Improving vital sign documentation at triage: an emergency department quality improvement project.

Background: Improving the quality and safety of patients seen in an emergency department (ED) has become a priority in Italy. The Tuscan Regional Health Ministry has supported quality improvement projects in several Tuscan EDs in cooperation with Harvard Medical International and Harvard Medical School.

Objective: To improve the triage process, we assessed the completeness of documenting the vital signs of patients seen at triage in the ED of the University Hospital Santa Chiara, Pisa, Italy.

Health impact assessment and short-term medical missions: a methods study to evaluate quality of care.

Background: Short-term medical missions (STMMs) are a well-established means of providing health care to the developing world. Despite over 250 million dollars and thousands of volunteer hours dedicated to STMMs, there is a lack of standardized evaluation to assess patient safety, quality control, and mission impact. The objective of this project is to design and implement an assessment tool that defines objective parameters of quality of care as identified by STMMs.

Privately funded quality health care in India: a sustainable and equitable model.

Objective: As the cost and degree of training necessary to provide state of the art health care has increased throughout the world, the present challenge in health care is to establish institutions that are financially sound and responsive to the dynamic needs of the communities in which they exist. As public funds have diminished, the role of the private sector in estabhshing innovative health care institutions has increased.

Setting And Study Participants: This paper reviews the case of the LV Prasad Eye Institute (LVPEI), an ophthalmologic institute in Hyderabad, India, that is financially sound and medically vital.

Critical pathways intervention to reduce length of hospital stay.

Purpose: Despite their popularity, critical pathways have been evaluated in only a few controlled studies. We evaluated the effectiveness of critical pathways in reducing length of hospital stay.

Subjects And Methods: We compared postoperative lengths of stay of patients who underwent coronary artery bypass graft (CABG) surgery, total knee replacement, colectomy, thoracic surgery, or hysterectomy before and after pathway implementation at a university hospital.

Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan.

Purpose: Unplanned hospital readmission within 30 days of discharge is considered a "sentinel event" for poor quality. Patients at high risk for this adverse event could be targeted for interventions designed to reduce their risk of readmission. The purpose of this study was to identify patient characteristics and risk factors at discharge associated with unplanned readmission within 30 days of hospital discharge.

Effect of computerized physician order entry and a team intervention on prevention of serious medication errors.

Context: Adverse drug events (ADEs) are a significant and costly cause of injury during hospitalization.

Objectives: To evaluate the efficacy of 2 interventions for preventing nonintercepted serious medication errors, defined as those that either resulted in or had potential to result in an ADE and were not intercepted before reaching the patient.

Design: Before-after comparison between phase 1 (baseline) and phase 2 (after intervention was implemented) and, within phase 2, a randomized comparison between physician computer order entry (POE) and the combination of POE plus a team intervention.

Payer-hospital collaboration to improve patient satisfaction with hospital discharge.

Background: Brigham and Women's Hospital, in Boston, and its major health maintenance organization (HMO), Harvard Community Health Plan, collected data in spring 1994 which revealed that patients were less satisfied with hospital discharge planning than with other elements of care.

Problem Identification Process: An interdisciplinary team, formed in November 1994 and composed of eight members from the hospital and HMO, used data from the hospital's Patient Satisfaction Survey, flowcharting, and phone interviews with patients to identify discharge planning-related problems. For example, follow-up contact with patients after discharge was erratic and no clear signal of the successful "hand off" of care from the hospital team to the community team existed.

Quality improvement in a hospital pharmacy department.

This article reports the successful implementation of two quality improvement efforts in the central pharmacy of a large tertiary care facility. The authors, who were participants in the project, describe the steps taken and the graphic tools used to document processes and measure improvements. The experience confirms that health care organizations can apply techniques of total quality management taken from other types of organizations.