Article

Basing decisions on better quality routine clinical data.

Department of Health Sciences, University of York, York YO10 5DD, UK.
Quality and Safety in Health Care (Impact Factor: 2.16). 11/2003; 12(5):327-8. DOI: 10.1136/qhc.12.5.327
Source: PubMed
0 Bookmarks
 · 
53 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since release of the Institute of Medicine Report "To Err is Human:Building a Safer Health System" in 1999, a huge effort has been expended on error-related clinically applied research and on the implementation of new standards and practices related to quality improvement and patient safety. Nonetheless, measurable improvements in the quality of delivered care and reductions in medical errors have been variable and modest in most cases. Multiple barriers to the implementation of patient safety and error reduction initiatives have been identified in the literature. The greater part of this article is devoted to three fundamental barriers: physicians' intolerance for uncertainty, health professionals' fears, and an organizational structure and culture that are incongruent with increasing patient safety.
    Clinics in Laboratory Medicine 01/2005; 24(4):901-11, vi. · 1.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The need to improve the clinical assessment and management of acutely poisoned patients presenting to an NHS hospital emergency department (ED). Creation of an electronic clinical toxicology database to prospectively collect all aspects of clinical information on poisoned-patient presentations. Systematic analysis of collated information to identify shortfalls in patient assessment and management. Bimonthly audit meetings, and design and implementation of educational interventions to address identified shortfalls. Ongoing audit to demonstrate continued improvement in patient care. ED in tertiary-level inner-city London teaching hospital. Study conducted by staff from the ED and clinical toxicology service. Demonstration of overall reduction in the incidence of predefined shortfalls in patient assessment and management during 12-month study period. Strategies for improvement: Targeted educational lectures and case-based clinical scenarios addressing identified deficiencies in the knowledge required to effectively manage poisoned patients. Weekly case-based anonymised feedback report sent electronically to staff involved in caring for poisoned patients. Implementation of targeted teaching of ED staff and regular electronic distribution of teaching cases. Between the first and second 6 months of the study, there was a significant increase in the proportion of presentations for which clinical management was graded as "good" (77.6% to 89.4%, p<0.0001) and a significant reduction in the proportion of "major" (9.9% to 5.8%, p = 0.012) and "minor" (12.6% to 4.8%, p<0.0001) shortfalls. Systematic collection of clinical information, using a dedicated electronic database and subsequent review and audit of collated data by interested clinicians, enabled design and implementation of targeted educational interventions to address shortfalls in patient management. This process has led to significant improvements in the clinical care of acutely poisoned patients presenting to the ED.
    Postgraduate medical journal 11/2008; 84(997):603-8. · 1.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose – The paper aims to outline benchmarking and performance monitoring practice developed by the New Zealand Health Information Service at a diagnosis-related group (DRG) level. Design/methodology/approach – The indicators are calculated from the routine hospital discharge data in the National Minimum Dataset. The benchmarks are set at either the 20th or 80th centile as a cut-point that can alert to possible issues or a target for which to aim. Benchmarks can be used to highlight variations by making comparisons with other health-care providers or the same provider over time. Findings – This approach provides an indication of which DRGs and outcome variables may be worth looking at in more detail. Using comparative measures across providers allows the identification of areas of health care with the most potential for gain. Practical implications – There is strong evidence of changed clinical practice and improved health outcomes following systematic evaluation of some patient management practices. Originality/value – This overview of benchmarking practice using routine data with some distinctive features would be of interest to those with similar undertakings.
    Benchmarking An International Journal 11/2005; 12(6):498-507.

Full-text (2 Sources)

View
23 Downloads
Available from
May 20, 2014