Jun 27, 2024

IHQSE faculty member Dr. Sandra Spencer and a team quality improvement experts at Children’s Hospital Colorado developed a novel fast-track model, typically seen in emergency departments, and implemented it in urgent care. The initiative resulted in a 74% reduction in door-to-provider time and 36% reduction in urgent care length of stay. The fast-track process also continued to function and reduce door-to-provider and urgent care length of stay times during a large volume surge. Improvements in these metrics for higher acuity patients in the co-located emergency department were also observed. The results of this QI project suggest that a FT model can improve efficiency in an appropriately selected UC setting.

Apr 21, 2024

IHQSE faculty, Dr. Michael Tchou, is lead author on a research article published in Journal of Hospital Medicine. The study examines rates of overuse of diagnostic testing in pediatric hospital settings and its ripple effect of negative impacts on both providers and patients.

Oct 23, 2024

Using patient-reported outcome measures to guide clinical care is associated with improved outcomes and widely regarded as a best practice in mental health. However, many systems have struggled to routinely adopt the practice. In an article in Psychiatric Services, IHQSE faculty, alumni, and members of the University of Colorado Department of Psychiatry describe how they used technology to address major barriers to using this best practice in their design and implementation of the Measurement-Assisted Care (MAC) program. In MAC, patient-reported outcome measures are automatically attached to patient eCheck-in and clinician documentation templates nudge clinicians to view and discuss the responses during visits. MAC increased the availability of patient-reported outcome measures from 5% to 60%+ of patient visits with more than 90% of clinicians reporting the information was useful.

Aug 14, 2024

Electronic Health Records (EHR) have become integral to quality care delivery in many specialties. In spite of the usefulness of the these tools, surgeons have been reluctant to incorporate EHR into their toolbox. IHQSE Faculty, Sarah Tevis, MD, is corresponding author of a viewpoint article published by JAMA Surgery that calls for surgeons to engage in electronic health record innovation to improve patient and clinician experience.

Oct 2, 2024

Secure messaging (SM) is becoming a common way for hospitalists to communicate, but most existing literature focuses on usage patterns and implementation science, without clear understanding of the benefits and challenges users may be encountering. IHQSE Faculty Michelle Knees, DO and team led a mixed methods study involving surveys and focus groups with hospitalists from 24 academic institutions, finding that, while SM enhances communication efficiency, it also increases multitasking, cognitive load, and alters interpersonal dynamics. The study underscores the need for clear institutional guidelines for SM use and emphasizes the importance of collaborating with frontline workers to improve communication practices.

Aug 1, 2024

A recent editorial penned by Madeline Higgins, MD and IHQSE director Jeff Glasheen, MD and IHQSE faculty member Sarah Tevis, MD explores the challenges with current patient safety data. Despite advances in medical care, patient safety remains a critical area of focus within healthcare given that many patients continue to experience harm. While patient safety has gradually improved over time, progress is limited by outdated data models that prevent measurement of the true burden of harm, and therefore reduces our ability to understand ongoing drivers and develop innovative solutions to improving patient safety. The authors call for a change in how we measure and track data related to patient safety.

Jun 1, 2024

Two IHQSE grantees, Drs. Christina Stuart and Robert Meguid, recently published findings of a retrospective cohort study evaluating the incidence and consequences of incidental perioperative hypothermia exposure in the thoracic surgery population. They found that more than 90% of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and that patients that developed hypothermia had associated increased rates of 30-day morbidity and infectious complications. Based on these data, Drs. Stuart and Meguid were awarded an IHQSE Clinical Effectiveness and Patient Safety grant to study structured and interval-specific interventions aimed at decreasing rates of inadvertent perioperative hypothermia and subsequent complications. This interventional study concluded in June of 2024 and the results are being analyzed.

May 1, 2024

Diagnostic error may result in serious harm for more than 500,000 patients and contribute to an estimated 10% of all patient deaths. Understanding diagnostic accuracy is crucial for improving patient outcomes and ensuring effective healthcare delivery. IHQSE Faculty, Drs. Michelle Knees and Katie Raffel, along with colleagues from the University of Colorado Division of Hospital Medicine, recently published an AHRQ Issue Brief aimed at furthering efforts to enhance diagnostic accuracy. The brief reviews a substantial body of literature on the impact of cognitive load on diagnostic accuracy, identifies areas for future research, and provides recommendations for integrating existing knowledge into current practice.

May 1, 2024

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is used to compare performance on patient experience metrics across hospitals, but its impact on patient outcomes as well as its utility as an incentive metric for providers remains unclear. In this article for the Hospitalist, members of the Society of Hospital Medicine Performance Reporting and Measurement Committee, including IHQSE faculty member Anunta Virapongse, MD, MPH discuss the pros and cons of using HCAHPS as a metric for measuring performance in hospitalist programs.

Apr 15, 2024

IHQSE faculty member, Dr. Katie Raffel, along with Dr. Katie Brooks and the UPSIDE research team, recently published findings from a multicenter retrospective cohort study evaluating the association between use of stigmatizing language and diagnostic error. The prevalence of stigmatizing language was higher among patients with diagnostic errors than those without. Use of this language was associated with delays in care at presentation and errors in communication with patients and caregivers. This raises the question of whether stigmatizing language may be indicative of clinician biases that interfere with data gathering, communication, and clinical reasoning.

May 21, 2023

Diagnostic errors (DE) are a critical but understudied cause of preventable patient harm. While much work has focused on examining the incidence and factors contributing to DEs in ambulatory and emergency room settings, fewer studies have examined the incidence of DEs in hospitals or how they contribute to adverse events during the hospital encounter. IHQSE Faculty, Dr. Katie Raffel, along with other experts on diagnostic error, led an AHRQ-funded study at 31 US hospitals aimed at defining the prevalence and underlying causes of DEs in patients who die in the hospital or are transferred to the ICU after the first 48 hours.

Dec 1, 2023

Physical therapy (PT) in inpatient settings is a limited and valuable resource. Inappropriate PT consultation is costly and can lead to delays in care and discharge planning. A team of IHQSE alumni, including faculty members, Dr. Emily Gottenborg and Dr. Moksha Patel, dug into the root causes of unnecessary PT consultations and deployed an intervention that reduced the rate of inappropriate PT consults to less than 10%.

Jan 8, 2024

Diagnostic error is common, morbid, and mortal. IHQSE faculty member, Dr. Katie Raffel, along with Dr. Andrew Auerbach and other experts on diagnostic error, recently published findings from a multicenter retrospective cohort study in which 2500 hospitalized adults who experienced ICU escalation or death were evaluated for diagnostic error. This study adds to a body of literature highlighting the importance of diagnostic safety within hospital medicine.

Jun 1, 2023

The early COVID-19 pandemic created substantial disruption to healthcare delivery, including changes to diagnostic processes. In this 8-center retrospective cohort study of diagnostic error among patients hospitalized with possible COVID-19, IHQSE Faculty Member Dr. Katie Raffel found that 14% of the 257 patients included experienced delayed, missed or wrong diagnosis, 1/3 of which may have led to harm. Unexpectedly, diagnostic process faults related to policies/procedures related to COVID-19 suspicion itself (such as need for isolation or medical distancing) were not independently associated with error. Instead, diagnostic process faults related to clinical assessment and test ordering/interpretation remained most prominent, similar to other studies of the diagnostic process.

Dec 6, 2023

Faced with rising maternal mortality, the first prenatal visit is essential but, in many cases, important topics are missed. An IHQSE small grant supported the redesign of the first visit, dividing it into a nurse-led telemedicine visit and an in-person visit with an obstetric clinician. Clinic no-shows dropped (9.9%-4.2%), the topics covered in the first prenatal visit increased (70.0%-95.6%), and improvements were observed for all key themes.

Oct 7, 2023

Few hospitals have created surveillance programs for diagnostic errors. Fewer have programs to translate those opportunities into improvement efforts to prevent future harm. IHQSE faculty Drs. Katie Raffel and Jeff Glasheen are part of the ADEPT working group funded through an AHRQ grant to build such a program. In this paper the authors share the methodology for building the surveillance program, creating the benchmarking dashboards, understanding the areas of opportunity, and building interventions. The program is live in 16 US hospitals.

Sep 26, 2023

A recent study by IHQSE alumna Jessica Kenny, PhD found that 7% of adolescents endorsed suicidal ideation (SI) in the most recent two weeks during a primary care visit. Multiple interventions were associated with reductions in SI frequency at a follow-up visit, including PCP referral to integrated behavioral health and family navigators, behavioral health providers conducting a risk assessment, completing a safety plan, involving caregivers, sending the adolescent to the emergency department when indicated, and referring to family navigators. The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.

Aug 1, 2023

IHQSE Alumna Diane Christopher, MD, was the lead author on a study investigating the current state of quality and patient safety (QPS) efforts in OB/GYN departments in the U.S. Dr. Christopher and her colleagues found that while departments leaders responded overwhelmingly positively regarding work to improve patient safety, most QPS committee leaders received neither protected time nor financial support, and formal training was required in less that one-third of the departments. The study also found that most departments monitored key performance indicators (KPI) for inpatient outcomes, but only half tracked outpatient KPI. Dr. Christopher and her colleagues concluded that OB/GYN departments should invest more resources in QPS efforts to fully realize the benefits to providers, patients, and hospitals.

Aug 3, 2023

Recent IHQSE graduate Shannon Acker, MD, was an author on an article published by JAMA advocating for better support systems for trainees during pregnancy and early parenthood. In addition to new policies from the Accreditation Council for Graduate Medical Education, Dr. Acker and her colleague emphasize the importance of a cultural shift and a comprehensive network of support for your parents.

Apr 13, 2023

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.