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PubMed2006

The implementation of occupational health guidelines principles for reducing sickness absence due to musculoskeletal disorders.

BACKGROUND: Occupational health guidelines recommend a biopsychosocial approach to manage sickness absence due to musculoskeletal disorders (MSDs), with a primary focus on early intervention through provision of a supportive network. AIMS: To investigate the implementation of a guidelines-based intervention (early contact of absentees; addressing psychosocial obstacles; offering temporary modified work; communicating among the players), and to determine whether this is effective for reducing return-to-work times and duration of future absence. METHODS: A non-randomized controlled trial was conducted within a UK company. Occupational health nurses at two experimental sites (1,435 workers) were trained to deliver the intervention to workers taking absence due to MSDs (low back and upper limb disorders), while usual care was delivered at three control sites (1,483 workers). Company-recorded absence data were collected over a 12-month follow-up period. RESULTS: The implementation of the experimental intervention was impeded by unforeseen organizational obstacles at one site (policies, procedures and individual approaches) which had a detrimental effect on uptake and delivery. At the site where the intervention was delivered per protocol, absence was significantly less compared with controls; 6.5 and 10.8 days, respectively. However, the duration of future absence was not significantly different (13.0 and 25.1 days, respectively). CONCLUSIONS: An early intervention addressing psychosocial obstacles to recovery can be effective for reducing absence due to MSDs. Successful implementation, where the key players are onside and organizational obstacles are overcome, is difficult to achieve.

England↗

PubMed2000

Selection and implementation for coagulation instruments/reagents in a multiple hospital/clinic network.

Selection, standardization, and implementation of instrumentation and reagents throughout a health care facility network can often be a difficult process. However, in today's ever-changing health care setting, it is often mandated. The Veteran's Integrated Systems Network 16 (VISN 16) was faced with such a task early in 1999, with the targeted area being its coagulation laboratories. The plan outlined in this paper was drafted to help facilitate the selection, standardization and implementation of coagulation systems for 17 health care facilities that make up the VISN 16 network. The VISN, encompassing 170,000 square miles, has 10 tertiary care hospitals, six of which have close relationships with affiliate universities. There are 299,733 patients enrolled in this health delivery system. The facilities range from large institutions performing both tertiary and outpatient care to small outpatient clinics. Because of the plan's detailed, comprehensive content, which included analyses of a large number of performance parameters as well as cost-efficiency, the selection process was carried out using a checklist that could be helpful to other organizations selecting equipment and reagents for coagulation studies. An implementation process was devised, resulting in coagulation standardization across the Integrated Health Network.

Autoanalysis↗

PubMed1994

Implementation of the AHCPR pain guidelines for children.

Successful implementation of Agency for Health Care Policy and Research (AHCPR) clinical practice guidelines must involve an institutional commitment and an interdisciplinary effort. This article describes how a pediatric nursing research committee took the leadership role in implementing the AHCPR acute pain guidelines for children. Steps toward implementation included assessment of current practice methods, nursing interventions, interdisciplinary interventions, and plans for evaluating the practice change through the institutional quality assessment and improvement program.

Acute Disease↗

PubMed1996

Clinical pathway implementation in the acute care hospital setting.

A study was conducted to assess the current status of clinical path implementation for acute care cases and to explore implementation issues related to defining discharge outcomes and measuring variances in clinical paths. Results indicated that documentation, identification of critical indicators and discharge outcomes, and variance detection and correction are three core issues that must be addressed by institutions that implement clinical paths. A discussion of each of these areas is provided.

Critical Pathways↗

PubMed1975

Implementing university hospital ambulatory care evaluation.

The clinics of a single university hospital center were observed to determine a practical rationale for and impediments to implementing a medical care evaluation program. A quality assurance mechanism is especially important in the ambulatory care setting because of problems with patient compliance, lack of policy continuity, lack of intercommunication among care providers, no counterpart for most inpatient quality-oriented activities, structural defects in many clinics, and general emphasis on the inpatient medicine. Impediments to implementing quality assurance programs include the condition of clinic records and individual charts, lack of established criteria for care, problems of care provider intercommunication during the evaluation process, manpower availability, choice of evaluation method, and method of implementing resulting plans for corrective action.

Ambulatory Care↗

PubMed1999

The "Balanced Scorecard": development and implementation in an academic clinical department.

If quality medical education is to survive in the increasingly competitive marketplace, medical schools need to adopt new tools that measure the value of all initiatives, both financial and non-financial, so that they can make informed decisions about their missions and future direction. The authors describe a tool of this kind called the Balanced Scorecard (originally created for traditional businesses), outline the version of it that they developed for the Department of Anesthesiology at Yale University School of Medicine, and discuss the first year of implementation (which began in 1997). The Balanced Scorecard is a set of measures designed to examine an organization's performance from the following four perspectives and to answer the key question suggested by each perspective: (1) The learning and growth perspective: Can we continue to improve and create value? (2) The internal business perspective: What must we excel at? (3) The customer perspective: How do our customers see us? (4) The financial perspective: How do we look to our shareholders? The first year of implementation of this approach at the Department of Anesthesiology involved creating measures of the four perspectives, determining whether data could be found for each measure and whether the data were in usable forms, and educating and involving the faculty in the process. The authors discuss the pros and cons of the Balanced Scorecard approach that they observed during the first year, and conclude with a list of seven lessons learned (e.g., start with measures that already exist). Overall, they are convinced that the Balanced Scorecard can be of great value to a department, even if the full implementation takes several years to complete.

Academic Medical Centers↗

PubMed1994

CNS roles in implementation of a differentiated case management model.

As advanced nursing practitioners and consultants, CNSs are leaders in affecting changes in nursing practice. During implementation of Primm's model of differentiated case management at Community Memorial Hospital, Menomonee Falls, Wisconsin, the CNSs enacted the roles of implementation consultant, researcher, direct care provider, educator, and performance and project evaluation consultant. The CNSs were committed to initiating and maintaining change, and facilitating momentum to incorporate the differentiated levels of staff nurse practice. We describe CNS roles in this process as well as outcomes seen after implementation of differentiated case management.

Education, Nursing, Continuing↗

PubMed2001

Comparing loudness normalization (IHAFF) with speech intelligibility maximization (NAL-NL1) when implemented in a two-channel device.

OBJECTIVE: At least two rationales are available for fitting wide dynamic range compression hearing aids. The goal of one rationale is to normalize loudness, and the goal of the second rationale is to maximize speech intelligibility. Neither rationale has been validated against other fitting rationales for the range of input levels common to the hearing aid user in the real world. The goal of the study was to compare the two rationales when implemented in a 2-channel compression hearing aid. DESIGN: Loudness normalization and speech intelligibility maximization were implemented using the Independent Hearing Aid Fitting Forum (IHAFF) and the National Acoustic Laboratories' Nonlinear (NAL-NL1) prescriptive formulas. Twenty-four subjects (eight for each of three groups of mild flat, moderate/severe flat, and steeply sloping hearing loss) participated in the study. Each subject completed an initial laboratory test, field test, and final laboratory test. The laboratory test consisted of a paired-comparison judgment for each prescriptive formula using four stimuli under both quiet and noisy listening conditions and a sentence recognition test using Bamford-Kowal-Bench sentences. In the field test, subjects evaluated the two rationales in individually selected everyday listening conditions for 4 wk. A digital simulation of the fitting rationales implemented in two channels was used for laboratory testing and a digital 2-memory, 2-channel device was used for field testing. Subjects adjusted the overall gain of each response to their preferred listening level in both the laboratory and in the field. RESULTS: Data collected in the laboratory before and after the field test showed no indication of significant learning or acclimatization effects. For each stimulus presented in the paired-comparison test more subjects preferred NAL-NL1 than preferred IHAFF. For the sentence recognition test, subjects performed significantly better with NAL-NL1 than IHAFF in a low-frequency weighted background noise. Sixteen out of 22 subjects who completed the field test reported a preference for the NAL-NL1 response. The remaining six subjects preferred IHAFF. The paired-comparison test and field test revealed that while the achieved root-mean-square (rms) difference between fittings for an input level of 65 dB SPL was small, the preference for either rationale was small. As the rms difference between fittings increased, the score in favor of NAL-NL1 increased. The correlation between the differences in satisfaction score obtained in the field test and the rms differences between the responses fitted was statistically significant. CONCLUSIONS: When the two fitting rationales prescribed substantially different responses for a 65 dB SPL input and these differences were achieved in the fitting, then the subjects preferred NAL-NL1. Even when the difference between fittings was small, the subjects preferred and performed better with NAL-NL1 when listening in a low-frequency weighted background noise.

Acoustic Stimulation↗

PubMed2001

Interorganizational health care systems implementations: an exploratory study of early electronic commerce initiatives.

Changing business practices, customers needs, and market dynamics have driven many organizations to implement interorganizational systems (IOSs). IOSs have been successfully implemented in the banking, cotton, airline, and consumer-goods industries, and recently attention has turned to the health care industry. This article describes an exploratory study of health care IOS implementations based on the voluntary community health information network (CHIN) model.

Commerce↗

PubMedDate not supplied

Early-stage success in service line implementation.

The results of a multimethod, qualitative data collection approach reveal a high level of consistency between early-stage dynamics identified in service line implementation and dynamics viewed within life cycle theory as more observable during the birth stage of development. This finding supports the idea that service line implementation unfolds similarly compared with other types of structures. In addition, it presents a more complex view of service line implementation at any given point in time by linking its unique aspects with issues and dynamics particular to the developmental stage in which the structure exists. The organization examined was the Behavioral Health Service Line of the Upstate New York Veterans Healthcare Network.

Community Mental Health Services↗

PubMedDate not supplied

User training costs in medical information system implementation.

Implementation of a Medical Information System (MIS) in a hospital environment is a complex, problematic, long-term endeavor. St. Vincent Hospital and Medical Center (SVHMC) in Portland, OR, completed the implementation of its base MIS five and one-half years after the original contract was signed. SVHMC prepared the MIS users through an extensive and well-documented training program focused on user competence and user acceptance. Over five and one-half years, 4581 individuals received 9,359 hours of training. Direct training costs were $116,000; total training costs were $317,000. There are many other costs to implement a major MIS project. Reported here are only the costs related to training the system's users. Training costs can be insidious and are often under estimated as institutions plan for large scale MIS projects.

Computers↗

PubMed1993

Changing the delivery of nursing care. Implementation issues and qualitative findings.

Faced with a shortage of professional nurses, 37 hospitals in New Jersey implemented a variety of approaches to changing the delivery of nursing care. Implementation issues, including the positive and negative effects of the changes, are discussed. Most project coordinators reported that implementation was more difficult than they had anticipated.

Computer Terminals↗

PubMed2004

The Meaningful Retention Strategy Inventory: a targeted approach to implementing retention strategies.

The present and projected shortage of registered nurses mandates that administrators implement workplace incentives to retain current staff. Although several articles and studies exist on job satisfaction among nurses, few have examined retention strategies. The authors developed, tested, and implemented a tool, the Meaningful Retention Strategy Inventory, in a multihospital system. Results from the Meaningful Retention Strategy Inventory were used to guide decisions in the implementation of site-specific retention strategies.

Adult↗

PubMed2002

Implementing preterm labor guidelines: a collaborative care improvement process.

Health care organizations today are being challenged to deliver care that is cost-effective, satisfying to patients, and based on quality outcomes. Urgency created by inadequate bed capacity as well as financial opportunity prompted United Hospital's Birth Center to launch care improvement activities aimed at assessing appropriateness of antepartal length of stay. Collaboration between all members of the health care team enabled a steering committee to implement evidence-based provider practice guidelines targeting variance around preterm labor management. Other multidisciplinary strategies implemented include a home care prescreening process, case management, and establishment of a peer review process. Within the 1-year care improvement process, the Birth Center successfully decreased the length of stay for preterm labor patients from 6.9 days to 5.3 days. This article describes one institution's efforts to improve care by implementing guidelines for the inpatient management of preterm labor.

Birthing Centers↗

PubMedDate not supplied

Car seat challenges: where are we in implementation of these programs?

Premature infants and infants with special needs are being discharged home at smaller weights and earlier postconceptional ages. This presents a challenge to safely transporting these infants in car seats. Car seat technology has not kept abreast of advances experienced in neonatal medical technology. Several studies have demonstrated that preterm infants are at risk for apnea, bradycardia, and oxygen desaturations while being transported in traditional car seats. The American Academy of Pediatrics issued policy statements recommending that all infants less than 37 weeks of gestational age be monitored in a car seat safety test prior to discharge. This article reviews current literature on implementing car seat safety testing in hospitals and the results of a research survey of newborn nursery and neonatal intensive care units across the United States to evaluate the status of these facilities in implementing car seat safety testing programs. The results show that many level II and level III units have begun to implement car seat safety programs despite the lack of literature and guidelines available on how to develop a program. Although most programs monitored the same criteria, there were variations in length of testing, which infants were tested, and recommendations for the infants who failed the testing.

Consumer Product Safety↗

PubMed1989

Implementation of intraosseous infusion technique by aeromedical transport programs.

Aeromedical transport program implementation of intraosseous infusion (IOI) was ascertained by telephone survey. One hundred thirty-three programs were polled: 69.2% had never utilized IOI nor were considering its use; 13.5% had previously utilized IOI; 15.8% had not yet implemented IOI but had been in-serviced on the technique; and 1.5% were considering implementation. Of 39 programs previously in-serviced or presently utilizing the procedure, seven restricted IOI insertion to physicians while 32 permitted placement by nurses or paramedics. Half of the programs would pursue IOI immediately after a 5-minute trial of peripheral line placement in preference to cutdown or central venous line attempts. About 50 IOI were performed by aeromedical transport personnel in 1986. Rate of successful insertion was approximately 80%. Complications were few and minor. This survey demonstrates that the simple, safe technique of IOI is being grossly under-utilized and warrants further consideration.

Aircraft↗

PubMed2003

Implementation of a tertiary trauma survey decreases missed injuries.

BACKGROUND: Missed injuries (MIs) adversely affect patient outcome and damage physician/institutional credibility. The primary and secondary surveys are designed to identify all of a patient's injuries and prioritize their management; however, MIs are prevalent in severely injured and multisystem trauma patients, especially when the patient's condition precludes completion of the secondary survey. We hypothesized that implementation of a routine tertiary trauma survey (TS) would reduce the incidence of MIs in a Level I trauma center. METHODS: In mid 1999, a TS form was created and TS documentation was mandated on all trauma intensive care unit (TICU) patients within 24 hours of admission. Patient data, including TS documentation and injury patterns, were concurrently recorded in an institutional trauma registry. Data were compared for patients admitted in 1997 to 1998 (PRE period) and 2000 to 2001 (POST period) using chi or Student's test. RESULTS: MIs decreased from 2.4% to 1.5% overall, and from 5.7% to 3.4% in TICU patients, after TS implementation. Patients with MIs were slightly older (49 vs. 45 years; > 0.05) and had higher Injury Severity Scores (21 vs. 10; < 0.05) than patients without MIs. Sixty percent of MI patients had brain injuries, 56% were admitted to the TICU, and 26% went directly from the emergency department to the operating room. The large majority of MIs in the POST period were detected in patients not undergoing timely TS. CONCLUSION: ICU patients-particularly brain injury victims and those undergoing emergent surgical procedures-appear to be at highest risk for MI. Implementation of a standardized TS decreased MIs by 36% in our Level I trauma center, and more timely TS would likely have further reduced MIs. A TS should be routine in trauma centers.

Adult↗

PubMed1999

The rural health care workforce implications of practice guideline implementation.

BACKGROUND: Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines. PURPOSE: To estimate the impact of a practice guideline for a single health condition on the needs of a rural health professional workforce. METHODS: The current care of a cohort of rural Medicare recipients with diabetes mellitus was compared with the care recommended by a diabetes practice guideline. The additional tests and visits that were needed to comply with the guideline were translated into additional hours of physician services and total physician full-time equivalents. RESULTS: The implementation of a practice guideline for Medicare recipients with diabetes in rural Minnesota would require over 30,000 additional hours of primary care physician services and over 5,000 additional hours of eye care professionals' time per year. This additional need represents a 1.3% to 2.4% increase in the number of primary care physicians and a 1.0% to 6.6% increase in the number of eye-care clinicians in a state in which the rural medical provider to population ratios already meet some recommended workforce projections. CONCLUSIONS: The implementation of practice guidelines could result in an increased need for rural health care physicians or other providers. That increase, caused by guideline implementation, should be accounted for in future rural health care workforce predictions.

Aged↗