Increasing Frequency of Hemoglobin A1c Measurements in Hospitalized Patients With Diabetes: A Quality Improvement Project Using Lean Six Sigma.

Background: The American Diabetes Association (ADA) recommends measuring A1c in all inpatients with diabetes if not performed in the prior three months. Our objective was to determine the impact of utilizing Lean Six Sigma to increase the frequency of A1c measurements in hospitalized patients.

Methods: We evaluated inpatients with diabetes mellitus consecutively admitted in a community hospital between January 2016 and June 2021, excluding those who had an A1c in the electronic health record (EHR) in the previous three months.

COVID-19 and telehealth in the intensive care unit setting: a survey.

Background: Coronavirus disease (COVID-19) has led to changes in how healthcare is delivered. Here, through the administration of surveys, we evaluated telehealth use and views in US intensive care units (ICUs) during the pandemic.

Methods: From June 2020 to July 2021, voluntary, electronic surveys were provided to ICU leaders of Johns Hopkins Medical Institution (JHMI) hospitals, members of the Neurocritical Care Society (NCS) who practice in the US, and Society of Critical Care Medicine (SCCM) members practicing adult medicine.

Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives.

Background: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown.

Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting.

Background: Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting.

Implementing a Health System-wide Patient Blood Management Program with a Clinical Community Approach.

Background: Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.

Methods: We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals.

Saccharomyces boulardii probiotic-associated fungemia: questioning the safety of this preventive probiotic's use.

We report a case of fungemia in an immunocompetent patient after administration of probiotic containing Saccharomyces boulardii. We demonstrated the strain relatedness of the yeast from the probiotic capsule and the yeast causing fungal infection using genomic and proteomic typing methods. Our study questions the safety of this preventative biotherapy.

Fostering Clinical Excellence Across an Academic Health System.

Objectives: Changes in the US healthcare economic system are requiring academic health centers (AHCs) to restructure in pursuit of their traditional tripartite missions; engaging the individuals focused on clinical care is becoming more important. We conducted this study to guide our institution's transformation by identifying ways to formally recognize clinicians who are excelling in patient care and understand which forms of acknowledgment would be acceptable and motivating.

Methods: A survey was developed by a large committee with representation spanning the AHC and was sent electronically in spring 2014 to stakeholders across the institution.

Clinical Communities at Johns Hopkins Medicine: An Emerging Approach to Quality Improvement.

Background: Clinical communities are an emerging approach to quality improvement (QI) to which several large-scale projects have attributed some success. In 2011 the Armstrong Institute for Patient Safety and Quality established clinical communities as a core strategy to connect frontline providers from six different hospitals to improve quality of care, patient safety, and value across the health system. CLINICAL COMMUNITIES: Fourteen clinical communities that presented great opportunity for improvement were established.

Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.

Objective: Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized ICUs have superior patient outcomes compared with less highly protocolized ICUs.

Design: Observational study in which participating ICUs completed a general assessment and enrolled new patients 1 day each week.

Structure, process, and annual ICU mortality across 69 centers: United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.

Objective: Hospital-level variations in structure and process may affect clinical outcomes in ICUs. We sought to characterize the organizational structure, processes of care, use of protocols, and standardized outcomes in a large sample of U.S.

Compensatory increased enteral feeding goal rates: a way to achieve optimal nutrition.

Background: Traditionally, enteral nutrition (EN) goal rates have been calculated based on an intended continuous 24-hour infusion rate. Many factors in the care of critically ill patients result in interruption of EN infusions, often for several hours daily, which may lead to significant underfeeding. The objective of this study was to evaluate the difference of daily EN volume deficits between a traditionally calculated infusion rate and a compensatory, higher calculated infusion rate in which the 24-hour volume was delivered over a 20-hour infusion period.

Guidelines for the inter- and intrahospital transport of critically ill patients.

Objective: The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient.

Data Source: Expert opinion and a search of Index Medicus from January 1986 through October 2001 provided the basis for these guidelines. A task force of experts in the field of patient transport provided personal experience and expert opinion.

Cost reduction and outcome improvement in the intensive care unit.

Objective: Decreasing reimbursement provided by third-party payors necessitates reduction of costs for providing critical care services. If academic medical centers are to remain viable, methods must be instituted that allow cost reduction through practice change.

Methods: We used short cycle improvement methodology to rapidly achieve these goals.

Comparison of infrared ear thermometer derived and equilibrated rectal temperatures in estimating pulmonary artery temperatures.

Objectives: To investigate the clinical accuracy of infrared ear thermometer derived and equilibrated rectal temperatures in estimating core body temperature. The clinical bias (i.e.

MRI protocol for critically ill patients.

BACKGROUND Ventilators compatible with magnetic resonance imaging machines are not universally available. However, the lack of such equipment should not preclude magnetic resonance imaging. We have developed a method by which a critically ill patient requiring mechanical ventilation can safely undergo such imaging without compatible equipment.

A nurse-directed protocol using pulse oximetry to wean mechanically ventilated patients from toxic oxygen concentrations.

The usual method of weaning mechanically ventilated patients from high FIO2 in our ICU, in which housestaff ordered all ventilator changes in an unstandardized manner (control group), was compared to a nurse-directed protocol that used a single arterial blood gas (ABG) analysis and multiple pulse oximetry measurements. The protocol required an ABG to be obtained upon the initiation of intubation/mechanical ventilation, followed by pulse oximetry measurements obtained in accordance with a standardized timetable. Decreases in FIO2 were guided by these results.