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At least 883 records · Page 49Linked to original sources
PubMed2006

Incident reporting in one UK accident and emergency department.

Greater focus is needed on improving patient safety in modern healthcare systems and the first step to achieving this is to reliably identify the safety issues arising in healthcare. Research has shown the accident and emergency (A&E) department to be a particularly problematic environment where safety is a concern due to various factors, such as the range, nature and urgency of presenting conditions and the high turnover of patients. As in all healthcare environments clinical incident reporting in A&E is an important tool for detecting safety issues which can result in identifying solutions, learning from error and enhancing patient safety. This tool must be responsive and flexible to the local circumstances and work for the department to support the clinical governance agenda. In this paper, we describe the local processes for reporting and reviewing clinical incidents in one A&E department in a London teaching hospital and report recent changes to the system within the department. We used the historical data recorded on the Trust incident database as a representation of the information that would be available to the department in order to identify the high risk areas. In this paper, we evaluate the internal processes, the information available on the database and make recommendations to assist the emergency department in their internal processes. These will strengthen the internal review and staff feedback system so that the department can learn from incidents in a consistent manner. The process was reviewed by detailed examination of the centrally held electronic record (Datix database) of all incidents reported in a one year period. The nature of the incident and the level and accuracy of information provided in the incident reports was evaluated. There were positive aspects to the established system including evidence of positive changes made as a result of the reporting process, new initiatives to feedback to staff, and evolution of the programme for reporting and discussing the incidents internally. There appeared to be a mismatch between the recorded events and the category allocated to the incident in the historical record. In addition the database did not contain complete information for every incident, contributory factors were rarely recorded and relatively large numbers of incidents were recorded as "other" in the type of incident. There was also observed difficulty in updating the system as there is at least a months time lag between reporting or an incident and discussion/resolution of issues at the local departmental clinical risk management committee meetings. We used Leape's model for assessing the reporting system as a whole and found the system in the department to be relatively safe, fairly easy to use and moderately effective. Recommendations as a result of this study include the introduction of an electronic reporting system, limiting the number of staff who categorise the incidents--using clear definitions for classifications including a structured framework for contributory factors, and a process that allows incidents to be updated on the database locally after the discussion. This research may have implications for the incident reporting process in other specialities as well as in other hospitals.

Data Collection↗
PubMed2001

A pilot study on home visiting in Aspen Community Care Services.

The aim of this study was to test a questionnaire for more detailed management information of a community care program in rural Alberta. A total of 24 community care clients and 486 home visits to these clients were assessed. The Client Homebound Score (CHS) and the Case Management Intensity Score (CMIS) were positively associated with time spent on home visits. These scores would be useful indicators for improved resource-based planning of home visiting.

Activities of Daily Living↗
PubMed1998

Continuous quality improvement: status of Canadian health care organizations.

The Canadian Council on Health Services Accreditation (CCHSA) surveyed its client groups to determine how involved they had become in continuous quality improvement (CQI) activities. This was a follow up to a 1992 survey. Most of the participating organizations indicated they had adopted a CQI philosophy. A major factor influencing this decision was the use of the CCHSA's client-centred standards. This article outlines the gains organizations have realized by implementing CQI, and the extent to which organizations have implemented CQI principles, methods and tools. The information from this survey has been used to develop the accreditation program for the year 2000--"The AIM Project: Achieving Improved Measurement."

Accreditation↗
PubMed1998

The development of a mental health service patient information management system.

In this paper we describe the development of the Mental Health-Patient Information Management System (MH-PIMS), which is an information management system designed for use in a modern, primarily community-based, mental health service. MH-PIMS is a computerised database which was designed by clinicians and is supported by a case management system and complementary patient record set-together called the Assessment and Care Evaluation (ACE) system. The paper also describes the ACE system. MH-PIMS can generate patient reports of use to case managers and teams in managing their caseloads and is of use to senior clinicians and service managers for audit and strategic planning purposes.

Case Management↗
PubMedDate not supplied

A simple, semi-prescriptive self-assessment model for TQM.

This article presents a simple, semi-prescriptive self-assessment model for use in industry as part of a continuous improvement program such as Total Quality Management (TQM). The process by which the model was constructed started with a review of the available literature in order to research TQM success factors. Next, postal surveys were conducted by sending questionnaires to the winning organisations of the Baldrige and European Quality Awards and to a preselected group of enterprising UK organisations. From the analysis of this data, the self-assessment model was constructed to help organisations in their quest for excellence. This work confirmed the findings from the literature, that there are key factors that contribute to the successful implementation of TQM and these have different levels of importance. These key factors, in order of importance, are: effective leadership, the impact of other quality-related programs, measurement systems, organisational culture, education and training, the use of teams, efficient communications, active empowerment of the workforce, and a systems infrastructure to support the business and customer-focused processes. This analysis, in turn, enabled the design of a self-assessment model that can be applied within any business setting. Further work should include the testing and review of this model to ascertain its suitability and effectiveness within industry today.

Communication↗
PubMed1996

Audit in palliative care: does practice change?

This study aimed to document current palliative care initiatives, identify any reported changes in working practice as a result of audit, and determine the opinions of palliative care staff towards audit. All 31 established palliative care services within the former North West Thames Regional Health Authority were sent a brief postal questionnaire on previous and current audit activities. Of the 28 units who responded, most (78%, n = 21) were currently involved in audit with a further 7% (n = 2) planning to implement audit in the near future. Changes as a result of audit included implementation of standards, for example response to referrals; improvements in documentation, for example revision of case notes; and changes to unit practice, such as converting to multidisciplinary care plans. The respondents viewed the main advantage of carrying out any audit project as the improvement or maintenance of the quality of patient care. The principal disadvantage expressed was the time-consuming nature of audit. An audit with a clear aim and thorough design can provide valuable evidence upon which new policies or strategies in palliative care can be based. By educating and training staff in audit and illustrating the benefits, any concerns about carrying out audit could be addressed.

Attitude of Health Personnel↗
PubMed2005

Adult-onset inflammatory myopathy: North Canterbury experience 1989-2001.

AIM: To perform a clinical audit of all patients diagnosed with inflammatory myopathy in the North Canterbury region. METHODS: A retrospective case note audit of patients with a discharge diagnosis of inflammatory myopathy from June 1989 to June 2001 was performed. The audit was based at Christchurch Hospital, New Zealand, which services a population of 430,000. RESULTS: Of 77 case notes reviewed, 44 patients were identified who were considered to fulfil clinical criteria for inflammatory myopathy. There was a female preponderance (80% female, 20% male). Diagnostic categories in descending order of frequency included: dermatomyositis (41%), polymyositis (39%), inclusion body myositis (IBM) (14%) and overlap syndromes (6%). Malignancy-associated myositis occurred in 20% overall (dermatomyositis 11%, polymyositis 9%). Delays in diagnosis and late age at presentation (average 72 years) were seen in the IBM group. Proximal limb weakness was common, but not universal at presentation (80%). A muscle biopsy was performed in all patients and electromyography in 82%. All were treated with high dose prednisone (0.5-1 mg/kg) of whom 29% were maintained on prednisone alone. Immunosuppressives/immunomodulators used included: azathioprine (58%), methotrexate (31%), intravenous immunoglobulin (13%), chlorambucil (13%), and cyclophosphamide (9%). Thirteen patients (42%) required more than one agent, with three trialling five agents. There were 59 relapses in 20 patients (45%), with mean time to first relapse of 7.8 months. At audit completion, 33% had deceased with malignancy and respiratory failure the main causes. CONCLUSION: Inflammatory myopathy is a challenging condition in both diagnosis and management. Our audit has shown delays in the diagnosis of IBM, a relatively high incidence of malignancy and a notable risk of relapse and mortality.

Aged↗
PubMed2003

Accreditation of general practices: challenges and lessons.

To flourish, practice accreditation must meet challenges. It needs to manage uncertainty over its effectiveness and cost effectiveness, to address concerns that it erodes professional autonomy, and to promote and elucidate the conditions under which it is appropriate. Lessons from Australia and New Zealand help to focus these challenges. The lessons include the need to reward quality practices, loosen professional control over accreditation, trade some consistency of standards for validity, develop standards that acknowledge cultural diversity, and be transparent. Another lesson is to separate quality control from quality improvement within a coordinated systems based framework, with practices being helped to pay for accreditation and quality improvement. Such assistance is important because, in the presence of unintended variations in practice service delivery, all practices should have to show that they meet or exceed minimum standards while aiming for excellence.

Accreditation↗
PubMed1996

Implementation of ISO 9000 in the healthcare sector: a case study.

In order to compete at the international level, companies are beginning to recognize ISO 9000 registration as a virtual necessity. As a result, the number of ISO certifications issued in the U.S. and Canada tripled between 1992 and 1994. By means of a case study, this paper describes how a large healthcare manufacturing organization recently achieved its ISO 9001 certification. Specifically, the strategies and the process used by the organization in obtaining the registration is explained.

Certification↗
PubMed1994

Periodic reviews improve pension fund management.

An independent review and audit of pension fund management can help a plan sponsor improve the fund's financial performance. Reviewing a pension fund's management periodically is important to determine if, among other things, the fund's investment policy is reasonable; the fees charged by investment managers, pension consultants, and trustees are acceptable; and certain revenue-generating ideas (i.e., securities lending and soft dollar usage) are being properly implemented/employed.

Financial Audit↗
PubMed1994

Collaborative benchmarking in a healthcare system.

Leading organizations outside of the healthcare industry have benefitted from benchmarking for more than a decade. In the last few years, healthcare organizations also have begun to use benchmarking to achieve breakthrough improvements in their performances. Most of these organizations have conducted their benchmarking studies independently, working one-on-one with outside benchmarking partners. More recently, some organizations have chosen to benchmark processes in conjunction with other healthcare organizations. This article discusses the application of a collaborative benchmarking project conducted by selected facilities within the Catholic Health Corporation (CHC). It reviews the rationale for implementing collaborative benchmarking efforts and the benefits such efforts bring to the organizations involved. Presentation of a work in process--a case study on workers' compensation--provides insights into collaborative benchmarking. The article focuses on the initial phases of the benchmarking process--selecting the project and establishing the benchmarking collaborative.

Catholicism↗
PubMedDate not supplied

Benchmarking: breakthrough results through structured analysis.

Benchmarking is the continuous process of measuring processes, services and practices against the toughest competition, or against companies recognized as industry leaders, for the purpose of identifying and adopting best practices. To facilitate this process, the Hamilton Civic Hospitals has developed a series of benchmarking templates, loosely based on the "unified model" of quality. This article presents the templates and describes their application as part of a benchmarking feedback loop.

Efficiency, Organizational↗