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Biomedical subjects

P Plsek

Publications and source records attributed to P Plsek.

7 recordsLinked to original sources
PubMed2005

Real time patient safety audits: improving safety every day.

BACKGROUND: Timely error detection including feedback to clinical staff is a prerequisite for focused improvement in patient safety. Real time auditing, the efficacy of which has been repeatedly demonstrated in industry, has not been used previously to evaluate patient safety. Methods successful at improving quality and safety in industry may provide avenues for improvement in patient safety. OBJECTIVE: Pilot study to determine the feasibility and utility of real time safety auditing during routine clinical work in an intensive care unit (ICU). METHODS: A 36 item patient safety checklist was developed via a modified Delphi technique. The checklist focused on errors associated with delays in care, equipment failure, diagnostic studies, information transfer and non-compliance with hospital policy. Safety audits were performed using the checklist during and after morning work rounds thrice weekly during the 5 week study period from January to March 2003. RESULTS: A total of 338 errors were detected; 27 (75%) of the 36 items on the checklist detected >or=1 error. Diverse error types were found including unlabeled medication at the bedside (n = 31), ID band missing or in an inappropriate location (n = 70), inappropriate pulse oximeter alarm setting (n = 22), and delay in communication/information transfer that led to a delay in appropriate care (n = 4). CONCLUSIONS: Real time safety audits performed during routine work can detect a broad range of errors. Significant safety problems were detected promptly, leading to rapid changes in policy and practice. Staff acceptance was facilitated by fostering a blame free "culture of patient safety" involving clinical personnel in detection of remediable gaps in performance, and limiting the burden of data collection.

Delphi Technique↗
PubMed2002

Quality collaboratives: lessons from research.

Quality improvement collaboratives are increasingly being used in many countries to achieve rapid improvements in health care. However, there is little independent evidence that they are more cost effective than other methods, and little knowledge about how they could be made more effective. A number of systematic evaluations are being performed by researchers in North America, the UK, and Sweden. This paper presents the shared ideas from two meetings of these researchers. The evidence to date is that some collaboratives have stimulated improvements in patient care and organisational performance, but there are significant differences between collaboratives and teams. The researchers agreed on the possible reasons why some were less successful than others, and identified 10 challenges which organisers and teams need to address to achieve improvement. In the absence of more conclusive evidence, these guidelines are likely to be useful for collaborative organisers, teams and their managers and may also contribute to further research into collaboratives and the spread of innovations in health care.

Cooperative Behavior↗
PubMed2000

Quality improvement around the world: how much we can learn from each other.

The USA National Forum on Quality Improvement in Health Care--organised by the Institute of Healthcare Improvement (Boston USA)--attracts many people from outside North America. At the 1999 meeting 20 countries were represented. A session on "Quality improvement around the world" was included in the pre-conference programme to bring together people working in many countries to explore and compare their experiences in a programme of short presentations (table 1). This article draws together some of the themes that emerged from the presentations and from the discussion.

Delivery of Health Care↗
PubMed1999

Innovative thinking for the improvement of medical systems.

If health care systems are not delivering the desired results, those systems must be changed in some way. Innovative thinking is sometimes needed to generate ideas for improvement. Many persons erroneously believe that innovative thinking is a special gift or that it requires an air of lightheartedness that seems inappropriate in a health care setting. Current research in the cognitive sciences has yielded methods to help individual persons and groups generate innovative ideas. These methods do not require any special gift and can be practiced in a serious way. Through a case example from a health maintenance organization, this paper shows that, given some direction, groups of health care professionals can produce useful and innovative ideas. The tools of idea generation are based on three principles: mental attention, escape, and movement. Activities that help persons pay attention to their current situations in a different way, escape their current mental patterns about the situation, and maintain movement in their thoughts support efforts to generate innovative, testable ideas for health system improvements. This paper illustrates several methods of stimulating innovative thinking and shows the ways in which they can be applied in health care.

Creativity↗
PubMed1995

Variability in clinical systems: applying modern quality control methods to health care.

BACKGROUND: Quality health care depends on timely completion of sequences of clinical care. This study evaluated the concepts and tools of quality management for measuring system performance in ambulatory care. STUDY DESIGN: Clinical staff in nine centers of a group model health maintenance organization described the procedure for ordering and completing a complete blood count, mammogram, and surgical consultation. Variability was noted among the processes as intended and as actually performed, as well as inconsistencies reported within and among centers. In two centers investigators tracked performance of key sequences of care and the achievement of other key quality characteristics believed desired by physicians and patients. Computerized patient records and departmental files were the only available sources of data for assessing completion and followup of tests and consultations. Even these data were difficult to obtain and, in many instances, incomplete. RESULTS: Although data were often difficult to obtain, the quality management techniques used were helpful in revealing process failures that appeared to be the result of design flaws built into the clinical systems. CONCLUSION: Robust process designs and improved management information systems for monitoring these processes are recommended to reduce variability and improve the quality of clinical care.

Blood Cell Count↗
PubMed1995

Interpreting quality improvement data with time-series analyses.

In quality improvement efforts, the data are frequently a series of measurements taken over time. A collection of statistical methods, commonly referred to as time-series analysis, provides a simple and understandable method for interpreting this longitudinal data. In this article, we present a time-series analysis of data on the quality of prenatal care at a mid-sized public hospital. We will demonstrate some simple tests that alert us to the potential value of using more sophisticated tests of association such as regression. Using regression, we show how to confirm a visual impression of an improvement. The analytical approach we present here is useful with many types of process or outcome data from health care quality improvement efforts.

Data Collection↗