| 1. |
Medication errors - computerization of MAR But the electronic MAR is not "user friendly" and difficult for me as physician to read. Many bugs to work out but better than paper system. Fix is beyond my capability Protocols for common diagnosis being developed and implemented including Stroke with multidisciplinary team. Strong leadership by neruology - and extra funding by county - made difference. |
| 2. |
Patient flow problems have been a major issue but have been addressed in multiple ways and we can see improvments already. A large amount of effort and expense was put into streamlining discharge processes, keeping discharge planning "in front of" the physicians and nursing staff and more recently, an estimated discharge date is at least attempted when the patient is admitted so planning can begin right away. |
| 3. |
Divert problems secondary to bed availability. Multipronged approach including discharge waiting area, improved communication across organization, looking into software support for bed status tool, facility team support to address high census in ED to help with dispo to units. |
| 4. |
Patient flow or utilization of emergency services are not the best. Generating alternative service paths require support of physician population that could best utilize the alternative service. Creation of alternative service path does require extended time line in development and modifing the behavior of physicians. |
| 5. |
Overuse of care. Many issues under this category relate more to psycho-social dynamics of healthcare than to actual illnesses. Patients use the medical office as an avenue to discuss persoanl issues that impact their living conditions. For these situations, the patient are referred to a Social Worker or other ancillary healthcare person depending on the patient's needs |
| 6. |
Delays in ED and direct admits to the floors. Attempts are being made at improved bed turn around times, better discharge planing and more rapid bed placment policies |
| 7. |
Our computer scheduling system that comes with our EMR is very rigid. Major fixes will have to wait until the upgrade of the system in the next 1-2 years. In the meantime, we are looking at what our department can do to try to optimize the situation in the short term. |
| 8. |
After my VTach cardiac arrest (no joke!, it happened while at work!) I went into therapy to cope with the stress of not being able to make a difference. Medication (cardiac, not psychiatric) has helped. There are too many ineffeciencies to count. I'll probably require a defibrillator/pacer if I try to make a difference and I now realize I am unempowered to accomplish anything in my lifetime. |
| 9. |
We are now linking bonus pay with quality improvement efforts including patient care, decreasing medical liability claims, corporate citizenship and meeting quality indicators by department. |
| 10. |
EXTENSIVE PEX PROGRAM FOR ED THRU-PUT TO DECREASE WAIT TIME AND ELOPEMENTS AND RELIEVE THE OVERCROWDING THAT IS DUE TO BACKLOG OF GETTING PATIENTS ADMITTED |
| 11. |
Barcoding for medication administration; central line protocols, computerized physician order entry; patient flow committee |
| 12. |
Patient flow problems: huge. Physical lack of acute care beds (ICU telemetry) vs. lack of money to invest in more. Inefficient in house bed managing being addresse dthrough various forms of discharge planning committees, Code Purple, etc. |
| 13. |
We have just started using EMR. Hopefully, this will help in helping with any inneficiencies we have and help with patient flow. |
| 14. |
Poor patient flow - high priority. Awareness raised by CEO emailing every patient and asking for feedback around being seen on time. Specific pressure put on clinics to identify roadblocks and correct them (of course without money). Overall, improved flow. |
| 15. |
Occupancy is often too high making transfers betweenm levels of care difficult. Many bed-management approaches/ software related changes have taken place but increasing pressure from critical access hospitals seem to consume our gains. |
| 16. |
problem at night with pediatric IV admixtures... hired a night pharmacist with peds experience |
| 17. |
"Overuse or underuse of care" is addressed with a voluntary hospitalist program. However, the standards of the hospitalist program appear to be substandard when compared with some active groups of physicians. |
| 18. |
Getting patients discharged in a timely fashion is a major impediment to flow within the hospital. Patients end being held in the ED, tying up ED beds, or in PACU. Both of these increase the waiting times and impacts productivity and patient satisfaction. A multidisciplinary committee has been formed to address the issue, speed the admission and discharge process and monitor the progress as new steps are implemented. |
| 19. |
We re-organized our admission process to reduce the time patients wait in the ED for a bed from 153 minutes to 55 minutes on average, with 80% of patients getting a bed in *60 minutes. This helped reduce overcrowding and wait times to see the doctor in the ED. |
| 20. |
patient flow, no solutions at present, building more beds currently |
| 21. |
working on med reconciliation at hosp discharge with hosp systme and our system |
| 22. |
patient flow issues impact the system by decreasing bed turnovers ultimately affecting the bottom line; a hospitalist program has been implemented and is making impact. |
| 23. |
Poor morale,quality,patient satisfaction and productivity are adversely affected by patient flow problems. We are seeking outside consultation but limited resources are a barrier to correction. |
| 24. |
We are a managed care organization with "Patient flow problem" manifested as long waiting time for services that was handled by outsourcing some of these services to other providers in the region so the physician group improved thier performance |
| 25. |
No Comments |
| 26. |
Unexplained variance in care is being dealt with through the development of order sets and guidelines by our Best Practice committee. |
| 27. |
Unexplained variance is being investigated with various standardized techniques to determine the source of the variance; standardized approached to investigation as well as standardized solutions to decrease variance are being implemented. |
| 28. |
Implemented medication bar-coding to improve accuracy of medication administration and reduce adverse drug events. |
| 29. |
Implementing a new Electronic Medical Record. An implementation team is looking at patient flow and data input into the EMR to reduce the amount of data entry requirements for physicians. |
| 30. |
Development of standard order sets and guidelines to standardize care for our major DRG's. Some are inplace and are working. |
| 31. |
We have had protocols for ACS, Pneumonia CHF, Stroke for over 3 yrs. M.D. resistance to its implementation has been a major obstacle. Administration's attempt to have an optimal pt. FTE ratio many times lead to "a full house" and therefore having to turn patients away even if we're way below our licensed bed capacity. |
| 32. |
Emergency room triage policies and procedures, handling of ambulance arrivals create a backlog of patients. Morbidity and mortality conferences have begun to design an approach and plan for these problems. |
| 33. |
SAFETY ISSUES HEAVILY PROMOTED MONITORING OF VARIANCES NURSING STAFFING BEING ADDRESSED. |
| 34. |
We are constantly evaluating and "fixing" medical errors and we are very behind on IT implementation due to little historical investment in a core system. We are working on "catching up" to current day technology tools. |
| 35. |
confidential reporting of safety issues identified |
| 36. |
The bigggest problem is ER through-put. We have hired a consultant (H*Works) to advise us on how to make the ER run more efficiently |
| 37. |
i am not considered by my hosp admin they are afraid of me |
| 38. |
increasing ALOS has affected ability to admit patients from ED in timely manner |
| 39. |
Causes redundancies and therefor wastes time and resources. Crew resource management is being introduced across the services. One department is looking at physicians who are the center of "activity", documenting their activities, bringing them to educational programs and revising policies to result in more stringent QA (TQM) targeting with a view toward inducing them to leave if issues persist. |
| 40. |
Through guidelines and procedures VAPs as well as catheter infections are lower than national benchmark |
| 41. |
Can not presently comment. |
| 42. |
unexplained variance of care-many iterations of this, our organization publishes evidence based quality measures from the hospitals and physicians. |
| 43. |
Variation in physician practice results in nursing not having a standard. We are developing more order sets and enforcing their use. |
| 44. |
We are improving communication and intake processes to make sure pt. flow is smooth and people get tho the place they need to be. |
| 45. |
Throughput. ED is built for a 35K capacity, functioning at 50K. Expansion in progress. Lean principles applied to maximize efficiencies. Bottlenecks in telemetry and desireable units ie step down. Also expanding floor beds. Multi-pronged approach. Errors and complications tracked & acted on in real time. |
| 46. |
Nurse epidemiologist keeps track of hospital acquired infections and they are trended per dept, physician and surgeon. Quality performanances are kept for drug reactions and transfusion reactions, Standard order sets have been developed for the Rx of stroke, CHF and pneumonia. |
| 47. |
All outpatient clinics are to undergo a patient flow/work flow analysis ovewr the next sevral months |
| 48. |
Patient flow issues relating to undercapacity. The hospital is overcrowded, resulting in closure of the ED to new patients 30% of the time. Patients are kept in the ED holding beds for up to two days, waiting for beds in the hospital. More inpatient beds are available, but floors are kept closed because staffing them would cost too much. |
| 49. |
Medical errors are reviewed bimonthly. If needed a root cause analysis is performed. Interventions are geared toward system changes as well as dealing withindividuals. Some things implemented: standardized dosing dispensed from pharmacy, including drips; computer order entry with prescreening reviews and specifically built order sets and screens. |
| 50. |
delay in transfer from ED, currently being evaluated |
| 51. |
Patient flow--opened an admission holding unit, added 16 med/surg beds, direct discussions with physicians to help flow patients (by VPMA and UR staff), expanding bed capacity of ED, "discharge by noon" program with physicians, patient team meetings every morning and evening, etc. |
| 52. |
Stock outs for medication and supplies, meaning when a nurse goes to the pyxis for a med or supply item it is out of stock. We have a team in place focused on a pull system to improve. Have seen a drop from 40 per day to less than 10 |
| 53. |
We are in the midst of implementing and EMR to reduce medical errors. Unfrotunately, so far the number of errors have inexplicably increased. Patients are not receiving ordered meds. Orders entered into the computer are not making their way to lab or pharmacy, etc. Lots of bugs are in the EMR that were not supposed to be part of the vendor's package. |
| 54. |
We are promoting transparency and reviewing, individually, data with each affected physician. |
| 55. |
Medication reconciliation and unit based Pharm D's, standardized order sets and pathways, hospitalists |
| 56. |
Our "bottle neck" is on time discharges (before noon) Due to unavailibility of test results, pending consultations. It "jams" the flow of patienys from ER. Cannot be corrected due to lack of funds to adequate clerical personnel. |
| 57. |
Medication errors. Flow process of ordering medication to delivery has been reviewed and revamped. |
| 58. |
Cost varience in CV services between two large CV groups.We are starting discussions to develope pathways to decrease cost while maintaining quality outcomes. |
| 59. |
Root cause analysis of incidents of significance. |
| 60. |
We are in the process of switching from paper to a fully paperless medical record |
| 61. |
There are times that a professional practice outside of standards; we are implementing a peer review process to assure monitoring |
| 62. |
EMR, CPOE, Pharmacist on envery unit, including the OR, EBM order sets (when there is evidence), a reasonable (but not great QA system), SCIP membership.... |
| 63. |
medication reconciliation implemented |
| 64. |
difficult to get ICU beds because of lack of nursing and poor patient flow |
| 65. |
Failure to follow our own guidelines - this is now something that is being very publically reported within our institution with a marked improvement in the compliance to follow the guidelines. |
| 66. |
Yes and No. Cost issues continue to be a reason for inadequate staffing of nurses on med-surg floors. |
| 67. |
UM review of hi tech imaging PET, CT, MRI to limit inappropriate use |
| 68. |
Access to care for enrolled populations was resolved by intsituting a " Sick Call" type of same day service. Pts have to wait but care is rendered on demand. |
| 69. |
Implementing a Central Line Check list Implementing MRSA screening for high risk patients |
| 70. |
med errors updating med list on EMR with every patient visit |
| 71. |
Ventilator associated infections minimized bt protocols that include all AHRQ guidelines |
| 72. |
PCOE, re-engineering pateint flow, hospital departmemntal quality indicators; pho profiling, analysis of adherence to evidence based clinical practice guidelines |
| 73. |
variance in care---we have increased scrutiny of primary care providers, and 'encouraged' several to limit scope of practice |
| 74. |
Interaction between pharmacy and nursing on inpt unit with short staffing and need to adhere to quality of care standards; unit leadership working closely on a daily basis to make changes; improved communication has led to improved work flow and patient outcomes |
| 75. |
patient flow and capacity management a major initiative with decreasing LOS for admitted and discharged patients in ED; OR TOT; and case management to keep beds open and available. Very successful.... |
| 76. |
developed "report cards" showing physicians where they stand compared to their peers locally as well as to a national data base regarding LOS and cost-per-case with the cost broken down into three major areas (pharmacy, lab, and radiology). |
| 77. |
Medication reconciliation project to be sure there are no errors in medication administration of inpatients. Has been a problem. |
| 78. |
Efforts are under way to identify variation, agree on appropriate care and implement the process changes required. |
| 79. |
Patient flow taskforce |
| 80. |
The larger the organization gets, the more administrative overlay there is - slows process improvement. Also, more levels to check for unseen impacts of changes. |
| 81. |
Inefficiency and long waiting times to be seen in the primary care offices. Staff not dedicated to improving patient flow. |
| 82. |
No available beds for admission of patients and going on diversion. We have established a process for early discharges and rapid turnover of beds. |
| 83. |
Inappropriately long follow-up periods are being addressed through ad-hoc on-call drop-in hours, but more staff resources are required. |
| 84. |
infection- post op Instituted anti-infection initiatives,e.g. clipping,not shaving; proper use of proph. antibiotics |
| 85. |
Re-energized Med Error Reduction Team, Medication Reconciliation Patient flow being addressed by adding more beds, as well as having constant vigilance by case management. |
| 86. |
We have Clinical Process Improvement Teams that are multidisciplinary and are focused on specific projects identified/prioritized to improve the above issues, by area of the hospital. In addition we have Clinical Operations Councils within our medical staff structure that identify and prioritize workshop related issues for nurses and physicians, with a focus on enhancing effectiveness, efficiency, safety and quality. |
| 87. |
-patient registry -pharmacy management program to increase appropriate generic medication use -implementation of practice guidelines -implementation of EHR |
| 88. |
Patient flow committee is working. |
| 89. |
Med reconcilliation - going to EMR |
| 90. |
performance teams formed to try to correct problems |
| 91. |
We are trying to address each of these issues. When a variance is suspected, performance evaluation is done for the entire department of performers comparing quality of performance. Address of the individual with quality issue occurs respectfully with identification of that performer only on the comparison data. Focused discussion of pertinent causes of lesser performance occurs and monitoring with communication has helped. |
| 92. |
Medication safety committee reviews all medication error reports that are submitted in a nonpunitive process. then the cause of erro0r is approached to prevent recurrences. |
| 93. |
Errors being addressed by EHR - outpt since 1999, and inpt since 2005. CPOE system wide by 7/2007. Over/underuse being addressed by protocols that are templated in computer-based system, but some physician resistance. Variation in care is the hardest to address bcs of intrenched practices. Newer docs, culture of quality improvement and external forces are helping to change that. |
| 94. |
The survey does not really apply to my organization as we are a true IPA in the messenger model and have not initiated any quality measures for our members besides NCQA compliant credentialing. |
| 95. |
change in pharmacy staffing and admin |
| 96. |
We have implemented a hospitalist program to address the overuse issue and variance. This is solving issues related to unassigned admissions from the ER. |
| 97. |
Overuse of care - for example in terms of Gastric Banding procedures (and the large number of complications from it) - everyone is offered it - there is no such thing as dieting anymore. Every week the local surgeon has a public meeting to talk about the procedure and sign people up! |
| 98. |
Patients sit in ICU becasue MDs don;t want t o send them to the floor, LOS goes up, costs go up |
| 99. |
Use of specialties "apparently" from primary care providers was noted to be recommended by other specialists, e.g. radiologist, neurosureon, etc. Such requests are now made directly to avaid the appearance of "overutilization" by primary care providers. |
| 100. |
Bar-coding of meds; Medication reconcilliation program |
| 101. |
Pharmacy created a program to computerize drug ordering. |
| 102. |
Getting throughput in ER to floor is a major problem for example. The obstancle is culture and unwillingness to change. |
| 103. |
Monitoring under/over utilization via extensive data reports which are circulated to both physician executives and top administrative staff. Currently, a medicaid initiative is being addressed with high ER and NICU utilization to uncover root causes and putting together action plan to correct. |
| 104. |
For pharmacy errors, a barcode system allows the front desk personnel to check the medications provided from the pharmacy. The physician writing a prescription must use a form where the physician's handwriting is eliminated. Medications are prefilled in standard quantity and dose, and labels are color-coded. Review of procedure demonstrated fivefold error reduction. |
| 105. |
Bar coding medication administration has resulted in dramatic decreases in medicationerrors. |
| 106. |
Patient flow backlog in ED holding beds. Implementing teletracking. |
| 107. |
Adverse drug events are a cause of hospital admissions and unnecessary complications and wasted health care dollars. We are supporting electronic prescribing for physician offices coupled with e-labs to increase office access to patient information and efficiency. |
| 108. |
1- Coordinating many workshops and training activities 2- Researches; Regional and National 3- Producing guidelines and mannuals. |
| 109. |
Medical Errors - we noticed that we had an increased number of medical errors that would have been prevented by using two identifiers and the 5 R's of nursing med administration. We held a "Medication 911" meeting with leaders from our clinical units describing the number of issues and how all would have been prevented if we were using standard practice. We then took their suggestions of how to spread to clinical nurses, and created reminders for all nurses for their badges. We have not had this type of error since then, but still are working for consistent use of two identifiers |
| 110. |
Instituting electronic health records to improve flow and communication with patients and with staff. |
| 111. |
Computerized medication lists and bar code dispensing |
| 112. |
Physicians order excessive testing which is unrelated to the patient's primary reason for being admitted to the hospital. We are counseling physicians individually when the occasion arises. |
| 113. |
advancing IT through slow implementation of changes has improved flow processes |
| 114. |
Not enough in-patient beds to accomodate ED volumes and holds--is not fixable, not enough capital to add bed capacity |
| 115. |
We first have a top down administrative complete alignment and drive to push quality as utmost importance in the organization. This filters down to each entity which is required and supported to participate in quality measures like the 100,000 lives campaign and publicly reported measures. Quality is central to everything we do. |
| 116. |
Most of the problems when they occur are being addressed. Some physicians are given preferential treatment. |
| 117. |
too numerous to tell in a very short survey |
| 118. |
when nurses act in way that is not in the best interest of the patient, action is taken immediately. |
| 119. |
we have a very difficult time getting unit type beds for patients coming from surgery. VEry often then are held for long periods of time in the PACU area. This causes a log-jam effect for the surery floow and occasionally we have to stop surgery until beds open up. They need o hire a bed coordinator who calls the surgeons and internists and tries to get them to discharge patients from unit bed early in the day and not late in the afternoon when they make their rounds. |
| 120. |
Underuse of EBM in diabetes is being addressed by expanding the care team to include PharmDs, changes in our EMR, patient registries, P4P and education in better patient communication. PS It's working! |
| 121. |
Emergency department capacity is compromised by other department policies and use of ED resources for inpatient care. Borders compromise our ability to timely see other patients and often administration does not understand the basic of this principle despite it being identified by the IHI and JCAHO as major barriers to providing good care. |
| 122. |
physician or nursing errors are traked via incident reports and quarterly reviewed for process improvement. |
| 123. |
Six Sigma programs in healthcare. Chronic disease state management being implemented, benchmark practices being studied and models developed. |
| 124. |
Impeded patient flow contributes to less than optimal outcome; increased patient and family frustration; poor publicity; increased stressors on the staff. |
| 125. |
Eg |
| 126. |
high volume surgeons who go one without any accountability. |
| 127. |
Pt flow problems-have hired a full complement of CM's and 2 Physician Advisors-rounds are held every day, an every unit, of every pt; also, CM's and PA's involved in ED and Access Svcs. |
| 128. |
Delays in processing admissions by RN's on floor results in delays for evaluations, getting admission medications completed so that physicians can use it when they admit patient. |
| 129. |
time delays in getting patients admitted out of t he er - multidisciplined committee with physician champion in lead. |
| 130. |
Medication errors. ::: drug recognicilation orders and printed order sheets. |
| 131. |
emergency room congestion problems treated as possible solutions within ERs only. Clearly the problem is much more systemic. unfortunately, the whole hospital is not taking adequate responsibility of their contribution to the ER congestion. |
| 132. |
We have major issues with patient flow in our Patient Recovery Unit ... we have been in this new unit just over one year, and continue to have major problems. In particular, holding up ORS on "outpatient" days. Thursday and friday are outpatient days so that fewer patients are utilizing hospital services over the weekend. With this method, we probably are appropriately staffed and have bed space for our "averages", but we swing wildly from almost all inpatient in the early part on the week, to almost all outpatient towards the end of the week - with extremely short case and quick turnovers in 12 rooms - unrealized by our current beds and nursing. |
| 133. |
Efficient admitting and discharging with quality medical care transition decision making is not happening. This results in delays in discharge, redamissions, and outpatient inefficiencies. There is a lot of forward care cost shifting. |
| 134. |
Worked with ED staff to stream line the flow and transfer to inpatient units. |
| 135. |
physician orders taken off late or wrong and attempts to improve situation falls on deaf ears |
| 136. |
Access to speciality care is a major problem and is causing patient dissatisfaction. We have hired consultants to analyze patient flow, scheduling templates, and capacity of specialists. |
| 137. |
Physicians practice pattern is being monitored. Medical errors and sentinel events are being investigated. Post-surgical wound infections are being monitored. |
| 138. |
overuse of care,etc, - addressed by monitoring adherence to standard of care. ie prior auth colon screening as well as compliance with screening efforts-both sides of the equation. |
| 139. |
ED Boarding because of lack of hospital throughput. This affects patient care, patient satisfaction, ambulance diversion, and physician morale. Drives me crazy and there seems to be no real end in sight. |
| 140. |
We are developing an algorhythm for management of back pain - currently there is too much imaging. Antibiotics are very often used for viral illnesses such as bronchitis and sinusitis. I think people are concerned that patients will not be satisfied without an antibiotic. |
| 141. |
Wait times in the emergency medicine department and number of people leaving without being seen have been tracked and critical services in areas like mental health have been revised to address the need to handle surges in business, including opening extra space to observe patients presenting with suicidal ideation. |
| 142. |
Patient flow from ED to inpatient bed is a major problem. The ED has brought this up many times but administration does not want to upset the floor nurses with taking hallway patients there. The end result is hallway patients in the ED and a lack of focus on the institution-wide nature of the problem. There are no dedicated radiology rooms/techs, no stat lab or virtual stat lab capability, and no push to get patients up to the floor. The ED physicians have brought in additional caregivers, the ED has developed streamlined treatment protocols, the 5 step triage system has been adopted, and there are still not any unit secretaries allocated to the department to even answer the phones (physicians and nurses make and answer all the calls). The recognition that the inefficiencies exist outside the ED walls as well as within those walls does not seem to register on the radar screen of administration. Requests for process action teams, mapping of processes, and basic implementation of a problem solving process that is interdepartmental in nature and make-up have been denied by administration saying that the ED needs to fix it's own problems. |
| 143. |
Medication errors were a problem. We now use bed-side barcoding and documentation. This has resulted a great reduction in medication errors. |
| 144. |
Shortages of non-physician staff (nurses, technicians) can adversely impact patient flow. |
| 145. |
e.g. a ventilator associated pneumonia costs us $33,000 on average. Reimbursement is nowhere near that amount. |
| 146. |
Developed ICU protocols, Sepsis bundle, Ventilator bundle; discharge nurses: check for ACE, ASA,B-Blocker prior to pt leaving, etc. |
| 147. |
Unexplained variance in care. This creates higher cost to treat the same diagnosis. We are making an effort to align our treatment protocols and care plans with evidence-based research and guidlines. |
| 148. |
Flow is a significant issue - the major part ot the variation in it is from the OR fixed schedule - there is a significant reluctance to take that culture on and make the schedule fit flow better |
| 149. |
EBM guidelines, P4P incentives; voluntary confidential error reporting |
| 150. |
committee meetings |
| 151. |
Patient flow is slow so new initiatives in the ED having a Fast Track walk in clinic, and a Chest Pain Center protocols for avoiding unnecesary admissions. Slow and late discharge from acute beds, implementing Discharge Appointment initiative. |
| 152. |
We are in the process of implementing "planned care nursing models" in some of our Primary Care Sites and in Endocrinology as pilot studies to be spread to the rest of the organizaiton if effective. |
| 153. |
tracking utilzation rates by physician and procedure to identify variance in care. |
| 154. |
Physician quaterly chart reviews with feedback and comparison to standard of care |
| 155. |
Very little consistency in treatment of common diseases. Variation is not super wide, but is wider than necessary. We are trying to get more evidence based guidelines in front of the docs at the right time in the care process |
| 156. |
Overuse of resources - attempting to implement clinical practice guidelines and use evidence based standards underuse - notifying patients to see their doctor, and tracking utilization. Notify doctors when patients are overdue for care. |
| 157. |
It is slow going but our organization has set high quality targets and is pushing toward achieving top decile performance. |
| 158. |
Studying the implications of implementing "lean". |
| 159. |
long waiting times, no response to complaints |
| 160. |
Our ER's are very overcrowded. We are currently expanding the hospital, but the regulatory requirements in CA are horrendous and seem to fight expansion at every turn. As a result, patients are placed on gurneys, in chairs. We have tried to be innovative in providing triage and care. A few months ago, we had one patient that was seen, triaged, labs done and treated without every leaving the bench outside the ER. |
| 161. |
Patiwnt flow is a huge issue, and there are many "meetings" concerning it. I just do not see any backbone to actually fixing it by improving efficiencies and enforcing existing policies (such as a 1 hour rule for consultants for ED consults). |
| 162. |
We are aware of complications and the ability of the public to get health-grade information. No one wants to take the bull by the horn and try to address the issues or put any bite into non-compliance issues with policies. |
| 163. |
Using case managers to try to push poor resource utilizers to have appropriate admissions and to push them to get patients out of the hospital that don't need inpatient care. |
| 164. |
multiple different implants and care pathways used in orthopedic patients. We are going to begin promoting those physicians who utilize the care pathways |
| 165. |
Major variances in how patietns access the main OR. I am currently spearheading a process to totally overhaul the system and remove as much variance as possible. |
| 166. |
EMR case managers |
| 167. |
medical errors due to poor handwriting - have done in service, using more preprinted orders, mandating nursing/pharmacy clarify order if at all uncertain; eventual ($$) move to CPOE |
| 168. |
Monitoring surgical infection rates. By tracking post op infections, able to detect particular problems in surgical rooms and institute compliance with perioperative antibiotics-type, timing, duration. |
| 169. |
Medication errors cause delayed care or sometimes cause harm. We use a medication reconciliation system that helps reduce errors at admission and discharge. This is in the process of being implemented. |
| 170. |
Issue of patient flow becomes critical when patients are not announced in a timely fashion or follow up appointments are not properly recorded. Administration trying to fix by new hires, but unfortunately top gun not aware of issues involved so he hires poor help. |
| 171. |
Unexplained varianceof care - lead clinician is meeting with regional office staff on a monthly basis for chart review, clinical training. |
| 172. |
Patient flow in the ER |
| 173. |
Access problems, difficulty responding to patients in timely manner, e.g. prescription refills not addressed for 2 to 3 days. |
| 174. |
We have started a very committed weekly meeting to improve patient flow with buy-in from many departments |
| 175. |
Medical errors are greatly minimized with our emr and electronic prescribing |
| 176. |
Patient flow an issue. We brought in a consultant for assistance. It is paying off. |
| 177. |
Our hospital partner is a county hospital. Although they purport a fault free reporting culture, they don't advocate for the program. Through Med Exec and the QRM, we hope to improve. |
| 178. |
Major effort on patient flow, working with outside consultants. Have added hospitalists to enhance throughput. |
| 179. |
Overutilization of hospital beds is a major problem at the nonprofit institution. This definitely creates greater financial stress on the institution with already limited resources since we see many indigent patients.We are attempting to reduce this inefficiency by prioritizing it in our UR committee and working on our strategy to use critical care pathways, physician facilitator, daily updates/reminders to the attendings, CMEs and rewards to help reduce this problem. |
| 180. |
focus on ER |
| 181. |
We set up a committee to look at and make changes to our polocies that affect patient flow. It is improving. |
| 182. |
The hospital where my group practices is extremely overcrowded leading to significant patient flow issues and increased risk for medical errors. It is a "disaster waiting to happen". The hospital administration and Board is not committed to making sufficient improvements. Consequently, my medical group is assisting a competing hospital in and expansion project and will move our practice to the new hospital. |
| 183. |
Moving toward more and more standing orders, most recently acute CVA. |
| 184. |
Organization is encouragin physicians to expand (or shift) office hours to enclude evenings. |
| 185. |
Medication errors are monitored via a robust protocol involving nursing, pharmacy and MEC. surgical site infections are closely monitored, ED patient throughput is being actively worked on |
| 186. |
Improving access to inpatient psychiatric care through applying Advanced Clinic Access principles to inpatient admissions and discharges. |
| 187. |
Proper use of abbreviations in medical ordering |
| 188. |
Patient flow is poor due to severe understaffing, resourcing of rooms, and lack of continuity with providers, support staff, etc. |
| 189. |
We have initiatied a pay staff for performance to improve our screening rates for diabetes care. In 6 months, we have increased our screening rates by approximately 7%. This is more improvement than we had seen in the previous 3 years combined. |
| 190. |
Unexplained Variance in Care Have created Standardized Order sets for some of the most common clinical conditions (AMI, Chest Pain, Pneumonia, Heart Failure, Stroke, Hip Fractures, Joint Replacements, Hysterectomies)as well as general admission order sets for adult medical, surgical and pediatric care. |
| 191. |
Patient flow sometimes is a problem. Fixing the problem involved evaluating each step of the process and having people accountable for the time it takes to accomplish their task. |
| 192. |
Weekly we implement something that improves process and cuts errors |
| 193. |
The acute care units are being redesigned to improve work flow. |
| 194. |
Six Simgma project to map hand patient hand off and communication as increased satisfaction and decreased variability in the process |
| 195. |
The service is free for users and thus there is an abuse by users leading to unnecessary visits which generate wasted resources |
| 196. |
Medication Errors are tracked monthly with goals of decreased med overrides. Started med reconciliation forms for inoatients. Near miss reporting line to promote disclosure |
| 197. |
Adoption of a programmatic approach to Total Joint replacment |
| 198. |
Using a pt. flow coordinator to enhance flow and decrease need for ED diversion |
| 199. |
We are a Mentor Hospital for IHI Save 100,000 Lives and Save 5 million lives campaign. We routinely teach small rural hospitals from around the country to improve safety and quality. Using our standard approach we have reduced acute med surg mortality from 2.6% to 1.2%, reduced IV associated infections to a statistical zero from 1.2%, reduced post operative infections by 50%, improved standard care for AMI to 100% and improved medication reconcilliation to 100% from 76%. We have actually generated a profit by improving the care that we give. |
| 200. |
Patient flow is a huge problem that affects every department and makes everyone frustrated. We have meetings about it, try to make new policies, even have a consultant working with us right now, but not much seems to change. I think a major reason is just the culture and folks not wanting to change or not trusting the folks on the giving or recieving end of patient transfers. |
| 201. |
Improving ability to improve compliance with clinical guidelines by adapting an EHR and upgrading the Quality of Care management team. |
| 202. |
Patient flow is a problem because we do not have the space necessary to care for the number of patients who depend on us. For instance, our physical facility is over 50 years old, and the Labor and Delivery area is 50% smaller than the minimum required for the number of deliveries we have. We are planning and building a new hospital but that takes a lot of time and resources. In the meantime we have contracted out some of the deliveries to nearby hospitals. |
| 203. |
availability of beds for patients coming from er and OR. have established a bed "czar" who can override floor nurses who attemt to defer admissions later in day |
| 204. |
Inefficiency: Patients with severe mental illnesses remain in hospital beds longer than medically necessary because of a history of community treatment failure. Fix: State Operated Services is developing an special residential programs allowing for an extended transition from hospital level of care to community level of care focused on the patients' development of community integration skills and compentencies. |
| 205. |
Inefficient OR turnover limits ability to get cases done in timely fashion, moving elective cases to late afternoon/evening on a daily basis. |
| 206. |
xxxxxxxxxxxx |
| 207. |
Tele-tracking implemented to support improved tracking and accountability for patient flow. Identification of problems enhanced, resources for solutions still inadequate but resource poor areas identified. |
| 208. |
Very high patient volume causes gridlock. We are instituting treatment protocols; are using LOS data and quality indicators to discuss and give feedback to physicians; and have instituted nurse/case manager-physician rounding. |
| 209. |
we have little objective sense of inefficiencies and dangers due to extrememly limited clinical data collection. correction coming very slowly... |
| 210. |
We do not know the full extent of medication errors and ID problems. Appropriateness of procedures do not undergo review and evaluation so patients tend to be overtreated if insurance is right. Overall complications from procedures are heavily reviewed and well known. Our serious occurrence process helps to drive improvements, but we are reluctant to take on the root cause medical staff issues. |
| 211. |
Active in IHI, CMS, VHA intitiatives/collaboratives. |
| 212. |
Hospital is participating in IHI campaigns. SCIP guidelines are well defined and have been shared; however, there is still considerable variance in use of prophylactic antibiotics which may be contributing to poor outcomes. |
| 213. |
Implementing electronic medical record, contracting with external auditor, Working to improve outpatient/community resources for care, collecting data to explore variability. |
| 214. |
implementing bar coding and eMAR |
| 215. |
very reasonable and well researched perinatal safety initiatives still not practiced by all OB staff. A few older OBs still respond witht eh "don't tell me how to practice" reprieve. Strong PEER review and restriction of privilege threats are finally starting to make a difference. |
| 216. |
1. Evaluating and revising pharmacy policies and establishing age specific satellite pharmacies. |
| 217. |
Major problem is flow of patients admitted through ED. Waits can be long pending discharges. Hospital has made great strides in tracking and communication with little impact on outcome. Currently hiring nurses to assist in flow issues. Patients waiting in ED get substandard care secondary to lack of clarity on who is managing patients. |
| 218. |
variance in care is being addressed by detailed study of the chargemaster, to determine actionable practice pattern changes a physician could make, when he/she is found to be at substantial variance for a particular DRG. |
| 219. |
Organized data collection |
| 220. |
underuse of care (rationing) is related to chronic understaffing which is in turn related to chronic underfunding of governmental healthcare systems. |
| 221. |
In terms of standardization of care, we have taken some control away from independent physicians and made hospital policies to address the issue. One example is the administration of antibiotics 60 minutes prior to surgery. This is no longer a physician option, but a hospital policy. |
| 222. |
With regard to variances in care, considerable effort has been expended within the system to standardize and expand the approach to physician peer review. Starting with adverse outcome case review and patient complaint profiles and expanding to the incorporation of performance in various processes of care, e.g. CMS core measures, we have tried to bring peer review out of the closet in a respectful and confidential manner. The intent is to provide physicians with performance feedback on a regular basis so has to promote an educational environment where physicians can seek assistance and self correct before trends become dangerous to their patients and their privileges. This has also been an effective way to address overuse and underuse as ordered by physicians. |
| 223. |
Boarding admitted patients in the ED is a problem for ED staffing and impedes the ability to move ED patients through the department in a timely manner. There is currently a 6-Sigma project looking at moving admitted patient out of the ED more quickly. |
| 224. |
Medication reconciliation, but major program to improve errors. |
| 225. |
Throughput on med/surg units with a team effort between nursing, case management and hospitalists to improve communication regarding patient discharge requirements. Also, building an Observation Unit in the ED which results in increased efficiency for patients with lower acuity medical needs such as low-risk and atypical chest pain. |
| 226. |
Patient flow is a large inefficiency. We now have a Medical Director of Practice Improvement whose team helps find out the problems and recommend solutions. |
| 227. |
Patients are having elective operations when their serum glucose is very high. Many of those also have very high HbA1c levels. We have introduced point of care glucose monitoring. Also, one surgical specialty really understands the importance of glucose control. We are using those physicians, who have received national recognition, for the quality of their work to encourage other surgeons to ensure their patients are controlled diabetics, as much as possible before they perform elective surgery. Internists and family practice docs will be getting information about the importance of ensuring their diabetic patients are well managed prior to and peri-operatively. |
| 228. |
Through-put: encouraging attending physicians to round first on the wards, then the ICU. This allows the discharges to be cmpleted at a "more reasonable time and allows for better, more timely moves from ICU to ward. |
| 229. |
Lacks of funds to hire needed personel |
| 230. |
Lack of full PT and OT services on weekends causes (1)reluctance to schedule procedures requiring above to be scheduled on Thursday or Friday, or (2) increased length of stay. |
| 231. |
Care overuse, hard to change, as the hospital is not paid, but the attending is.LOS is often lenghthier. Hard to change this pattern we are tracking individuals and their LOS. Setting pathways for care/investigation. |
| 232. |
nursing covers things up and if someone in nursing trys to speak up they are "let go" |
| 233. |
Medical errors are about the only thing that cause sentinel events anymore. Death from anticoagulation error, for instance. Multiple efforts are in process for medication safety and management. |
| 234. |
ED crowding and lack of hospital beds |
| 235. |
We have been working with our Health System to utilize both Six Sigma and LEAN methodologies to identify and address quality issues |
| 236. |
using EMR to track usage and give remindser to PCPs for ordering routine health maintence. |
| 237. |
We have had a problem with inadequate utilization of vaccines. We are now monitoring all physicians to be sure vaccination schedule adhered to. |
| 238. |
Partipating in a statewide collaborative to reduce hospital associated infections (involves almost all acute care hospitals in this state). |
| 239. |
major initiatives to correct notification of results to patients |
| 240. |
Continued monitoring of timely health care, early discharge planning to streamline the end of hospital stay. Enhanced communication between doctors and nurses regarding floor patients. |
| 241. |
OFFICE REDESIGN PROJECT AND QUALITY INIATIVES ARE IN PROCESS AS IS A NEW EMR |
| 242. |
Nursing staff giving wrong med or wrong dose (order written for renal adjustment but not followed properly) -- working toward computer MAR so that hand written ones are updated in a timely manner with ultimate plan to have physician computer entry. |
| 243. |
New focus on hand-washing and other hygiene measures to reduce nosocomial infections. |
| 244. |
Continued refinement and manditory use of electronic records allows a much quicker identification of variance in care. First we need to identify when it is happening , and if we do so swiftly we may change the provider's thought process or better understand the rational for the variance. |
| 245. |
1) Patient flow: We can order imaging sepcific for Discharge and these are done early, as well as phlebotomy for discharge is done first 2) A new computerized order set for Argatroban has decreased unnecessary usage 3) Antibiotic consult team has been implemented and reduced inapropriate use of antibitics thus saving money and decreasing resistant organisms |
| 246. |
inadequate staffing for admissions - ED is forced to hold patients waiting for a bed which is available but not staffed |
| 247. |
they say they are |
| 248. |
Variation in care being addressed through through our Best Practice Committee's development of practice guidelines and the collection of data to monitor physician performance. |
| 249. |
Reliability/Decreased variance is being addressed through standardized tools in EMR and consistant patient flow/assigned responsibilities in the outpatient setting. |
| 250. |
Quality monitoring. |
