Chasing the Rabbit: Official Blog by Author Steven Spear

The health care debate centers on the question: Provide more care to more people despite the  cost or save money by not providing care?  Both sides assume that better care requires more resources implying that  we  can’t learn how to better put resources to more efficient, effective use.  Beth Israel Deaconess (Boston) has rejected the false premise that there is nothing else to be learned about delivering care, highlighting at this week’s Silverman Symposium staff led projects to improve access, patient and staff safety, efficiency, and effectiveness–100 in all.

Effectiveness

An Evaluation of the Influence of Simulation on the Development of Critical Thinking Among Novice Nurses
Determining the Presence of Errors in 72 Hour Return Visits to the Emergency Department
Developing a Gastroenterology Quality Improvement Dashboard
Implementation of a Self Medication Program for Transplant Recipients
Implementing a Post Cardiac Arrest Therapeutic Hypothermia Protocol
Implementing Evidence Based Policies
Inpatient Psychiatric Outcomes
New Monitoring System to Decrease Microsurgical Flap Loss In Breast Reconstruction
Prescription of Inhaled Corticosteroids for Patients with Asthma
Provision of Flu and Pneumovax Vaccinations for Patients with COPD
Reducing Ventilator Associated Pneumonia One Step at a Time
Reduction of Hypoglycemia in Postoperative Cardiac Surgery Patients on Insulin Infusions
POE Alternate View Dashboard
Urinary Catheter Surveillance at BIDMC: Can We Use the Electronic Medical Record to Track Catheter Use?

EFFICIENCY

CCI Process for Determining IRB Review Requirements
Deviation Based Cost Modeling: A Novel Model to Evaluate Clinical and Economic Impact of Clinical Pathways
Electronic Patient Specific Progress Note Templates to Reduce/Eliminate Documentation Errors
Eliminating Amylase from the Evaluation of Pancreatitis in the Emergency Department
GI Specimen Tracking Redesign
Impact of Point of Care Creatinine Testing on Same Day Cancellations in MRI
Improving NICU team Structure: Use of Social Network Analysis
Improving Time to First Dose Antibiotics in the ICU
Inpatient Scanning Project
Institution Wide “Fast Track Pathway” for Colectomy Units Surgeons to Decrease Postoperative Length of Stay
Lean Clean Supply Rooms – Spread
Lean ED & Lab Workflow Redesign – Hemolysis
Lean West CPD & OR Decontamination – Safety 1st !
Linac Machine Downtime Emergency Recovery Plan
New White Boards on L&D
Re-Work Eliminated in Transplant Billing Process

EMPLOYEE SAFETY

Creating Transparency Around Employee Incidents
Emergency Management Employee Resources
Employee Occupational Health Flu Campaign
Fit-Test Compliance of Employees
Improving Compliance With TB Screening Among Health Care Workers
Improving Compliance with Use of Personal Protective Equipment (PPE) – Health Care Workers
Improving TB Compliance Among BIDMC’s MDs
Notifying Senior Leadership of Employee Incidents
Observational Experience
Reducing Needle-stick Exposures by Preventing Re-use of Needles
Repetitive Stress Syndrome Symptoms in Radiology: Prevalence and Response to Ergonomic Interventions
Workplace Safety in the Psychiatry Department

EQUITABLE

Communication Phrases for Limited English Proficient Patients
Domestic and Community Violence Screening – Bowdoin Street Health Center
Spanish Optometry Clinic

PATIENT CENTEREDNESS

Advanced Directives: Leading by Example
Automating Patient Requests for Chaplaincy via IPA
Embedding “Ethics” Throughout the Fabric of BIDMC
Emergency Department Patient Liaison Project
Enhancing Blood Gas Analysis for NICU Patients
Hearing Their Voice: Developing an Advisory Council
Improving Communication with Patients and Families
Improving Nursing Competency in Pain Management
Improving Patient-Centered Care Through a Pre-Operative Joint Replacement Class
Measuring Patient Satisfaction in Psychiatry
Mystery Shopping Results: Podiatry
Orthopedics Phone Improvement
Spiritual Care Increases Patient Family Satisfaction in ICUs
The Facts @ BIDMC – Promoting Transparency

PATIENT SAFETY

A Multi-Modal Approach to Improve Hand Hygiene on a Medical Unit
Bar Code Initiative for the NICU ADC
Benzodiazepine Use By Elderly Patients
Central Venous Line Education Tool
Evidenced Based Practice in Pre-Employment PPD Screenings
Global Triggers for Detecting Harm
Fall Prevention Program
Hospital Evacuation Plan
Implementation of a New Electronic Documentation System
Implementing ISBT 128 Symbology and Labeling
Implementing a Scripted Timeout – Preventing Wrong Site Surgery
Inclusion of Anesthesia Resources in Interventional Endoscopy
Increasing ICU Throughput through Ventilator Bundle and Oral Care Compliance
Long Term Follow-Up on Endoscopic Procedures
Management of ICU Patients in Interventional Procedural Areas
Medication Order Review in the NICU
Nursing Hourly Rounds
Observers in the Operating Room
Paperless is Powerful for Medication Reconciliation Process
Pharmacist Monitoring of Anticoagulation – Implementation of JC NPSG (3E)
Pregnancy Counseling for Women on Methotrexate or Cyclophosphamide
Pressure Ulcers
Prevention of Unintentionally Retained Objects Through a Count Resolution Pathway
Resource Management Plan
QI Evaluations of Renal Biopsies
Quality and Safety Workshop
Restraint and Seclusion Reduction
Safely Managing Perioperative Patients with Sleep Apnea
Safety Culture Survey in the Perioperative Areas
Safe Use of Epinephrine for Anaphylaxis
Skin Care Initiative – CVI
Venous Access Flush Orders
Standardizing Handoff Communication on the Medical Surgical Units
Sternal Wound Precaution Compliance and the Resulting Restrictions to Activity in Patients Status Post Cardiac Surgery via Midsternotomy
Surgical Site Infection Task Force
Universal Protocol Side / Site Discrepancies

TIMELINESS

AMI ‘D2B’ – Rapid Review and Improvement
Follow Up on CT Chest Scans
Improving Follow Up of Abnormal/Unsatisfactory Pap Smears
Prostate Needle Tracking
Yearly Eye Exam for Patients on Hydroxychloroquine Sulfate

Last Updated: March 31, 2009

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2. Incident Reporting Systems: Inadequate tool for quality and safety…
3. Beth Israel Deaconess: Systems, safety, and (avoided) severance…
4. Krugman concedes main objection: In fact, more care needn’t cost more…
5. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All