Decreasing Wait Times and Increasing Patient Satisfaction: A Lean Six Sigma Approach.

BACKGROUND: Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend. PURPOSE: The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design. RESULTS: There was a statistically significant decrease in wait times (P < .0019) and an increase in patient satisfaction scores in 3 areas: registration wait times (from 17 to 99 percentiles), test/treatment (from 19 to 60 percentiles), and likelihood to recommend (from 6 to 97 percentiles). CONCLUSIONS: Lean Six Sigma was an effective framework for use in decreasing wait times and improving patient satisfaction.

Symptom clusters, functional status, and quality of life in older adults with osteoarthritis.

BACKGROUND: One in two people may develop symptomatic knee osteoarthritis (OA) in their lifetime. Many OA sufferers have multiple symptoms, including pain, fatigue, and depressive symptoms. Determining whether symptom clusters exist among these older adults and what their effects are on outcomes such as quality of life (QOL) and functional status is essential to provide evidence-based geriatric healthcare. PURPOSE: The purposes of the secondary analyses were to explore symptoms that form clusters in older adults with OA of the knee and the effects of symptom clusters on their QOL and functional status. METHOD: A cross-sectional, methodological exploration of existing data from a convenience sample (N = 75) of adults aged 50 years and older with OA of the knee was used. Hierarchical and k-means cluster analyses were used to identify symptom clusters. MANOVA was performed to test for joint differences in QOL and functional status. RESULTS: Two large clusters of pain, fatigue, and depressive symptoms were identified from the cluster, and significant relationships were found between symptom clusters and both QOL (p = .008) and functional status (p < .001). Conclusions about QOL or functional status differences were similar for alternative clustering strategies or numbers of symptom clusters in sensitivity analyses. CONCLUSION: The findings of this study provide a foundation for targeted interventions to improve QOL and functional status of older adults with OA of the knee.

Differences in intraoperative prep solutions: a retrospective chart review.

Surgical site infections (SSIs) are the most common type of health care-associated infection in surgical patients. We wanted to identify which intraoperative prep solution used in our health network for adult open abdominal surgical procedures resulted in the lowest incidence of SSI 30 days after surgery. In addition, we wanted to know specifically how parachoroxylenol compared with chlorhexidine gluconate, povidone-iodine, and 0.7% iodine and 74% isopropyl alcohol as an intraoperative prep solution. We conducted a retrospective medical record review of 162 consecutive patients ages 18 years and older who had undergone elective open abdominal procedures from December 2008 to December 2010 at four acute care community hospitals within an integrated, tertiary health network in the southeastern United States. No SSIs occurred after procedures in which parachoroxylenol intraoperative prep solution was used (n = 71), whereas five SSIs occurred after procedures in which other prep solutions (ie, chlorhexidine gluconate [no SSIs], povidone-iodine [two SSIs], and 0.7% iodine and 74% isopropyl alcohol [three SSIs]) were used (n = 91). A chi-square test indicated a significant difference in the incidence of SSIs among patients prepped with parachoroxylenol intraoperative prep solution compared to patients prepped with the other solutions.

Intraoperative patient skin prep agents: is there a difference?

For health care institutions, intraoperative prep agents are a critical link in combating surgical site infections and the associated economic burden. The question remains, is there an intraoperative prep agent that is truly superior to the others? We conducted a literature review to examine available empirical evidence related to intraoperative prep agents used in our health system for open abdominal, general surgery procedures: povidone-iodine, chlorhexidine gluconate, parachoroxylenol, and iodine povacrylex in 74% isopropyl alcohol. Intraoperative surgical skin prep studies were limited in providing empirical evidence to support one superior prep agent. Each prep agent has a specific mechanism of action along with specific advantages and disadvantages. We concluded that no one perioperative skin prep agent is superior in all clinical situations. Factors to consider when choosing an appropriate intraoperative skin prep agent include contraindications, environmental risks, the patient's allergies and skin condition, the surgical site, the manufacturer recommendations for the prep agent, and surgeon preference.

Creating a successful certification examination review program: the nursing process approach.

The nursing professional development specialist has an increasing expectation to design and implement learning activities for professional nurses. These activities are critical in developing excellence in nursing practice. The purpose of this article is to demonstrate a step-by-step approach to the development of a continuing education program, using the nursing process as an organizing framework. This framework can be applied to the development of other continuing education programs as well.