Integrating Palliative Care to Promote Earlier Conversations and to Increase the Skill and Comfort of Nonpalliative Care Clinicians: Lessons Learned From an Interventional Field Trial.

While the uptake of palliative care in the United States is steadily improving, there continues to be a gap in which many patients are not offered care that explicitly elicits and respects their personal wishes. This is due in part to a mismatch of supply and demand; the number of seriously ill individuals far exceeds the workload capacities of palliative care specialty providers. We conducted a field trial of an intervention designed to promote the identification of seriously ill patients appropriate for a discussion of their goals of care and to advance the role of nonpalliative care clinicians by enhancing their knowledge of and comfort with primary palliative care skills.

Surgical Specimen Management: A Descriptive Study of 648 Adverse Events and Near Misses.

Context: - Surgical specimen adverse events can lead to delays in treatment or diagnosis, misdiagnosis, reoperation, inappropriate treatment, and anxiety or serious patient harm.

Objectives: - To describe the types and frequency of event reports associated with the management of surgical specimens, the contributing factors, and the level of harm associated with these events.

Design: - A retrospective review was undertaken of surgical specimen adverse events and near misses voluntarily reported in the University HealthSystem Consortium Safety Intelligence Patient Safety Organization database by more than 50 health care facilities during a 3-year period (2011-2013).

Advancing a Culture of Health: Population Health Programs in Place at Essential Hospitals and Academic Medical Centers (2012-2014).

This study is a systematic review of a national sample of hospital-led population health programs in place at essential hospitals and academic medical centers in the US from 2012 to 2014. We conducted a content analysis of abstracts describing 121 population health initiatives to understand how hospital leaders are translating population health objectives into action. Intended patient population, services provided, and outcomes measured are described.

The Prevalence of Inpatients at 33 U.S. Hospitals Appropriate for and Receiving Referral to Palliative Care.

Background: The extent of unmet need for palliative care in U.S. hospitals remains largely unknown.

The characteristics of patients frequently admitted to academic medical centers in the United States.

Background: The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishing characteristics that require novel solutions.

Methods: A comprehensive administrative database (University HealthSystem Consortium's Clinical Data Base/Resource Manager) was analyzed to identify demographic, social, and clinical characteristics of frequently admitted patients in 101 US academic medical centers.

Governance practices and performance in US academic medical centers.

Recognition of the complex nature of modern health care delivery has led to interest in investigating the ways in which various factors, including governance structures and practices, influence health care quality. In this study, the chief executive officers (CEOs) of US academic medical centers were surveyed to elicit their perceptions of board structures, activities, and attitudes reflecting 6 widely identified governance best practices; the relationship between use of these practices and organizational performance, based on the University HealthSystem Consortium's Quality & Accountability rankings, was assessed. High-performing hospitals showed greater use of all 6 practices, but the strongest evidence supported a focus on board member education and development, the rigorous use of performance measures to guide quality improvement, and systematic board self-assessment processes.

Retained surgical sponges: findings from incident reports and a cost-benefit analysis of radiofrequency technology.

Background: Retained surgical items (RSIs) are serious events with a high potential to harm patients. It is estimated that as many as 1 in 5,500 operations result in an RSI, and sponges are most commonly involved. The adverse outcomes, additional medical care needed, and medico-legal costs associated with these events are substantial.

The reliability of AHRQ Common Format Harm Scales in rating patient safety events.

Objectives: A study was conducted to determine the reliability of Agency for Healthcare Research & Quality (AHRQ) Common Format Harm Scale versions 1.1 and 1.2 in rating patient safety events among users of the UHC Patient Safety Net, a Web-based incident reporting tool.

An analysis of patient falls and fall prevention programs across academic medical centers.

UHC conducted an analysis of more than 25 000 patient fall reports entered into the UHC Patient Safety Net incident reporting tool. Gaps were found in the completion of fall risk assessments, the ability of tools to accurately assess risk, and prevention strategies in particular inpatient units and emergency department. Common factors in falls resulting in major harm or death included age more than 80 years, altered mental status, ambulation (often without assistance), toileting, and diuretics and anticoagulants.

Using patient safety morbidity and mortality conferences to promote transparency and a culture of safety.

Background: Although creating a culture of safety to support clinicians and improve the quality of patient care is a common goal among health care organizations, it can be difficult to envision specific efforts to directly influence organizational culture. To promote transparency and reinforce a nonpunitive attitude throughout the organization, a forum for the open, interdisciplinary discussion of patient safety problems--the Patient Safety Morbidity and Mortality (M&M) Conference--was created at Northwestern Memorial Hospital (Chicago). The intent of the M&M conference was to inform frontline providers about adverse events that occur at the hospital and to engage their input in root cause analysis, thereby encouraging reporting and promoting systems-based thinking among clinicians.

Compliance with acute MI guidelines lowers inpatient mortality.

Within the last decade, health care providers have seen the emergence of numerous patient care guidelines that can be used to prevent or manage specific medical conditions. The American College of Cardiology (ACC) and American Heart Association (AHA) have issued guidelines for the management of patients with acute myocardial infarction (AMI). In November of 2002, at the annual scientific session of the AHA, researchers presented the results of the first study to show a direct relationship between inpatient mortality and the level of a hospital's compliance with these guidelines.