ABSTRACT
BACKGROUND: Concurrent review is a quality improvement strategy in which patients are tracked from admission to discharge, and messages are communicated to the responsible physician when quality stroke measures have not been met. There is little research regarding interventions that might influence clinical practice patterns and improvement in compliance with core quality measures. This study sought to evaluate whether concurrent review implementation was associated with change in performance on stroke measure outcome data. METHODS: Randomly selected charts from 2 hospitals (A and B) during 3 time periods were reviewed. In period 1, neither hospital had a process for concurrent review. In period 2, hospital A, where concurrent review was implemented, was compared with hospital B without this process. In period 3, both hospitals had the process of concurrent review. Information on baseline demographics, insurance status, and length of stay was collected, as well as stroke performance measures. RESULTS: A total of 620 medical records were reviewed during the 3 time periods. Although the number of beds and annual stroke volume were higher at hospital B, patient characteristics were similar. During period 2, when hospital A implemented concurrent review and hospital B had not, a statistically significant higher compliance with performance in 7 stroke measures occurred in hospital A than in hospital B. In period 3, when both hospitals utilized concurrent review, no statistical significant differences occurred in 7 of the 10 stroke measures. CONCLUSION: Concurrent review is a quality improvement intervention that increases performance with stroke performance measures.
Subject(s)
Concurrent Review/organization & administration , Length of Stay/statistics & numerical data , Practice Patterns, Physicians'/organization & administration , Quality Improvement/organization & administration , Stroke/therapy , Aged , Concurrent Review/standards , Female , Hospital Administration , Humans , Male , Practice Patterns, Physicians'/standards , Quality Improvement/standards , Quality Indicators, Health Care , Random AllocationABSTRACT
Results from a research project examining nurses' knowledge of diabetes empowered direct-care nurses to develop a hypoglycemia protocol, increasing accountability for the care provided and helping move from tradition-based to evidence-based practice.
Subject(s)
Clinical Protocols , Diabetes Mellitus/nursing , Evidence-Based Nursing/organization & administration , Hypoglycemia/nursing , Nursing Care/organization & administration , Nursing Staff, Hospital/organization & administration , Attitude of Health Personnel , Decision Making, Organizational , Education, Nursing, Continuing , Health Knowledge, Attitudes, Practice , Helping Behavior , Humans , Nurse's Role , Organizational Case Studies , Organizational Innovation , Pilot Projects , Power, Psychological , Practice Guidelines as Topic , Professional Autonomy , Program Development , Rhode IslandABSTRACT
BACKGROUND AND PURPOSE: A potential way to improve prehospital stroke care and patient handoff is hospital-directed feedback for emergency medical service (EMS) providers. We evaluated whether a hospital-directed EMS stroke follow-up tool improved documentation of adherence to the Rhode Island state prehospital stroke protocol for EMS providers. METHODS: A standardized, 10-item feedback tool was developed in 2012 and sent to EMS directors for every transported patient with a discharge diagnosis of ischemic stroke. We reviewed patient charts meeting these criteria between January 2008 and December 2013. Performance on the tool was compared between the preintervention (January 2008 through January 2012) and postintervention (February 2012 through December 2013) periods. RESULTS: We identified 1176 patients with ischemic stroke who arrived by EMS in the study period: 668 in the preintervention period and 508 in the postintervention period. The overall score for the preintervention group was 5.31 and for the postintervention group 6.42 (P<0.001). Each of the 10 items, except checking blood glucose, showed statistically significant improvement in the postintervention period compared with the preintervention period. CONCLUSIONS: Hospital-directed feedback to EMS was associated with improved overall compliance with state protocols and documentation of 9 out of 10 individual items. Future confirmatory studies in different locales and studies on the impact of this intervention on actual tissue-type plasminogen activator administration rates and EMS personnel knowledge and behavior are needed.
