RESUMO
Current research suggests that hourly rounds on hospitalized patients may be associated with improvements in care delivery and in the patients' perception of care, as well as a reduction in patient safety events. Implementing an hourly rounding protocol involves a major change in nursing staff workflow and a substantial training and education program to ensure the success of the program. This quasi-experimental study aimed to determine if a standardized hourly rounding process (SHaRP), implemented through a formal education program, would result in improved efficiency, quality, safety, and patient satisfaction metrics when compared to a less standardized process introduced through the traditional train-the-trainer method. Data were collected over a 6-month period and results were trended for an additional 6 months later to determine if significant gains were sustained over time. Significant reductions in call light use during the study period (p = .001) and the number of steps taken by the day-shift staff (p = .02) were seen on the intervention unit. Differences in the number of patient falls, 30-day readmission rates, and patients' perception of care were not statistically significant.
Assuntos
Cuidados de Enfermagem/organização & administração , Administração dos Cuidados ao Paciente , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Acidentes por Quedas/prevenção & controle , Atenção à Saúde , Hospitais Religiosos , Humanos , Readmissão do Paciente , Qualidade da Assistência à Saúde/organização & administração , EnsinoRESUMO
Improving healthcare in the 21st century will depend on how well vast amounts of data are mined. However, converting data contained in multiple hospital and clinical databases into information that can be used for clinical decision support is a complex task. The process involves a combination of cultural and technological steps that are time-consuming and resource-intensive. The authors describe one hospital's long journey toward becoming a data-driven organization.
Assuntos
Mineração de Dados , Gestão da Informação , Garantia da Qualidade dos Cuidados de Saúde , Bases de Dados como Assunto , Registros Eletrônicos de Saúde , Hospitais , Estudos de Casos Organizacionais , Texas , Recursos HumanosAssuntos
Cuidados Críticos/organização & administração , Parada Cardíaca/prevenção & controle , Sistemas Multi-Institucionais/organização & administração , Equipe de Assistência ao Paciente , Desenvolvimento de Programas , Colorado , Tomada de Decisões Gerenciais , Parada Cardíaca/diagnóstico , Humanos , Unidades de Terapia Intensiva , Monitorização Fisiológica/normas , Sistemas Multi-Institucionais/normas , Estudos de Casos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Comitê de Profissionais , Fatores de TempoRESUMO
The primary objective of this study was to determine the prevalence of colorectal cancer (CRC) screening among eligible patients in a large medical practice. A secondary objective was to compare CRC screening rates obtained from medical records with physician self-reported CRC screening recommendation. We conducted a retrospective record review of 214 patients ages > or = 50 years of a large multispecialty medical organization in Houston, Texas, for receipt of fecal occult blood test (FOBT), flexible sigmoidoscopy (SIG), and/or colonoscopy (COL). We estimated prevalence using two definitions: (a) FOBT in past year or SIG in past 5 years or COL in past 10 years; and (b) FOBT in past year and SIG in past 5 years or COL in past 10 years. Age, gender, race/ethnicity, family history, number of chronic conditions, and index visit were independent variables. Contingency table and logistic regression analysis were used to test for associations between outcomes and independent variables. Our study population was 48% male with a mean age of 63 years (range: 53-84 years). One-quarter of the records showed FOBT by 3-day kit (51 of 214) and 27% by digital rectal exam (57 of 214). SIG was recorded in 32% of records. Half (54%) of the records had documentation of CRC screening according to definition no. 1 and 19% according to definition no. 2. Screening rates from medical record review were lower than those derived from physician self-report. Our findings underscore the need for interventions to improve CRC screening in primary care settings.
Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Sangue Oculto , Atenção Primária à Saúde/estatística & dados numéricos , Sigmoidoscopia/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores SexuaisRESUMO
The SETON Healthcare Network in Austin, TX, significantly reduced length of stay in six diagnostic-related groupings by successfully combining medical management activities and cost-savings targets. This article describes how organizational infrastructure, leadership, clinical redesign, and risk-adjusted data were combined to drive performance improvements and create enthusiasm for change.