Browsing by Subject "Quality Improvement"
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Item Building a Central Repository for Research Ethics Consultation Data: A Proposal for a Standard Data Collection Tool(ACTS, 2015-08-01) Cho, Mildred K.; Taylor, Holly; McCormick, Jennifer B.; Anderson, Nick; Barnard, David; Boyle, Mary B.; Capron, Alexander M.; Dorfman, Elizabeth; Havard, Kathryn; Reider, Carson; Sadler, John; Schwartz, Peter H.; Sharp, Richard R.; Danis, Marion; Wilfond, Benjamin S.; Department of Philosophy, IU School of Liberal ArtsClinical research ethics consultation services have been established across academic health centers over the past decade. This paper presents the results of collaboration within the CTSA consortium to develop a standard approach to the collection of research ethics consultation information to serve as a foundation for quality improvement, education, and research efforts. This approach includes categorizing and documenting descriptive information about the requestor, research project, the ethical question, the consult process, and describing the basic structure for a consult note. This paper also explores challenges in determining how to share some of this information between collaborating institutions related to concerns about confidentially, data quality, and informatics. While there is much still to be learned to improve the process of clinical research ethics consultation, these tools can advance these efforts, which, in turn, can facilitate the ethical conduct of research.Item Caring for Incarcerated Patients: Can it Ever be Equal?(Elsevier, 2021-11) Douglas, Anthony D.; Zaidi, Mohammad Y.; Maatman, Thomas K.; Choi, Jennifer N.; Meagher, Ashley D.; Surgery, School of MedicineBACKGROUND: Incarcerated patients represent one of the most vulnerable populations in the United States healthcare system. Studying disparities in care they receive, however, has been difficult due to a history of abuse at the hands of medical researchers rendering this population excluded from most current medical research. Due to incarceration, these patients are frequently maintained in shackles and under constant guard when receiving healthcare. There is a paucity of literature on the influence these measures exert on healthcare workers and the care they provide. Our study aimed to measure surgical trainee's perception of health inequities and disparities in incarcerated individuals undergoing surgical care. METHODS: An anonymous cross-sectional survey was administered at our single institution to all general surgery trainees assessing perceptions in delivering care to incarcerated patients within our hospital system. The survey consisted of 10 items, nine of which were yes or no responses, and 1 open-ended text question. Survey results were averaged, and percentages were reported. RESULTS: Of all current general surgery residents (n = 60), 40 (66%) completed the survey. Almost all respondents (n = 39, 97.5%) have cared for a patient that was incarcerated or in police custody. Most respondents (n = 25, 62.5%) have operated on an incarcerated patient with an armed guard present in the operating room. Similarly, most respondents (n = 26, 65%) have cared for a patient intubated and sedated that was shackled to a bed. The majority of respondents (n = 30, 75%) recalled incidents where a trauma patient was actively questioned by law enforcement during the primary/secondary survey during initial trauma evaluation. At the time of hospital discharge, a quarter (n = 10, 25%) of respondents reported being unable to prescribe all of the medications that a non-imprisoned patient would receive with the same condition. In addition, 18 (45%) respondents felt they were unable to arrange outpatient follow-up with physical or occupational therapy and/or the patient's primary/consulting physician due to patient's incarcerated status. Strikingly, half of respondents (n = 19, 47.5%) believed that the incarcerated patient received substandard care, and the majority of respondents (n = 28, 72%) agreed that the holding areas for incarcerated patients in the emergency room provide substandard patient care. CONCLUSIONS: The current status of caring for incarcerated patients within our system represents an urgent and needed area for quality improvement. Surgical trainees report difficulty caring for these patients, and they perceive these individuals receive substandard care. Though our cross-sectional study did not assess the origin of this disparity, the challenges trainees face in caring for incarcerated patients, from assessment to diagnosis and treatment, as well as in follow-up signals an area requiring further research and study.Item Commentary: Launch of a quality improvement network for evidence-based management of uncommon pediatric endocrine disorders: Turner syndrome as a prototype(Oxford University Press, 2015-04) Rosenfeld, Robert L.; DiMeglio, Linda A.; Mauras, Nelly; Ross, Judith; Shaw, Natalie D.; Greeley, Siri A.W.; Haymond, Morey; Rubin, Karen; Rhodes, Errin T.; Medicine, School of MedicineBACKGROUND: Traditional, hypothesis-oriented research approaches have thus far failed to generate sufficient evidence to achieve consensus about the management of children with many endocrine disorders, partly because of the rarity of these disorders and because of regulatory burdens unique to research in children. OBJECTIVE: The Pediatric Endocrine Society is launching a quality improvement network in spring 2015 for the management of pediatric endocrine disorders that are relatively uncommon in any single practice and/or for which there is no consensus on management. DESIGN: The first of the quality improvement programs to be implemented seeks to improve the care of 11- to 17-year-old girls with Turner syndrome who require initiation of estrogen replacement therapy by providing a standardized clinical assessment and management plan (SCAMP) for transdermal estradiol treatment to induce pubertal development. The SCAMP algorithm represents a starting point within current best practice that is meant to undergo refinement through an iterative process of analysis of deidentified data collected in the course of clinical care by a network of pediatric endocrinologists. CONCLUSION: It is anticipated that this program will not only improve care, but will also result in actionable data that will generate new research hypotheses and changes in management of pediatric endocrine disorders.Item Defining a project proposal to enhance the Medical Library Association’s annual meeting through Session-level assessment: The exploration of the 2017-2018 Rising Star cohort(Hypothesis: Journal of the Research Section of MLA, 2018) Theis-Mahon, Nicole; Menard, Laura M.; Schmillen, Hanna; Stark, RachelObjectives: Associations and organizations rely on feedback from membership to assess conferences, programs, and meetings. The Medical Library Association (MLA) utilizes post-conference assessment to get an overall evaluation of the meeting. While this informs future meeting planning, it does not provide targeted assessment data about the perceived quality and relevance of sessions, papers, or posters. Incorporating session-level, just-in-time feedback would further engage meeting attendees and ensure relevance of the meeting to the membership. Methods: The 2017-2018 MLA Rising Star cohort investigated the interest in and use of session level, just-in-time feedback at conferences of seven peer associations. A five-question survey to gauge MLA member interest in session-level feedback was distributed in February 2018. The survey was only available to current MLA members and advertised on the MLA blog, distributed to Section and SIG, state, and select MLA Chapter lists. Live polling was also conducted at the May 22, 2018, MLA Rising Star project proposal presentation. Results: The cohort received responses from five peer associations and only three are using some form of session-level, just-in-time assessment at their conferences. The February 2018 MLA membership survey yielded 157 responses. 94% of respondents (n=147) had attended a MLA meeting and 72% of respondents agreed that they would find session-level assessment valuable. Respondents indicated that they would be interested in receiving feedback from attendees about the application of their session’s content, whether attendees learned something new, and if their session met expectations. Of attendees at this May 22, 2018, project proposal presentation, 97% agreed that they would value the opportunity to provide session-level, and 91% indicated that as a presenter would find attendee feedback useful. Conclusion: The investigation by the 2017-2018 MLA Rising Star Cohort indicated an interest in session-level, just-in-time feedback for MLA’s annual meetings.Item Educational QUality-improvement in APRN Learning: Reducing Health Inequities for ALL Program (EQUAL-ALL Program)(2020-03-03) Oruche, Ukamaka M.We proposed a quality improvement project focused on MSN students to ensure they are well prepared to contribute with all diverse patient populations from both the United States and beyond. Specific aims are to assess MSN students’ learning needs and develop and implement a training program to increase MSN students’ knowledge and skills for working with different others.Item Enhancing the Sexual Health of Youth in Systems of Care: Factors Affecting Risky Sexual Behaviors and Implications for Pregnancy Prevention Programs(2024-05) Armstrong Richardson, Eprise AJ; Adamek, Margaret E.; Ott, Mary A.; Mariscal, Susana; Glassburn, SusanThis study investigates factors contributing to risky sexual behaviors and teenage pregnancies among youth in systems of care (YSC). Secondary analyses were conducted on quality improvement data from two sexual education programs in the urban Midwest. Descriptive analyses uncovered disparities in risky sexual behaviors between the study samples; moreover, both groups exhibited higher rates compared to those reported in existing literature and the general population. In the Indiana Proud and Connected Teens (IN-PACT) study (N = 1916, mean age = 16.1 years), multivariate analysis showed that, when controlling for age, adverse childhood experiences (ACEs), and system involvement, pregnancy risk scores—a measure of participants' engagement in risky sexual behaviors—were positively associated with decision-making capacity and negatively associated with perceptions of pregnancy as undesirable. Furthermore, among a population of youth currently involved, or at risk of future involvement, in systems of care, those within juvenile justice (JJ) systems reported higher pregnancy risk scores, while youth in child welfare (CW) systems reported lower scores. In the Healthy Teen Connection (HTC) study (N = 603, mean age = 15.7 years), descriptive analyses revealed that 6.3% of participants scheduled appointments post-intervention, indicating limited success in linking participants to reproductive health clinics. The analyses also highlighted patterns regarding participants’ sociodemographic and sexual health characteristics, including an increased proportion of youth reporting sex under the influence during the pandemic. Thematic analysis of coordinators’ reflections links the intervention’s limited success to multifaceted barriers hindering participants’ access to sexual and reproductive health (SRH) services, resources, and education. However, coordinators suggested that, by fostering a safe and supportive environment and engaging caregivers in the intervention, HTC was successful in empowering participants in their sexual health. Acknowledging limitations such as reliance on self-reported data, the findings lay the groundwork for comprehensive policy and practice recommendations. Collaborative efforts are needed to provide YSC with tailored sexual health programming, including comprehensive and developmentally appropriate sexual health education, and accessible SRH resources and services. Future research should prioritize comprehensive needs assessments and explore disparities in sexual health behaviors and outcomes to enhance program development and implementation efforts.Item Handover Practices in Trauma and Acute Care Surgery: A Multicenter Survey Study(Elsevier, 2020-10) Puzio, Thaddeus J.; Murphy, Patrick B.; Virtanen, Piiamaria; Harvin, John A.; Hartwell, Jennifer L.; Surgery, School of MedicineBACKGROUND: The handover period has been identified as a particularly vulnerable period for communication breakdown leading to patient safety events. Clear and concise handover is especially critical in high-acuity care settings such as trauma, emergency general surgery, and surgical critical care. There is no consensus for the most effective and efficient means of evaluating or performing handover in this population. We aimed to characterize the current handover practices and perceptions in trauma and acute care surgery. METHODS: A survey was sent to 2265 members of the Eastern Association for the Surgery of Trauma via email regarding handoff practices at their institution. Respondents were queried regarding their practice setting, average census, level of trauma center, and patients (trauma, emergency general surgery, and/or intensive care). Data regarding handover practices were gathered including frequency of handover, attendees, duration, timing, and formality. Finally, perceptions of handover including provider satisfaction, desire for improvement, and effectiveness were collected. RESULTS: Three hundred eighty surveys (17.1%) were completed. The majority (73.4%) of respondents practiced at level 1 trauma centers (58.9%) and were trauma/emergency general surgeons (86.5%). Thirty-five percent of respondents reported a formalized handover and 52% used a standardized tool for handover. Only 18% of respondents had ever received formal training, but most (51.6%) thought this training would be helpful. Eighty-one percent of all providers felt handover was essential for patient care, and 77% felt it prevented harm. Seventy-two percent thought their handover practice needed improvement, and this was more common as the average patient census increased. The most common suggestions for improvement were shorter and more concise handover (41.6%), different handover medium (24.5%), and adding verbal communication (13.9%). CONCLUSION: Trauma and emergency general surgeons perceive handover as essential for patient care and the majority desire improvement of their current handover practices. Methods identified to improve the handover process include standardization, simplification, and verbal interaction, which allows for shared understanding. Formal education and best practice guidelines should be developed.Item Implementation of a High Flow Nasal Cannula Management Protocol in the Pediatric ICU(American Association for Respiratory Care, 2021-04-01) Peterson, Rachel J.; Hassumani, Daniel O.; Hole, Acrista J.; Slaven, James E.; Tori, Alvaro J.; Abu-Sultaneh, SamerItem Improving Graduate Medical Education in China: Leading Teaching Hospitals Engage in Self-Analysis(Accreditation Council for Graduate Medical Education, 2018-04) Zhang, Shuyang; Yan, Zuoqin; Wan, Xuehong; Shen, Ye; Lei, Guanghua; Kuang, Ming; Pan, Hui; Yu, Qing; Wang, Xingyue; Jiang, Guoping; Peng, Jie; Tang, Lina; Guo, Chao; Zhu, Jiming; Inui, Thomas S.; Medicine, School of MedicineItem Public Health and Health Care Partnerships for Improved Tobacco Cessation(Wolters Kluwer, 2022) Hilts, Katy Ellis; Yeager, Valerie A.; Kooreman, Harold; Smith, Regina; Busching, Brian; Spitznagle, Miranda; Health Policy and Management, School of Public HealthContext: Tobacco use remains a leading cause of preventable death and disease. While most tobacco users are interested in quitting, few receive professional assistance. Program: This state health department-led project leveraged partnerships to build capacity and support 9 health care organizations in implementing system-level initiatives to improve delivery of tobacco cessation. Implementation: Participating organizations' initiatives targeted 3 focus areas: implementing best practices for tobacco cessation; quality improvement; and utilization of the electronic health record. Evaluation: A qualitative study was conducted to examine facilitators and barriers to tobacco cession systems change among participating health care organizations. Common barriers included time constraints, staffing issues, and organizational structure. These factors often differed by organization type (eg, large vs small). Facilitators included leadership buy-in, organizational priority, technical assistance, teams/teamwork, and IT support. Discussion: Initial findings suggest that this type of partnership model can be leveraged to gain organizational support, build capacity, address key barriers, and ensure that systems change strategies align with best practices for tobacco cessation across a diverse set of health care organizations. Findings presented in this report provide insights for other public health and health care organizations looking to implement similar initiatives.