identify specific areas of potential quality improvement. It establishes a continuous quality improvement cycle of establishing guidelines, monitoring performance, identifying areas for change, and measuring the effects of changes made.
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MAST and its application in RENEWING HEALTHAnna Kotzeva
This document discusses the Model for Assessment of Telemedicine (MAST) and its application in the RENEWING HEALTH project. MAST provides a comprehensive framework for the multidisciplinary assessment of telemedicine, including preceding considerations, assessment across multiple domains, and evaluating transferability. The RENEWING HEALTH project applies MAST to evaluate telemedicine interventions for diabetes, COPD and CVD across multiple outcomes like clinical effectiveness, user perspectives, economic impacts and organizational effects. Common tools were developed to ensure quality and comparability, including a minimum dataset, common templates, and guidance for analysis and reporting. By validating MAST across diverse settings, the project aims to establish an accepted methodology for complex telemedicine evaluations.
Lisa Hancock OIG Board Quality PresentationLisa Hancock
IU Medical Group's quality improvement goals are to decrease mortality and morbidity, increase patient satisfaction, improve patient safety, and link these goals to management accountability. Metrics such as UHC reports and patient satisfaction surveys are used to measure progress. Clinical department chairs must annually report progress on these goals to the board. The organization utilizes numerous quality reports and surveys to measure and improve patient care. Each clinical department is responsible for quality and safety programs within their department.
Optimising the Model of Care for Patient Management at The Tweed Cancer Care ...Cancer Institute NSW
The document describes the implementation of a morning handover process utilizing the MOSAIQ electronic medical record (EMR) system at the Tweed Cancer Care and Haematology Unit. An evaluation found the EMR handover process improved staff satisfaction, coordination of patient care, and reduced incidents. It was concluded the handover process meets national standards and could benefit other ambulatory care units utilizing EMRs.
Keynote Presentation "Meaningful Use Stage 2 and Meaningful Use Audit Insight"
Think far beyond just threshold increases. The differences between Meaningful Use (MU) Stage 1 and Stage 2, including the 2014 Clinical Quality Measures, are technically and clinically challenging. And just when you thought you could safely look at Stage 1 in the rearview mirror, here come the audits! I will highlight the Stage 1 and Stage 2 differences and talk about the challenges they have initiated at Tenet. I will touch on the impact of Quality measures and will also provide you with insight into the basics of MU Audits and will take you through the actual audit experience at Tenet.
Learning Objectives:
∙ Review the program and measure changes from Stage 1 to Stage 2 and how the changes are being managed at Tenet
∙ Provide insight into the 2014 Clinical Quality Measures chosen by Tenet, the challenges posed, solutions that work and a little about the overall
impact of Quality measures
∙ Discuss Meaningful Use Audits, covering the basics as well as providing the benefit of the Tenet experience
Our current approach to root causeanalysis is it contributi.docxgerardkortney
Our current approach to root cause
analysis: is it contributing to our
failure to improve patient safety?
Kathryn M Kellogg,1 Zach Hettinger,1 Manish Shah,2 Robert L Wears,3
Craig R Sellers,4 Melissa Squires,5 Rollin J Fairbanks1
ABSTRACT
Background Despite over a decade of efforts to
reduce the adverse event rate in healthcare, the
rate has remained relatively unchanged. Root
cause analysis (RCA) is a process used by
hospitals in an attempt to reduce adverse event
rates; however, the outputs of this process have
not been well studied in healthcare. This study
aimed to examine the types of solutions
proposed in RCAs over an 8-year period at a
major academic medical institution.
Methods All state-reportable adverse events
were gathered, and those for which an RCA was
performed were analysed. A consensus rating
process was used to determine a severity rating
for each case. A qualitative approach was used
to categorise the types of solutions proposed by
the RCA team in each case and descriptive
statistics were calculated.
Results 302 RCAs were reviewed. The most
common event types involved a procedure
complication, followed by cardiopulmonary
arrest, neurological deficit and retained foreign
body. In 106 RCAs, solutions were proposed.
A large proportion (38.7%) of RCAs with
solutions proposed involved a patient death. Of
the 731 proposed solutions, the most common
solution types were training (20%), process
change (19.6%) and policy reinforcement
(15.2%). We found that multiple event types
were repeated in the study period, despite
repeated RCAs.
Conclusions This study found that the most
commonly proposed solutions were weaker
actions, which were less likely to decrease event
recurrence. These findings support recent
attempts to improve the RCA process and to
develop guidance for the creation of effective
and sustainable solutions to be used by RCA
teams.
INTRODUCTION
The problem of morbidity and mortality
from adverse events in healthcare has
undergone over 15 years of intense scru-
tiny, funding, regulation and research
worldwide. Despite dramatically intensi-
fied efforts to increase the safety of the
healthcare system, reports have suggested
that safety has not improved. The adverse
event rate has remained essentially the
same, suggesting that our current solu-
tions to the problem are not working.1–10
This lack of progress persists despite the
devotion of a tremendous amount of
financial and human resources at the
local, state and national levels in an effort
to reduce errors and patient harm.11
One common, resource-intensive, prac-
tice is the root cause analysis (RCA)
process, which is used by most hospitals
in the USA.12–15 The RCA process has
been mandated in response to sentinel
events by the Joint Commission since
1997.16 Although the RCA process has
been presumed to induce change, its
effectiveness has been questioned and
there is not robust literature to support
its efficacy.17 18 In healthcare, there are
reports of difficul.
The document summarizes a study that surveyed physical rehabilitation (PR) programs for patients after hip fracture surgery in Denmark. The main findings were:
1) PR was typically initiated 1-2 weeks after hospital discharge and lasted 8-12 weeks, with sessions 1-2 times per week.
2) Over half of municipalities lacked formal PR descriptions and 86% provided no details on exercise intensity/progression.
3) Common rehabilitation modalities included functional exercises, strength/balance training, and range of motion. However, programs varied between therapists with few standardized measures.
4) The study concluded that PR for hip fractures in Denmark currently lacks national guidelines and standardization, calling for an evidence-based optimized
This study sought to improve undertriage and overtriage rates at a Level II Pediatric Trauma Center by updating outdated trauma team activation (TTA) criteria and improving adherence to the criteria. The study was conducted in two phases: Phase I focused on improving adherence to newly revised TTA criteria, while Phase II moved triage responsibility to nurses and included transfer patients. Undertriage decreased from 15% to under 5% by the end of the study, while overtriage rates stabilized within recommended ranges. Standardizing processes through evidence-based criteria updates and role changes led to more accurate trauma patient triage and resource utilization.
Home Telehealth for COPD Patients in Spain - ATA conference Austin ePoster (A...Ofer Atzmon
1) A study in Spain evaluated the efficacy of a home telehealth monitoring service for severe COPD patients by comparing healthcare utilization between a telehealth group and conventional care group.
2) The telehealth group had significantly fewer emergency room visits, hospital admissions, and shorter hospital stays compared to the conventional care group.
3) Patients adapted well to the home telehealth monitoring, were satisfied with the service, and it was effective in following severe COPD patients and optimizing their care.
This document discusses patient generated data (PGD) and how mobile health (mHealth) technologies can be used to capture it. PGD includes data recorded by patients about their health symptoms, medication adherence, biometric data from wearables, and patient reported outcomes. The document outlines how PGD can help with clinical trials and care by providing more comprehensive real-world data. Challenges with PGD like data quality, privacy and regulatory issues are discussed. The document provides examples of how the Aparito platform captures different types of PGD through mobile apps and connected devices to improve disease understanding and drug development.
The document discusses a study assessing patient satisfaction with outpatient services at a tertiary care teaching hospital in Lucknow, India. It outlines the study objectives to evaluate availability and utilization of services, information sources, waiting times, and reasons for (dis)satisfaction among internal and external patients. The methodology section describes a prospective descriptive study using interviews and record reviews involving 701 patients across departments from January to March 2013. Preliminary findings show most patients were female, from Uttar Pradesh, and utilization increasing over 2008-2012 for both internal and external patients.
In this case study, we delve into the crucial role of Business Process Management (BPM) in optimizing the efficiency and responsiveness of a Hospital's Emergency Department. We uncover how process modeling and automation, coupled with performance metrics, enhance patient care and throughput. We also discuss our unique KPI formula, designed to quantitatively evaluate improvements and steer towards evidence-based decision making. Join us as we explore the transformational power of BPM in the healthcare sector.
Quality of Life Post Elective Total Joint Replacement: A Cross-sectional Stud...BRNSSPublicationHubI
This cross-sectional study assessed the quality of life and patient satisfaction following total knee replacement (TKR) and total hip replacement (THR) surgeries among 241 patients in Saudi Arabia. The mean age of participants was 64.5 years and most were female. Regarding satisfaction, 55% were very satisfied and 35% were highly satisfied with their surgeries, while only 2.4% were not satisfied. Patients reported mean physical and mental health scores on the SF-12 questionnaire that matched those of healthy Americans aged 75 and older, indicating the surgeries successfully improved quality of life. In conclusion, joint replacement surgeries in Saudi Arabia are effective solutions that relieve pain and enhance function and quality of life for
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Confidence intervals should read (-1 -40 minutes )
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Emergency Medical Services
Electrocardiogram
Statistics
Institutional Review Board
Confidence intervals should read (-1-40 minutes)
JACC.2009;54(23)2205-2241
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