Peripherally inserted central catheters (PICCs) provide reliable central vascular access for hospitalized patients, but PICCs are associated with morbid and potentially lethal complications. To curb these outcomes, IHQSE Faculty Dr. Tyler Anstett and team developed a decision support tool in the EHR to help hospital-based providers utilize more appropriate catheter devices for their patients.
The transfusion of blood is a life-saving measure but is sometimes overused leading to worse outcomes for patients and excess costs for health systems. A team including IHQSE Faculty member Dr. Tyler Anstett engaged clinicians from different specialties to rethink the design of blood transfusion orders in the EHR at University of Colorado Hospital.
Andrea Prinzi, Ph.D., MPH, a member of the 2020 cohort of the IHQSE Certificate Training Program published their work in the Journal of Clinical Microbiology, showing that endotracheal aspirate cultures commonly overreport lower respiratory tract infections due to contamination, often resulting in excess antimicrobial therapy.
Venipunctures are clinically necessary for hospitalized patients, but failed add-on lab tests can lead to excess venipunctures and patient harm. In a recent publication in Applied Clinical Informatics, IHQSE faculty member, Tyler Anstett, DO and team used QI methodology to identify a root cause of add-on failures and then implemented a simple and effective solution.
IHQSE Certificate Training Program Graduates Dr. Norman Friedman, Renee Crowder and Sarah Derieg developed a set of screening criteria to predict children who would need overnight monitoring after surgery for sleep-disordered breathing. They report that 75% of patients did not have a prolonged oxygen requirement making them candidates for same day surgery. The probability of a prolonged oxygen requirement was only 18% if patients did not have a diagnosis of asthma or a resting pulse oxygen measurement of < 96%. They conclude that all patients who are off oxygen within 3 hours of surgery and pass a sleep room air challenge are safe for discharge to home.
IHQSE Faculty member, Dr. Sarah Tevis, and team surveyed patients with stage 0-IV breast cancer about the information they received about potential sexual side effects of their treatment. The survey revealed that patients—most of whom receive little to no information—desire personalized education early and often to better navigate these effects during treatment.
Diagnostic errors are common and important causes of preventable morbidity and mortality in a variety of medical settings. Diagnostic errors leading to harm are most likely to involve diagnoses of cancer, vascular events, or infection. IHQSE Faculty, Dr. Katie Raffel, along with Sumant Ranji, MD, takes a look at approaches to measurement, etiologies, and interventions to decrease diagnostic error.
IHQSE faculty members, Drs. Emily Gottenborg, Jeff Glasheen, and Tyler Anstett, along with IHQSE alumna Dr. Julia Limes, published the first program evaluation of a residency training program focused on Hospital Medicine. The paper describes the University of Colorado’s experience of training over a hundred hospitalist residents over 15 years. Notably, the program found that graduates were highly likely to choose careers in hospital medicine with over 80% holding quality, safety and operational leadership roles.
Dr. Moksha Patel, IHQSE Lead Physician Informaticist, authored a perspective piece, looking at ways to reimagine the way we measure hospital-provider productivity. This paper focuses on the limitations of traditional measures of hospital-provider value, such as clinical productivity and emphasizes the patient, employee, and institutional outcomes such as quality, safety and experience.
Despite decades of effort to drive quality improvement, many health care organizations still struggle to optimize their performance on quality metrics. The advent of publicly reported quality rankings and ratings allows for greater visibility of overall organizational performance but has not provided a roadmap for sustained improvement in these assessments. In 2012, the Institute for Health care Quality, Safety, and Efficiency was launched, which is an integrated set of quality and safety training programs, with a focus on leadership development and support of performance improvement through data analytics and intensive coaching. After 10 years, the IHQSE has trained nearly 2000 individuals and has been associated with significant improvement in organization-level quality rankings and ratings, offering a framework for organizations seeking systematic, long-term improvement.