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Clinical Communities Improve Patient Safety, Care and Value in Hospitals

Added on August 25, 2015 in Press Releases

(OAKBROOK, Illinois, August 25, 2015) – Joint Commission Resources, Inc. today released the September 2015 issue of The Joint Commission Journal on Quality and Patient Safety featuring the article, “Clinical Communities at Johns Hopkins Medicine: An Emerging Approach to Quality Improvement,” by Lois J. Gould, MS, PMP, Peter J. Pronovost, MD, PhD, and colleagues. The article discusses the role of clinical communities as an emerging strategy to connect frontline providers to improve patient safety, quality of care and value across a health system. 
In 2011, the Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, established clinical communities from six inpatient hospitals within the Johns Hopkins Health System (JHHS). Fourteen communities were created, focusing on either a clinical area, patient population, group, process, safety-related issue or other health care issue. Each community included representation from all of the participating hospitals.
Before a hospital joins a clinical community, its “executive leadership needs to understand that patient safety and quality improvement (QI) progress at the speed of trust and begin with clinicians and staff closest to patients,” noted the authors. Clinicians and staff know where problems lie, as well as which interventions are likely to improve care, reduce variation in practice and deliver value to the organization. At JHHS, the clinical communities engaged clinicians from across the health system to participate in QI and shared learning with peers through team-building activities and facilitated discussions. After a community was established, patients and families were invited to provide their own personal perspectives and experiences.
The authors identified three key elements for a clinical community’s success:

  1. Engage physician champions and seek multidisciplinary membership to ensure that all services with a vested interest are represented.
  2. Assign an administrator with project management skills and dedicated time to organize meetings and support the work.
  3. Ensure that executive leadership provides sufficient resources for the infrastructure to support the communities.

The remaining articles from the September 2015 issue are as follows:

Information Technology
A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency
Alissa L. Russ, PhD; Siying Chen, PharmD; Brittany L. Melton, PharmD, PhD; Elizabette G. Johnson, BA; Jeffrey R. Spina, MD; Michael Weiner, MD, MPH; Alan J. Zillich, PharmD

Detection and amelioration of drug-drug interactions (DDIs) before dispensing medications is critical for patient safety. Human factors engineering principles were applied in the redesign of DDI alerts. In a counterbalanced, crossover study, Department of Veterans Affairs prescribers resolved redesigned alerts in about half the time with a comparable number of prescribing errors.

Care Processes
Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement
Winthrop  F.   Whitcomb,  MD;  Tara   Lagu,  MD,  MPH;    Robert J. Krushell, MD; Andrew P. Lehman, MD; Jordan Greenbaum, MD; Joan McGirr, BSN, RN; Penelope S. Pekow, PhD; Stephanie Calcasola, MSN, RN; Evan Benjamin, MD; Janice Mayforth; Peter J. Lindenauer, MD, MSc

Bundled (episode-based) payments are intended to contain health care costs and promote quality. In 2011, a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. The program was associated with similar total costs, decreased post hospital costs, fewer discharges to rehabilitation facilities and improved quality.

Performance Measures
Effect of a Real-Time Pediatric ICU Safety Bundle Dashboard on Quality Improvement Measures
Susanna J. Shaw, MD; Brian Jacobs, MD; David C. Stockwell, MD, MBA; Craig Futterman, MD, FAAP; Michael C. Spaeder, MD, MS

In a pediatric ICU, a unit-wide, real-time dashboard showing safety-bundle data was implemented, with querying of the electronic health record for compliance and five-minute updating. One and three months after dashboard activation, improvements were shown in presence of consent for treatment, urinary catheters in place > 96 hours and completion of medication reconciliation, but not in presence of restraint orders, deep venous thrombosis prophylaxis, or development or worsening of pressure ulcers.

Departments: Rapid Response Systems
Rapidly Increasing Rapid Response Team Activation Rates
Jane S. Braaten, RN, PhD; Graham DeGunst, RN, BSN, CCRN; Katherine Bilys, BS, CPHQ

A group of interventions were implemented at a tertiary care hospital to overcome identified barriers to rapid response team (RRT) activation. Activation rates tripled; lower non-ICU code blue rates and more positive attitudes toward the RRT intervention also resulted.

Departments: Tool Tutorial
Using Multidisciplinary Rounds to Improve Patient Safety Through Venous Thombrosis Embolism Prevention Awareness
Beth Karasin, MSN, APN, AGACNP-BC, RNFA, CNOR; Christina Maund, MS, RN, CPHQ

Re-education regarding the importance of venous thromboembolism (VTE) prophylaxis and choosing the appropriate preventative interventions on the basis of patient risk factors need to be emphasized with physicians, nurses and all health care providers to prevent deep venous thrombosis. Accordingly, a multidisciplinary rounds tool was developed to promote awareness of Joint Commission accountability measures, with a focus on the five VTE measures, in a 45-bed cardiac telemetry unit. Compliance increased from 83 to 100 percent in one year and has been sustained at 97 percent since.


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