IBCD: development and testing of a checklist to improve quality of care for hospitalized general medical patients.
ABSTRACT Several studies have demonstrated the usefulness of medical checklists to improve quality of care in surgery and the ICU. The feasibility, effectiveness, and sustainability of a checklist was explored.
Literature on checklists and adherence to quality indicators in general medicine was reviewed to develop evidence-based measures for the IBCD checklist: (I) pneumococcal immunization, (B) pressure ulcers (bedsores), (C) catheter-associated urinary tract infections (CAUTIs), and (D) deep venous thrombosis (DVT) were considered conditions highly relevant to the quality of care in general medicine inpatients. The checklist was used by attending physicians during rounds to remind residents to perform four actions related to these measures. Charts were audited to document actions prompted by the checklist.
The IBCD checklist was associated with significantly increased documentation of and adherence to care processes associated with these four quality indicators. Seventy percent (46/66) of general medicine teams during the intervention period of July 2010-March 2011 voluntarily used the IBCD checklist for 1,168 (54%) of 2,161 patients. During the intervention period, average adherence for all four checklist items increased from 68% on admission to 82% after checklist use (p < .001). Average adherence after checklist use was also higher when compared to a historical control group from one year before implementation (82% versus 50%, p < .0001). In the six weeks after the checklist was transitioned to the electronic medical record, IBCD was noted in documentation of 133 (59%) of 226 patients admitted to general medicine.
A checklist is a useful and sustainable tool to improve adherence to, and documentation of, care processes specific to quality indicators in general medicine.
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ABSTRACT: Objective: To provide a narrative review of the impact of provider-based, organizational strategies in acute care settings to improve pneumococcal vaccination rates among patients over 65, and 2-64 years with high risk medical conditions. Methods: A search was conducted using MEDLINE, Scopus, CINAHL and Web of Science databases for hospital-based, inpatient studies which evaluated strategies to improve pneumococcal vaccination rates. Studies published in English from 1983 to 2013 were included. Data abstracted was analyzed descriptively. Results: A total of 35 studies were included; 15 evaluated physician reminders (e.g. chart or paper reminders, pre-printed orders (PPOs), computerized reminders, checklists) and 21 standing orders programs (SOPs). The most common study design was pre/post, and only 7 studies had a control group. Overall, 32 studies showed improvements in the rate of pneumococcal vaccination following intervention (19 statistically significant), with reminders showing 29-74% immunization rate, PPCO 5-42%, and SOPs 3.4-78%. Conclusion: Hospital-based interventions improve pneumococcal vaccination in older adults and younger individuals at risk. Although this review found that more success was observed with SOPs the impact on immunization rates in eligible patients varied significantly. Thus, high quality, randomized-controlled studies are required to determine the effect of each type of institutional immunization strategy.Preventive Medicine 07/2014; 67. DOI:10.1016/j.ypmed.2014.07.015 · 2.93 Impact Factor
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ABSTRACT: Changes in the clinical learning environment under resident duty hours restrictions have introduced a number of challenges on today's wards. Additionally, the current group of medical trainees is largely represented by the Millennial Generation, a generation characterized by an affinity for technology, interaction, and group-based learning. Special attention must be paid to take into account the learning needs of a generation that has only ever known life with duty hours. A mnemonic for strategies to augment teaching rounds for hospitalists was created using an approach that considers time limitations due to duty hours as well as the preferences of Millennial learners. These strategies to enhance learning during teaching rounds are Flipping the Wards, Using Documentation to Teach, Technology-Enabled Teaching, Using Guerilla Teaching Tactics, Rainy Day Teaching, and Embedding Teaching Moments into Rounds (FUTURE). Hospitalists serving as teaching attendings should consider these possible strategies as ways to enhance teaching in the post-duty hours era. These techniques appeal to the preferences of today's learners in an environment often limited by time constraints. Hospitalists are well positioned to champion innovative approaches to teaching in a dynamic and evolving clinical learning environment. Journal of Hospital Medicine 2013;. © 2013 Society of Hospital Medicine.Journal of Hospital Medicine 07/2013; 8(7). DOI:10.1002/jhm.2057 · 2.08 Impact Factor