New Improvement Topic Index

Have a suggestion for a new performance improvement topic? Post it here:

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Note from WikiHealthCare Administration: The WikiHealthCare site is currently being tested as a pilot project. The initial focus of the pilot is smoking cessation, and a decision has not yet been made with respect to when additional topics, such as those suggested below, will be added to the site (i.e., during or after the pilot project). Stay tuned, and keep your suggestions coming. Thanks.

• Fall Prevention - (Added to Quality Improvement Section)
• Competency Assessment (Need additional info to create QI topic)
• Medication Administration (Need additional info to create QI topic)
• Sepsis Protocols (Need additional info to create QI topic)
• Using tracers to improve the safety and quality of patient care (Posted by MichaelMcClain on 29 Jun 2007)
  
• Safely reducing the use of 1:1 observation (Added to Quality Improvement Section) (*Posted by RamiroJervis on 04 Jul 2007)
  Our hospital, like many others, finds that 1:1 observation is an overly used resource. it's uses range from fall prevention, suicidality or psychiatric observation on a medical floor, or risk that the patient may otherwise harm him or herself.
• Discharge Summary (Already Addressed in Heart Failure Section) (Posted by RamiroJervis on 04 Jul 2007)
  Standardize content in the DC summary to improve transition of care fro inpatient to outpatient.
• ED triage to improve patient throughput (Added to Quality Improvement Section) (Posted by RamiroJervis on 04 Jul 2007)
  Hospitals are often running at maximum capacity. How can we use triage at the ED level to improve the flow of patient, and decrease ED LOS?
• Medication Reconciliation (Added to Quality Improvment Section) (Posted by RamiroJervis on 04 Jul 2007)
  
• Suicide Assessment (Added to Quality Improvement Section) (Posted by NicholasMorris on 11 Jul 2007)
  For hospitals with and without behavioral health units.
• Handoffs among medical staff (Added to Quality Improvement Section) (Posted by DaleHarvey on 21 Jul 2007)
  
• Reducing Pressure Ulcers (Added to Quality Improvement Section) (Posted by LfTorres on 23 Jul 2007)
  
• Ventilator Dependent Care in LTC vs, Hospitals (Posted by LfTorres on 23 Jul 2007) (Need to narrow topic)
  
• Controlling type 2 diabetes with diet. (Posted by TomaGrubb on 09 Aug 2007)
  The Type 2 diabetes problem is a growing health concern. The percentage of diagnosed diabetics in 1950 was under 1%. By the early 90s the percentage of population had risen to 3%. In 2007 it is over 7%. These statistics vary according to the source but regardless of who's statistics you use, the prevalence is growing at am alarming rate. Study after study has shown that the best strategy for prevention and treatment is Healthy diet and lifestyle changes. I know I will raise hackles by presumptuously entering this debate without a medical degree. I am a type 2 diabetic who has learned how to control blood glucose with diet. There is a strong need worldwide do start getting serious about this issue that threatens to undermine many of the worlds health delivery systems because of the high and growing cost of treating diabetes. I am doing my part by sharing what I have learned through my website www.Diabetic-Diet-Secrets.com. You can help by reviewing my site and making suggestions to improve it. If you would like to be more involved join the sites Advisory Board (Basic medical research, not QI)
• NPSG 3E: Managing anticoagulation and methods for compliance (Posted by CeliaWeskamp on 10 Aug 2007) (Need to narrow topic)
  
• Reduction of Seclusion and Restraint in Behavioral Health Care Organizations (Already Addressed in Restraint and Seclusion Section) (Posted by LeahGuthrie on 28 Aug 2007)
  
• Mortality reduction (Posted by NapoleonKnight on 06 Sep 2007)
  All of the topics mentioned above serve to accomplish a common goal. To ensure that patients who enter an acute care hospital receive the care that they should, and leave alive. I would like to see what strategies are being utilized by health care organizations to address this issue. Certainly looking at the 4 box tool at the IHI site is a start. Also, how can hospitals compare themselves fairly and accurately across all patient types and all institutions, to see how they are doing? Certainly the HSMR that is available from the IHI is a start. (Need to narrow topic)
• Micro Ionized Water and its effect on acid-alkaline balance for disease prevention (Posted by LouAnnSavage on 07 Sep 2007)
  Cancer, diabetes, heart disease, auto-immune diseases, according to Nobel Prize winner, Otto Warburg (1933) are rooted in the acid-akaline balance of the inner biological terrain. Micro ionized water that can be highly alkalizing has been shown to boost the immune system significantly and reduce the acid in the system. It is this acidic condition, according to scientists like Dr. Warburg and others which encourages disease to thrive. Dr. T. Colin Campbell, Cornell University, in his book "The China Study" puts together 20 years of research to make the point that acid-alkaline balance is critical to either the promotion of or the reduction of disease and obesity. Under the germ theory that Louis Pasteur introduced in the early 1900s whereby germs bring disease was refuted on his death bed where he proclaimed that he had been wrong about such a concept but that instead it's the polluted biological terrain that brings the germs and supports the acid-alkaline balance theory. More needs to be introduced to the public on this topic. Your forum seems like just the right place for this point of view. I work with a naturopathic physician who has done much work in this field with significant results. (Basic medical research, not QI)
  
• Reporting Adverse Events and Near Misses (Added to Quality Improvement Section) (Posted by TimGee on 15 Sep 2007)
  Improving patient safety in acute care settings is hampered by the scarcity of adverse and near miss event data. This topic would explore current reporting requirements, strengths and weaknesses of currently available data, suggestions for improving data, and a discussion of barriers to improved reporting.
• Educate patients and healthcare teams on reduction of hospital infections (Added to Quality Improvement Section) (Posted by BernardFarrell on 20 Sep 2007)
  This is currently being publicized by RID, the committee to Reduce Infectious Deaths. They've listed a set of suggestions on a web page at: http://hospitalinfection.org/protectyourself.shtml.
  I continue to see doctors and nursing staff that do not clearly wash their hands in my presence. I, for one, will be bringing the web page printout with me and asking healthcare professionals to wash their hands before examining me.
• Improving access to effective health care for the uninsured and underinsured (Posted by SteveG on 23 Sep 2007)
  This is an enormous problem worldwide, not just for the USA and Europe. It is also a huge issue for doctors and for other healthcare workers, who all have specific professional and wider moral obligations to help ease the sufferings of their fellow human beings. Improving the quality of hospitals is not a lot of use to those human beings who cannot afford to utilise their services in the first place. I would love to read the views of the distinguished and able colleagues participating in this blog site about how this problem might best be tackled. I mention this issue because it is fundamental to the delivery of quality health care, and wishing to open up this debate is by no means meant to imply that other questions being posed and discussed on this web site are not important - they most certainly are. Thank you (for background, for example, please see http://www.ama-assn.org/ama/pub/category/11453.html & http://www.rand.org/hot_topics/access.html) (Health care policy topic)
• chf discharge instructions (Posted by KristyDutton on 04 Oct 2007) Topic already exists - See DischargeInstructions )
  
• Reduction of Acute Care Hospitalizations in the Home Care Setting (Posted by SusanThorn on 19 Oct 2007) (Need to narrow topic)
  
• Implementation of 2008 NPSG (Posted by SusanThorn on 19 Oct 2007)
  A forum for the disscusion and sharing of strategies for meeting the new requirements would be very helpful. (Need to narrow topic)
• care of psychiatric patient in the ED by non psychaitric (Posted by ThomsonM on 20 Oct 2007)
  (Need to additional information to create QI topic)
• HME/DME Supplier Accreditation (Posted by RThomasVanDyke on 22 Oct 2007)
  Has anyone been through the process or preparing to go through the process? Looking for resources/guidance as we prepare to be surveyed. (Not a QI topic)
• human resources (Posted by LisaGomez on 29 Nov 2007)
  (Need to narrow topic)
• Guidelines pertaining to Heart Teams and How they respond to an "on-call" emergency (Added to Quality Improvement Section) (Posted by JanVick on 03 Dec 2007)
  Guidelines on how Heart Teams work in a hospital facility..need to be implemented..especially pertaining to how the "on-call" cardilogist responds to an "on-call" emergency. There is an urgent need for "time frames" for the doctor to respond. There should also be "disciplinary measures" in place for doctors who do not respond in a "timely manner". Such was the case with my twin-sister Ann S. Perdue...the cardiologist on call waited an hour to respond to a 0 BP emergency. Ann died from coronary tamponade. Thank you.
• Beyond Measure (Posted by TomLeifer on 11 Dec 2007)
  Capturing, analyzing and reporting on data are critical to improvement. But the object is to improve? How are hospitals responding to data? How do you move forward, toward the real objective: IMPROVEMENT? (Need to narrow topic)
• Collaborative QI (Posted by TomLeifer on 11 Dec 2007)
  A discussion of how hospitals can work together on quality improvement projects. What kinds of projects are best suited to collaborative, multi-hospital efforts? What are the examples of things that have worked, and things that haven't?(Need to narrow topic)
• Advance Directive:Operational Process and Compliance (Added to Quality Improvement Section) (Posted by ReneeHarvey on 20 Dec 2007)
  A discussion on how to streamline this process and achieve compliance.
• Timing of therapy evaluations (Posted by ThomasD on 08 Jan 2008) (Added to Quality Improvement Section)
• Incident Management (Posted by BobBillings on 11 Jan 2008)
  (Need to narrow topic)
• Unusal Occurences (Posted by BobBillings on 11 Jan 2008)
  Software applications that provides a centralized procedure for reporting, investigating, managing and analyzing patient care related incidents. By correcting problem areas of facilities...that improves hospital effectiveness. (Need to narrow topic)

• Emergency Management (Posted by StevenShea on 17 Jan 2008)
  (Need to narrow topic)
• Reducing Inpt recidivism or LOS for per with Bipolar and Substance Use Disorders (Posted by CMcCray on 18 Jan 2008) (Added to Quality Improvement Section)
  

• Patient Flow indicators (Posted by MistyAnderson on 11 Feb 2008) (Need additional info to create QI topic)
  
• Communication Algorithms (Posted by BartWindrum on 12 Feb 2008)
  Establish Communication Algorithms for all MDs and specialties. Train and test for adequate and timely communication of vital information to patient-families. Base licensure on passing a range of communication algorithm scenarios. Bart Windrum, Author, Notes From the Waiting Room: Managing a Loved One's End-of-Life Hospitalization (Added to Quality Improvement Section - see Palliative Care)

• Formally Distinguish Curative Allegiance from Palliative at End of Life (Posted by BartWindrum on 12 Feb 2008)
  Change the paradigm regarding establishment orientation toward dying and death. Those MDs who want to practice curative medicine and not palliative ought to (proudly) say so, differentiating themselves from palliative docs, so patient-families know with whom they are dealing. Hospitals ought to record deaths occurring on the curative track under that heading so statistics are neither skewed nor biased. -- Bart Windrum, Author, Notes From the Waiting Room: Managing a Loved One's End-of-Life Hospitalization (Added to Quality Improvement Section - see Palliative Care)
• Complete, Proactive Patient-family Resuscitation Education (Posted by BartWindrum on 12 Feb 2008)
  Establish policy in all hospitals and with all providers to engage hospitalized patient-families proactively in complete resuscitation conversations in order to protect against family decisional freezing during treatment due to unexpected ambiguities related to intersection of treatment plan and resuscitation desires, options, policies, and MD interpretation. "Conversation can begin with canned video but must be complimented/supplimented with MD-delivered face to face conversation. -- Bart Windrum, Author, Notes From the Waiting Room: Managing a Loved One's End-of-Life Hospitalization (Added to Quality Improvement Section - see Palliative Care)
• Widen Access to Palliative End-of-Life Pathway (Posted by BartWindrum on 12 Feb 2008)
  Encourage, and provide in fact a wider pathway for patient-families to select non-hospitalized demises. Loosen hospice access rules and move forward on the disease trajectory. Remove (or at least lessen the role of) MDs as the arbiters of hospice pathway access, this to establish end-of-life choice as squarely the right, and responsibility of, individuals. -- Bart Windrum, Author, Notes From the Waiting Room: Managing a Loved One's End-of-Life Hospitalization (Added to Quality Improvement Section - see Palliative Care)
• Quality Control in Pharmaceuticals (Posted by JeoffryGordon on 18 Feb 2008)
  With many recent revelations about supervision of a quality control in the production of pharmceutical grade chemicals as well as pharmaceutical products in both China and Puerto Rico physicians and pharmacists need communication resources as well as laboratories for asseys to document and inform one another about adverse effects of poor quality pharmacuticals. I am thinking about the reports of four recent deaths due to ? poor grade ? contaminated heparin from Baxter. I suggest we develop a clinically based control system along the infectious disease model where there would be CDC like reports and pharmacuticals could be tested (like environmental specimens are tested by publichealth departments for bacteria and other pathogens). (Need to narrow topic)
• Improving patient Vital signs monitoring (Posted by JosephD on 31 Mar 2008)
  Especially "Intake/Output" and Weights that are often ignored, not reported accurately etc (Added to Quality Improvment Section)
• Focused Physician Performance Evaluation (Posted by DebOndeck on 27 Apr 2008)
  (Added to Quality Improvement Section - see Improving Physician Performance Evaluations)
• Ongoing Physician Performance Evaluation (Posted by DebOndeck on 27 Apr 2008)
  (Added to Quality Improvement Section - see Improving Physician Performance Evaluations)
• Culture of Safety (Posted by DebOndeck on 27 Apr 2008)
  (Need to narrow topic)
• Best Practices in Documenting Performance Measurement Data (Posted by LizLutheran on 01 May 2008)
  
• Nursing Education (Posted by TeresaBriggs on 11 May 2008)
  This section can include nursing school (ADN, BSN), continuting education for licenses nurses, and furthering your education to the next level (ie. ADN to BSN, BSN to MSN)(Need to narrow topic)
• Beyond Core Measures: Composite Quality Dashboard (Posted by ScottHodson on 14 May 2008)
  (Added to Quality Improvement Section - see Presentation of Quality Information)

• ER- (Posted by FaonRodriguez on 14 Jun 2008)
  
• No national standard for ED turnaround time (Posted by FaonRodriguez on 14 Jun 2008)
  SCOPE: To survey the field and build a database with quality information on ER-TAT. We would like to survey: 1-What clinical laboratory tests are being monitored? 2-Under what conditions: Ordered to Received, Received to Resulted or Total= Ordered to Resulted?. 3-What are the expected thresholds and goals for each time frame. 4-How do other hospitals measure outliers? 5-Are they measured separately especially when a CKMB or Troponin becomes an oulier when they get ordered along with a basic metabolic panel. 6-From the montly ER-TAT data, where do other hospitals see the need for improvement? Is it from ORDERED-TO-RECEIVED, or from RECEIVED-TO-RESULTED? 7-What is being done to correct it? 8-What controls TAT besides methodology and transportation?
• NPSG 3E for Home Care: implementation when pharmacy services are not provided (Posted by DianaReaves on 29 Jul 2008)
  
• Coordination of Care between Mental Health Professionals and PCP's (Posted by MaryHerkert on 04 Sep 2008)
  
• Emergency Management (Posted by DustinCole on 12 Sep 2008)
  Could be broken down further (EOP,COOP,DR) I have something in the Sandbox if you want to take a look.
• Credentialing and Privileging in the SNF Setting (Posted by SarahEmery on 18 Sep 2008)
  
• Emergency Managment 2 (Posted by DustinCole on 13 Oct 2008)
  I see in a past post there is one for EM. It stats it needs to be narrowed down. I agree that it does but it needs to have a beginning. EM is the top but if you don't have anything to build from where do we start. Plus DR, ICS(HICS), COOP and others all work together. Any suggestions on how to narrow it down?
• Challenging/Aggressive Behavior in Persons with Dementia; Prevention vs Treatment (Posted by JudyBerry on 22 Oct 2008)
  Non-pharmacolgical behavior management by Pro-actively meeting the emotional needs of each person in addition to physical needs is key! Recent study results were a 93% reduction in behavioral hospitalizations over 10 year period using Lakeview Ranch Model of Specialized Dementia Care. Current research in progress to identify actual reductions in health care costs by utilizing pro- active preventative disease management and collaborative model of specialized dementia care. Posted by Judy Berry on October 21, 2008

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