BACKGROUND:Safe opioid prescribing remains a national priority amid rising overdose-related morbidity and mortality. Prescription drug monitoring programs (PDMPs) aim to improve prescribing safety by identifying high-risk medication patterns; however, clinician engagement remains inconsistent despite legal requirements. Internal audits at our institution demonstrated PDMP review in only 67.6% of opioid-prescribing discharges within the Hospital Internal Medicine Department, identifying a clear quality improvement (QI) opportunity. PURPOSE:This QI project aimed to increase PDMP review during opioid-prescribing discharges at our Hospital Internal Medicine Department by 20% over a 3-month period. METHODS:Using the DMAIC framework, interventions targeted hospitalist physicians, advanced practice providers, and pharmacists. Strategies included stakeholder education, standardized documentation templates, pharmacist secure-chat reminders at discharge, workflow algorithms, and weekly dashboard monitoring with targeted feedback. The primary outcome was the proportion of opioid-prescribing encounters with documented PDMP review. The balancing measure was the percentage of patients discharged before noon to ensure operational efficiency was preserved. Chi-square and two-sample t tests were performed. RESULTS:Among 336 eligible discharges, PDMP review increased from 67.6% at baseline to 84.8% by March 2025, with a peak of 100% observed during the final measurement week (p < .001). Review rates increased steadily, with the largest gains after dissemination of workflow algorithms and targeted feedback. Discharge-before-noon rates remained stable (11.67% vs. 13.47%; p = .27), with no effect on operational efficiency. CONCLUSIONS:This QI initiative significantly improved PDMP review adherence without affecting discharge efficiency. IMPLICATIONS:This scalable, multidisciplinary model supports regulatory compliance and strengthens system-level opioid stewardship across health care settings.
INTRODUCTION:Central line-associated bloodstream infections (CLABSIs) remain a major source of preventable harm and cost. Although daily chlorhexidine gluconate (CHG) bathing is recommended for patients with central venous catheters (CVCs), adherence is often inconsistent in non-intensive care unit (ICU) settings where device visibility and maintenance workflows may be less standardized. PURPOSE:To improve the consistency of CHG bath ordering and documentation among non-ICU adult inpatients with CVCs in a community hospital. METHODS:We conducted a single-center quality improvement project using system redesign principles. Interventions included enhanced electronic medical record visibility of CVCs, standardized CHG bath orders within CVC maintenance workflows, and multidisciplinary education and feedback. Process measures included CHG bath order placement compliance and CHG bath completion compliance. Run charts evaluated trends over time. RESULTS:At baseline, CHG bathing orders were lower among patients who developed CLABSI compared with those who did not (42% vs. 60%). The baseline rate of documented CHG baths was 0.42 baths per central line day among patients without CLABSI compared with 0.22 baths per central line day among patients with CLABSI. After implementation, CHG bath order compliance improved to 66-80% and bath completion compliance improved to 69-78%. After stabilization, documented CHG bathing increased to 0.84 baths per central line day. CONCLUSIONS:System-level workflow redesign improved reliability of CHG bath ordering and documentation for patients with CVCs in non-ICU settings. IMPLICATIONS:System-level approaches that prioritize leadership engagement and standardization may help improve central line maintenance practices in non-ICU settings.
INTRODUCTION:In vitro fertilization (IVF) cycles typically require multiple in-person visits for blood tests and ultrasonography to monitor the response to gonadotropins and predict treatment outcomes.The aim of the quality improvement project was to reduce the number of in-person visits for patients undergoing IVF while maintaining high-quality patient care. METHODS:A multimodal quality improvement (QI) initiative was implemented for patients undergoing IVF through changes to the default settings in the electronic medical record and staff education. Data were collected prospectively for all patients undergoing IVF from June to August 2020 and retrospectively from June to August 2019. RESULTS:A total of 178 and 202 IVF cycles were included in the preintervention and postintervention periods, respectively. The median number of visits per IVF cycle was reduced by 50% in the postintervention period compared with baseline (4.00 [3.00, 5.00] vs. 8.00 [7.00, 8.00], p < .001). There were no statistically significant differences in the odds of having more than 20 oocytes retrieved (OR 1.568; 95% CI 0.91-2.703), moderate or severe ovarian hyperstimulation syndrome (OHSS) symptoms (OR 1.08, 95% CI 0.17-6.73), or pregnancy rate per embryo transfer (OR 0.82, 95% CI 0.45-1.50). A high level of patient satisfaction was observed. CONCLUSIONS:In-person visits during an IVF cycle were rapidly reduced, with good patient satisfaction and no statistically significant differences in outcomes.
BACKGROUND:Contaminated blood cultures can lead to diagnostic errors, inappropriate antimicrobial use, and prolonged hospital stays. Although a contamination rate ≤3% is generally considered as an acceptable upper limit, the rate in our hospital exceeded this benchmark. PURPOSE:We aimed to reduce blood culture contamination rates by a hospital-wide, evidence-based quality improvement (QI) approach. METHODS:A multidisciplinary team including clinical pathology, infectious diseases, nursing, and quality management implemented a QI initiative using Plan-Do-Study-Act (PDSA) cycles. Root cause analysis identified inconsistent disinfection practices, inadequate formal training, and lack of feedback. Interventions included standard operating procedures revision based on current best practices, development of standardized instruction and e-learning, monthly unit-level feedback, and device standardization. RESULTS:The preintervention contamination rate was 4.74% (range: 4.08%-5.77%). After implementation, the rate decreased to 2.82% (2.71%-2.90%). Improvement was sustained over 1 year, with a rate of 2.42% (2.17%-2.65%). Additional outcomes included increased blood culture volume and reduced reporting time. CONCLUSIONS:A multidisciplinary collaboration and evidence-based QI initiative targeting all staff involved in blood culture collection was the key to effectively reducing and sustaining lower contamination rates. IMPLICATIONS:Blood culture contamination is a modifiable quality metric. Evidence-based, multidisciplinary QI programs using PDSA cycles are a replicable framework for improving patient safety, diagnostic accuracy, and antimicrobial stewardship.
BACKGROUND:Length of stay (LOS) is a process metric for optimizing hospital resource planning. PURPOSE:To identify an intervention bundle that would reduce Vizient LOS index for a quaternary, academic medical center department of surgery. METHODS:We applied three interventions: (1) multidisciplinary discharge rounds; (2) quarterly data sharing of surgeon- and procedure-specific LOS data; (3) electronic health record (EHR)-based summary capable of capturing patient complexity. We performed a running prospective analysis of Vizient LOS index, assessing impact of interventions implemented in a pragmatic, bundled fashion. Pre- and postintervention LOS data were analyzed using a two-sample t-test to assess statistical significance at a 95% confidence interval for difference in means. RESULTS:From 6/2022 to 6/2025, 14,754 patients were discharged from the Department of Surgery. When comparing pre- and postintervention data, our bundled efforts led to a decline in observed average LOS (aLOS) from 6.208 to 5.777 days (difference = -0.431; [0.153, 0.709]; t[34] = 3.150, p = .003). This reduction contributed to an improvement in the LOS index (ratio of observed to expected LOS), from 0.950 to 0.857 days (difference = 0.093; [0.053, 0.134]; t[34] = 4.718, p = .000). This reduction in observed aLOS by 0.43 days resulted in an annual estimated cost savings of >$5.1 million. CONCLUSIONS:Implementing bundled LOS interventions helped our quaternary, academic department of surgery reduce LOS and improve throughput while reducing cost.
OBJECTIVE:To evaluate patient-reported experiences after interhospital transfer (IHT) within an integrated health system and identify communication and coordination domains associated with overall satisfaction. METHODS:This retrospective study included adults admitted to Mayo Clinic Health System hospitals between July 1, 2024, and June 12, 2025. Patients were categorized as transferred or nontransferred during their index admission. Propensity score matching (1:1) using demographic, clinical, and hospital characteristics compared patient experience survey responses. Logistic regression identified factors associated with a "very good" overall hospital rating. Open-ended comments from transferred patients were summarized by Copilot for recurring themes. RESULTS:Among 3,138 nontransfer and 163 transfer patients, 3,301 provided experience data. After matching, 163 pairs were analyzed. Overall hospital ratings did not differ significantly between groups ( p = .40). No individual communication or coordination domain differed after matching. Environmental cleanliness was independently associated with higher odds of a "very good" rating (odds ratio 1.76; 95% confidence intervals: 1.04-2.98; p = .036). Qualitative feedback emphasized clear communication and coordinated care as key drivers of satisfaction, whereas discharge instructions and intersite communication remained areas for improvement. CONCLUSION:Within an integrated health system, IHT did not adversely affect patient satisfaction. Cleanliness, communication, and coordination most strongly influenced overall experience.
INTRODUCTION:To identify areas of opportunity and gaps and develop and test strategies to improve patient treatment in the observation units of two regional community medical centers. METHODS:The Plan-Do-Study-Act (PDSA) approach identified the two common emergency department complaints (syncope and collapse; unspecified atrial fibrillation) with the longest patient length of stay (LOS) in observation. Fishbone exercises elucidated these gaps. Departmental meetings, group discussions, and 1:1 discussion of particular cases provided education to reduce LOS. RESULTS:Plan-Do-Study-Act target goal for median LOS for these two complaints was 30 hours, which was approximately 12% less than the median LOS during the data collection stage. The PDSA process improved care efficiency, as demonstrated by reduced LOS for the atrial fibrillation cohort between the early and later months after launch and implementation. For the syncope cohort, the median LOS met or remained below the target threshold of 30 hours from the mid-point through the later stages of the implementation period. CONCLUSIONS:The reproducible PDSA-improved processes lowered the median LOS of patients with syncope or atrial fibrillation in observation status to the target goal of 30 hours or less in the past 5 and 8 months, respectively, of the launch and implementation stages.
Background:National and international agencies charged with assuring quality of healthcare need to select quality indicators. This study aimed to identify criteria used to prioritize healthcare quality measures, with particular focus on healthcare disparities.Methods:A scoping review (osf.io/e5duc) combined comprehensive scientific literature review searches in seven databases with detailed reviews of gray literature sources in December 2024. We mapped the criteria across various identified approaches, documenting similarities and differences.Results:We identified 103 criteria sets; sets were intended for population/public health and general or specific healthcare settings. The use of formal consensus methods and involvement of interest -holders varied. Commonly used criteria included importance, validity, reliability, feasibility, scientific soundness, improvability, and usability of measures, but operationalizations varied. The need for parsimony and minimizing measurement burden was a recurring theme, along with calls for alignment with broader health system goals.Conclusions:Selecting criteria for quality-of-care and healthcare disparities has implications for how the quality-of-care is scored, healthcare organizations are evaluated, and healthcare is delivered. This review documents the process and relative frequency of proposed criteria. Many different criteria have been suggested, and approaches vary considerably across agencies, highlighting the complexity and diversity of the process.
INTRODUCTION:According to the CDC, approximately 80%-90% of antibiotic use occurs among outpatients and at least 30% of these prescriptions are unnecessary. METHODS:In 2024, multidisciplinary team at our institution developed a program to monitor outpatient antibiotic use for high priority respiratory conditions. Best practice guidelines from the Agency for Healthcare Research and Quality Outpatient Antibiotic Stewardship Toolkit were used, and feedback was provided to providers in the program. Data were tracked using an electronic medical record to pull high priority respiratory conditions such as upper respiratory infection, acute bronchitis, sinusitis, otitis media, pharyngitis, and pneumonia by ICD-10. RESULTS:Antibiotic Prescription rates decreased from 528.32 antibiotics per 1,000 persons in 2023 to 270.91 in 2024 ( p < .05). Overall community-acquired C. difficile admissions decreased from 21 in 2023 to 16 in 2024 ( p > .05). The percentage of C. difficile admissions with outpatient antibiotics within 90 days reduced from 8 (33%) in 2023 to 1 (6%) in 2024 ( p < .05). CONCLUSIONS:Outpatient Antibiotic Stewardship Programs can reduce the number of inappropriate prescriptions potentially leading to a reduced risk for patients developing C. difficile . A cost savings was established to promote key stakeholder buy in and program sustainability.
INTRODUCTION:The National Association for Healthcare Quality (NAHQ ® ) has refreshed its Healthcare Quality Competency Framework ™ , ensuring health care professionals are equipped with essential skills to navigate the complexities of modern health care systems. Originally introduced in 2016, these competencies have served as the industry standard for defining the knowledge and capabilities required to advance quality and safety across health care environments. PURPOSE:The framework emphasizes the necessity of competencies that enhance quality, safety, and strategic objectives within health care organizations. METHODS:Through collaborative efforts involving subject matter experts and leadership interviews, the process addressed the present-day challenges faced by practitioners and health care entities. RESULTS:The framework revisions further defined each domain, consolidated overlapping competencies, and strengthened the integration of patient experience and engagement throughout all domains. The changes were implemented to support broader application of quality and safety competencies across all health care professions. The update emphasizes the importance of continuously refining competencies to adapt to the evolving demands of health care, which may help promote an environment that enhances patient outcomes. CONCLUSIONS:The framework serves as a central reference for health care professionals at all levels, nurturing effective collaboration across multidisciplinary teams, and promoting a culture of continuous learning and improvement. This article explores the evolution of the framework, the historical context of health care quality, and the importance of aligning standard competencies to elevate patient care standards in an increasingly complex environment.
INTRODUCTION:Artificial intelligence (AI) continues to reshape health care, supported by advances in computing power, affordable data storage, and widespread electronic health record adoption. METHODS:This systematic review followed PRISMA 2020 guidelines, searching PubMed, IEEE Xplore Digital Library, and Web of Science for studies published between January 2020 and September 2025. Eligible articles included original research addressing AI applications in clinical contexts with prospective or external validation. RESULTS:Fifteen studies met inclusion criteria. Publication volume peaked in 2024 (n = 5, 33.3%). Deep learning was the most widely adopted method (60.0%), with convolutional neural networks frequently used in medical imaging. Radiology comprised 33.3% of applications, followed by oncology (20.0%) and cardiology (13.3%). The median diagnostic performance of imaging-based models was an area under the curve (AUC) of 0.91 AUC. Primary implementation challenges included regulatory compliance (53.3%), lack of algorithmic transparency (40.0%), data quality problems (33.3%), and clinical integration challenges (26.7%). Compared with earlier reviews (2015-2019), recent studies demonstrated increased external validation rates (rising from 23% to 46.7%) and greater focus on algorithmic fairness. CONCLUSIONS:Artificial intelligence demonstrates substantial potential to advance health care quality across multiple domains improving diagnostic accuracy and patient safety, enhancing care efficiency and timeliness, and supporting equitable care delivery when appropriately validated across diverse populations. However, realizing these quality improvements requires addressing persistent implementation barriers including regulatory uncertainty, algorithmic transparency, data quality concerns, and clinical workflow integration challenges.
BACKGROUND:Maryland's Episode Quality Improvement Program (EQIP) incentivizes nonhospital practitioners to improve care quality and reduce healthcare costs through an episode-based payment framework. METHODS:Results from EQIP's performance year one (January 1, 2022 to December 31, 2022) were published by the Maryland Chesapeake Regional Information System and the Maryland Health Services Cost Review Commission. Savings for every clinical episode category and type were determined by comparing an entity's 2022 spending to target prices. RESULTS:Fifty entities enrolled in EQIP in 2022 and experienced a total savings of $11,763,026. Entities reported 37,758 clinical episodes and payments totaling $385,701,806, which was less than the target price of $397,464,832. Entities participated in 15 clinical episode types divided into three categories: Orthopedics (50%, 25 entities), Cardiology (40%, 20 entities), and Gastroenterology (34%, 17 entities). Orthopedics was the only clinical episode category with savings at a rate of 5.9%. Cardiology episodes had savings at a rate of -0.3%, and gastroenterology episodes had a rate of -1.8%. CONCLUSIONS:Episode Quality Improvement Program yielded cost savings in Maryland. Other states could learn from this model when implementing their own value-based care models. Policies that create an enabling environment for value-based care programs like EQIP should be supported.
BACKGROUND:Disability is a major problem facing older adults. Durable medical equipment (DME) is used to reduce disability. DME cost is projected to continue to grow. The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program for individuals who live in the community while being nursing home eligible. The program's goal is to prevent or delay institutionalization by attending to participant's needs including the need for DME. The institution, through its interdisciplinary team, noticed that not all DME provided was used. PURPOSE:To understand DME utilization for PACE participants, to identify barriers to use, and to assess financial costs associated with DME nonutilization. METHOD:The institution developed a quality improvement project using the Plan-Do-Study-Act (PDSA) cycle to assess and understand DME nonutilization. RESULTS:Although the financial goal of reducing costs related to DME nonutilization was not met, quality improvements were observed, including reduced barriers to utilization and changes in prescription patterns, indicating progress toward more appropriate and targeted DME use. CONCLUSIONS:Barriers to DME utilization are complex. An educational session for the interdisciplinary team led to quality improvements and underscored the importance of a person-centered approach to prescribing, coordinated team interventions, and ongoing education and monitoring.
BACKGROUND:The Centers for Medicare and Medicaid Services developed Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) with the priority of increasing nursing home residents' vaccine rates to prevent respiratory diseases including COVID-19, pneumonia, and influenza. The Pennsylvania Pharmacists Care Network (PPCN) partnered with Pennsylvania's QIN-QIO to increase the rate of immunizations of nursing home residents across the state. PURPOSE:To evaluate vaccination improvement rates in Pennsylvania nursing home residents after community pharmacist-led vaccination clinics. METHOD:A retrospective analysis was conducted of data from pharmacist-led vaccination clinics conducted at Pennsylvania nursing homes between March 1, 2024, and February 28, 2025. Outcomes were analyzed using descriptive statistics. RESULTS:There were 68 vaccination clinics across 33 Pennsylvania nursing homes. Nineteen pharmacies administered 4,938 vaccines to nursing home residents including 2,193 COVID-19 vaccines, 1,193 pneumococcal, and 853 influenza vaccines. The average relative improvement rates among nursing home residents after the pharmacist-led clinics were 46.3% for influenza vaccines, 41.4% for COVID-19 vaccines, and 26.3% for pneumococcal vaccines. CONCLUSIONS/IMPLICATIONS:A partnership between a QIN-QIO and PPCN community pharmacies improved respiratory vaccination rates among nursing home residents in Pennsylvania. This study demonstrates that community pharmacists are well positioned to conduct vaccination clinics at nursing homes to improve vaccination rates.
BACKGROUND:U.S. hospitals generate ∼6 billion tons of medical waste annually. Disposal costs exceed $4 billion. High-temperature incineration, required for sharp wastes, is the most costly and carbon-intensive disposal. Inappropriate waste contributes significantly to health care's financial and environmental burdens. METHODS:This single-blinded cross-sectional study involved a one-time audit of 176 sharps containers from operating rooms, procedure rooms, and clinics across a Level 1 trauma center, conducted on a single day in 2023. Containers were photographed before disposal. Metadata, such as specialty and room type, were recorded separately. Independent reviewers who analyzed the images were masked to the containers' origins. The proportion of image area occupied by nonsharp items was calculated using ImageJ. Statistical comparisons were performed using independent-samples t-tests and ANOVAs. RESULTS:Overall, 24.74% of sharps container contents were inappropriate. Emergency services had the highest rate (40.22%), followed by surgical (22.37%) and medical services (9.79%) ( p < .001). Specialties differed significantly ( p < .001); orthopedics, otolaryngology, and plastic surgery had lower inappropriate disposal, while emergency medicine and general surgery had higher rates. CONCLUSIONS:Our findings highlight an opportunity for targeted interventions to reduce medical waste misclassification. Standardized protocols and specialty-specific education may reduce costs and support environmental sustainability.
BACKGROUND:The operating room (OR) is a dynamic environment requiring close communication between surgeons, anesthesiologists, and clinicians. First-case on-time starts (FCOTS) is a common metric of OR efficiency. OR delays are multifactorial and can increase hospital expenditures. PURPOSE:We sought to determine whether implementing explicit deadlines, in conjunction with feedback to late individuals, would improve our institution's FCOTS. METHODS:After obtaining approval from quality board at our tertiary care, Level 1 trauma institution, a "pre versus post" quality improvement project implemented a multicomponent initiative with explicit deadlines for perioperative tasks, feedback to late surgeons, and OR tracking boards. We included American Society of Anesthesiologists (ASA) classification score ≤4 patients, undergoing elective or urgent surgery. RESULTS:A total of 14,609 patients were included (6,635 preimplementation and 7,974 postimplementation). Both groups were well balanced regarding most potential confounders, for example, age, sex, and ASA score. We observed a significant difference ( p < .0001) in FCOTS between the preimplementation (39.0%) and postimplementation (74.0%) phases. Using a 5-minute grace period, the monthly average FCOTS percentage increased from 54.8% preimplementation to 83.2% postimplementation ( p < .0001). CONCLUSIONS:Implementation of a central OR tracking board, clinician feedback, and explicit 5:10:15:20-minute goals was associated with significant improvement of our hospital's FCOTS.
BACKGROUND:Rectal bleeding is a common concern among primary care patients and a risk marker for colorectal cancer. Yet, primary care patients who present with rectal bleeding frequently do not complete timely colonoscopies. We sought to determine if a phone-based, scheduling intervention for patients presenting with rectal bleeding in primary care would improve the rate of scheduling and completion of ordered colonoscopies. METHODS:We conducted a nonrandomized pre-post intervention study at an urban, academic, hospital-based primary care clinic. We included patients with a colonoscopy order for rectal bleeding who had not scheduled a colonoscopy within 2 weeks of the order date. We created a baseline cohort from August to October 2022 and an intervention cohort from November 2022 to June 2023. The pilot intervention involved up-to-3 outreach phone calls by a primary care-based phone service representative to study participants. RESULTS:Compared to the baseline cohort, patients in the intervention cohort had a significantly higher rate of colonoscopy completion at 365 days ( p = .04). Higher rates in loop closure were seen across demographic cohorts. DISCUSSION:Proactive, primary care-based, outreach phone calls increased rates of completion of colonoscopies ordered for rectal bleeding.
BACKGROUND:Target-based care (TBC) uses institutional data to create a shared mental model of anticipated postoperative milestones. This study evaluated the impact of a clinical effectiveness strategy, combining TBC with a clinical pathway and decision support, on outcomes in patients undergoing pectus excavatum repair. METHODS:This was a prospective study at a quaternary children's hospital between 2022 and 2024. Patients undergoing repair from 2018 to 2021 were historical controls. Target-based care included displaying bedside targets for length of stay (LOS) (outcome metric), Foley catheter and patient-controlled analgesia (PCA) discontinuation (process metrics), and a multidisciplinary evidence-based clinical pathway with an electronic order set. RESULTS:Overall, 91 patients were included: 52 preintervention and 39 postintervention. Median LOS decreased from 3 to 1.8 days (95% confidence interval [CI] 0.8-1.6, p < .05). The proportion of patients who met the LOS target of 2 days increased from 44.2% to 91.8% ( p < .05). The mean time to PCA discontinuation decreased from 1.6 to 0.8 days (95% CI 34.8-118.7, p < .05). The time to Foley catheter removal diminished from 22.2 to 17.1 hour (95% CI 0.6-9.6, p < .05). CONCLUSIONS:A data-driven TBC with a clinical pathway had an immediate and sustained impact on patient care. Length of stay, PCA discontinuation, and time to Foley discontinuation decreased after TBC.
ABSTRACT:Medical appointment no shows cause a delay in a patient receiving the care that they need and cause a burden for the health care provider organization. The purpose of this project was to explore whether the use of empathic language in preappointment text message communications with a patient would affect appointment attendance rates. This project was conducted within a mental health treatment organization and included 419 patients scheduled for a virtual intake appointment during a 30-day period. The results indicated that adjusting the language used in preappointment text message communication with patients did not generate a statistically significant change in attendance rates. Additional findings point to possible gender differences, although sample size limitations affected the strength of these findings. The days of the scheduled appointments also seemed to affect attendance rates.
