Use of Unit-Based Interventions to Improve the Quality of Care for Hospitalized Medical Patients: A National Survey

O’Leary, Kevin J.; Johnson, Julie K.; Manojlovich, Milisa; Astik, Gopi J.; Williams, Mark

doi:10.1016/j.jcjq.2017.05.008

Cited by 13 publications

(21 citation statements)

References 19 publications

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“…This unit-based intervention approach to improve quality of care is not common. 28 When unit-based interventions (ie, interdisciplinary rounding, nurse–physician co-leadership, access to quality performance data) are used, they often are not adopted completely or consistently. The current approach—unit-based, interprofessional, continuous professional development—may have greater impact and more easily demonstrable benefit for both the individual and the unit.…”

Section: Discussionmentioning

confidence: 99%

An Interprofessional Quality Improvement Training Program That Improves Educational and Quality Outcomes

et al. 2019

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A key component of quality improvement (QI) is developing leaders who can implement QI projects collaboratively. A yearlong interprofessional, workplace-based, continuing professional development program devoted to QI trained 2 cohorts of teams (dyads or triads) to lead QI projects in their areas of work using Plan-Do-Study-Act methodology. Teams represented different specialties in both inpatient and outpatient settings. They spent 4 to 6 hours/week on seminars, online modules, bimonthly meetings with a QI coach, and QI project work. Evaluations conducted after each session included pre–post program QI self-efficacy and project milestones. Post-program participants reported higher levels of QI self-efficacy (mean = 3.47; SD = 0.39) compared with pre program (mean = 2.02, SD = 0.51; P = .03, Cohen’s d = 3.19). Impact on clinical units was demonstrated, but varied. The coach was identified as a key factor for success. An interprofessional, workplace-based, continuing professional development program focused on QI increased QI knowledge and skills and translated to improvements in the clinical setting.

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Section: Discussionmentioning

confidence: 99%

An Interprofessional Quality Improvement Training Program That Improves Educational and Quality Outcomes

et al. 2019

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“…Unit-based interventions, including GCh, to improve inpatient care are receiving attention. 7,8 Ongoing surveillance of any improvement effort is critical to assure its success and identify any emerging unintended consequences. 9 To the study team’s knowledge, this work represents the first attempt to gather impressions from a national cohort of clinicians regarding the impact of GCh.…”

Section: Discussionmentioning

confidence: 99%

“…This variability is similar to the findings of O’Leary et al who also noted inconsistent adoption of several unit-based interventions in a national survey. 8 These differences may be both a challenge and an opportunity to study the ideal structure of GCh that optimizes patient and clinician outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hospital-Based Clinicians’ Perceptions of Geographic Cohorting: Identifying Opportunities for Improvement

et al. 2017

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Members of the Society of Hospital Medicine were surveyed about geographic cohorting (GCh); 369 responses were analyzed, two thirds of which were from GCh participants. Improved collaboration with the bedside nurse, increased nonclinical interactions, decreased paging interruptions, and improved efficiency were perceived by >50%. Narrowed clinical expertise, increased fragmentation, increased face-to-face interruptions, and an adverse impact on camaraderie within the hospitalist group were reported by 25% to 50%. Academic practices were associated with positive perceptions while higher patient loads were associated with negative perceptions. Comments on GCh benefits invoked improvements in (1) interprofessional collaboration, (2) efficiency, (3) patient-centeredness, (4) nursing satisfaction, and (5) GCh mediated facilitation of other interventions. GCh downsides included (1) professional and personal dissatisfaction, (2) concerns about providing suboptimal care, and (3) implementation barriers. GCh is receiving attention. Although it facilitates important benefits, it is perceived to mediate unintended consequences, which should be addressed in redesign efforts.

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“…Many large hospitals have disease or pathology specific inpatient units however patients with specific conditions best served on a particular unit may be dispersed over the entire hospital. While the clinical microsystem and unit-based interventions are critically important to improving outcomes, [9] our work suggests that patients' care pathways are rarely straightforward. Analyzing the network in relationship to specific disease states may help us both assess any differences in outcomes related to mismatches between patient need and patient placement, but also to create a map of our patient needs.…”

Section: Discussionmentioning

confidence: 99%

Patient transfers during hospitalization: An examination of intra facility patient locations using network analysis

Sadowski

Luetkemeyer

Kara

2020

JHA

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Patient movements following hospitalization are difficult to track. In a large Midwestern academic institution, we analyzed data using network statistics for patients discharged by the hospitalist service between June 2016-June 2018. We retrieved all major patient movements logged in the patient throughput management system following admission. The 4,869 patients discharged by the hospitalist service during the study period experienced 6,832 movements. The mean was 1.4 movements per patient while the maximum was 8. Most patients (72.3%) moved once following hospitalization while 27.7% moved more than once. The predominant movement type was downgrades which comprised 51.8% (n = 3,543) of all movements. Lateral movements were the next most common (25.9%, n = 1,771). Network statistics revealed progressive care units to be central to patient flow across the system. Transfers following hospitalization are common. Visualizing these transfers using network statistics may provide valuable insights to enhance patient safety.

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Use of Unit-Based Interventions to Improve the Quality of Care for Hospitalized Medical Patients: A National Survey

Cited by 13 publications

References 19 publications

An Interprofessional Quality Improvement Training Program That Improves Educational and Quality Outcomes

An Interprofessional Quality Improvement Training Program That Improves Educational and Quality Outcomes

Hospital-Based Clinicians’ Perceptions of Geographic Cohorting: Identifying Opportunities for Improvement

Patient transfers during hospitalization: An examination of intra facility patient locations using network analysis

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