Case Studies from the Quality Improvement Support System
DIANE Publishing, Dec 1, 1998 - 107 pages
These case studies of continuous quality improvement (CQI) initiatives represents a compilation of key CQI features of practical value to people engaged in the delivery of health services. Addresses: acute chest pain management; applications of pharmaceutical clinical algorithms used in conjunction with critical pathways; asthma; cardiac surgery; carotid endartectomy length-of-stay; Caesarean section utilization; chronic obstructive pulmonary disease improvement; Coumadin management; myocardial perfusion; open heart DRG outcome; pregnancy and parenting; surgical preparedness; and total hip replacement care.
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admission afﬁliated algorithm angiogram anticoagulant assessment asthma patients Azmacare bronchodilator cardiac surgery cardiac surgery patients Cardiopulmonary Services carotid endarterectomy cesarean section cesarean section rates changes chest pain clinical pathway coordinator COPD patients Coumadin deﬁned deﬁnite delays delivery difﬁcult discharge documentation Emergency Department Emergency Room evaluation exams extubation facilitator feedback Figure ﬁnancial ﬁrst ﬂow heparin home health home health nurse home healthcare hospital hospital’s identiﬁed implementation Improvement Team initial inpatient intubation involved length of stay literature Medical Imaging monitor multidisciplinary myocardial perfusion tests NSCP nurse ofﬁce orthopedic outcomes outpatient patient education percent pharmacists Pharmacy physicians Pitocin postoperative prenatal preoperative procedure Project Team prophylaxis protocols rapid recovery reduce respiratory Respiratory Therapy scheduling signiﬁcant speciﬁc staff surgeons surgical team leader team meetings team members team’s team’s efforts total hip replacement variation
Page 58 - American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.
Page 16 - Reducing lengths of stay for patients hospitalized with chest pain using medical practice guidelines and opinion leaders. Am J Cardiol 1993;71:259-62. 17. Weingarten S, Ermann B, Bolus R, Riedinger MS, Rubin H, Green A, et al. Early "stepdown" transfer of low-risk patients with chest pain.
Page 65 - Developing guidelines for local use: Algorithms for costefficient outpatient management of cardiovascular disorders in a VA medical center.
Page 61 - ... to change physician practice without having a system in place to reinforce those changes. The algorithm called for significant changes in practice that many busy physicians had little time to learn, and since the process took place in physicians' offices, the team had little power to influence the change.
Page 38 - Rudisill PT, Phillips M, Payne CM. Clinical paths for cardiac surgery patients: a multidisciplinary approach to quality improvement outcomes.
Page 63 - The closer interaction enhances the staffs ability to determine causes of variation in patient test results, and individualized education reduces the likelihood of noncompliance. The clinic also reduces variation in treatment practice, since the responsibility of monitoring INR levels has been transferred from multiple primary care physicians to the ACC staff.
Page 59 - Coumadin are monitored by measuring the amount of time a patient's blood takes to clot. If a blood test shows that a patient's blood-clotting time is not in a therapeutic range, a physician must determine an appropriate course of action, taking into account the complex set of factors that influence how a patient may respond to Coumadin therapy.
Page 21 - In the GUSTO (Global Utilization of Streptokinase and TPA for Occluded coronary arteries)-!
Page 59 - Anticoagulants decrease the clotting ability of the blood, thereby helping prevent harmful clots from forming in the blood vessels. Coumadin, a brandname form of the anticoagulant warfarin, is prescribed as prophylaxis or treatment for several diagnoses, including deep vein thrombosis, pulmonary embolus, myocardial infarction, atrial fibrillation, and certain other forms of heart disease.