Listen and learn from the lived experience of skilled critical access hospital quality improvement (QI) staff from across the country! These virtual QI mentors will come together periodically for quality time to share PIE—their performance improvement experience. They discuss key themes that help drive quality improvement in their rural hospitals. Listen to their lessons learned, strategies, tips, and ideas. Find valued supportive resources for each of their topics, along with their favorite ...
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From the JAMA Network, this is JAMA Performance Improvement: Do No Harm, the podcast about performance improvement and medicine that aims to elevate the quality of care, one patient at a time, with host Ed Livingston, MD.
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QI Mentor Conversation: Improving Swing Bed Quality
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17:15In this session of Quality Time: Sharing PIE, mentors Kathe Bryant from Covington County Hospital in Collins, Mississippi, and Cara Cruz from Carson Valley Medical Center (CVMC) in Gardnerville, Nevada, share the proactive approaches they took to improve their swing bed programs.
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QI Mentor Conversation: Preventing Readmissions
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21:21In this session of Quality Time: Sharing PIE, mentors Tammy Sudtelgte from Floyd Valley Healthcare in Le Mars, Iowa, Stacey Karvoski from Wallowa Memorial Hospital in Enterprise, Oregon, and Linda Webb from Pulaski Memorial Hospital in Winamac, Indiana share their varied approaches their teams have used to reduce avoidable hospital readmissions.…
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QI Mentor Conversation: Fall Prevention Strategies
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16:10In this session of Quality Time: Sharing PIE, QI Mentors Gloria Barth from Harrison County Hospital, Corydon, Indiana and Jen Monzo, from McKenzie Health System, Sandusky, Michigan, share how they implemented successful fall prevention strategies at their critical access hospitals.
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QI Mentor Conversation: Patient and Family Engagement
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14:47In this session of Quality Time: Sharing PIE, Mentors Karen Hooker from Melissa Memorial Hospital in Holyoke, Colorado, and Brenda Stevenson from Titusville Area Hospital in Titusville, Pennsylvania, share some of the ways that staff at their facilities routinely engage patients and families in the care process.…
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QI Mentor Conversation: Making Quality Improvement Fun
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18:49In this session of Quality Time: Sharing PIE, Mentors Mariah Hesse, BSN, RN, CENP, from Sparrow Clinton Hospital, St. Johns, Michigan, and Brenda Stevenson, RN, from Titusville Area Hospital, Titusville, Pennsylvania, share how they work to make quality improvement (QI) fun and engaging for the staff at their hospitals, including creative ways they…
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QI Mentor Conversation: Using “Small Data” to Drive Big Improvements
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15:11In this session of Sharing PIE, Ben Power, MS, CPHQ, from Barrett Hospital & HealthCare in Dillon, Montana, and ArvaDell Sharp, RN, from Pembina County Memorial Hospital in Cavalier, North Dakota, talk about data and how they approach using different sources of data in their small critical access hospitals.…
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QI Mentor Conversation: How Board and Leadership Drive Quality Outcomes
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13:59In this second leadership-focused session of Sharing PIE, executive, board, and clinical representatives from Sparrow Clinton Hospital in St. Johns, Michigan, share examples of how their board and senior leaders are engaged in helping drive quality outcomes.
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QI Mentor Conversation: Involving Board and Leadership to Drive Quality Outcomes
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15:47In this episode, quality, clinical, and board representatives from Horizon Health’s Paris Community Hospital in Paris, Illinois, discuss how successful board and leadership engagement drives quality outcomes.
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A Better Way to Manage Chronic Medical Conditions in Homeless Emergency Department Patients
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35:41Homeless patients with chronic medical conditions who need long-term care often repeatedly present to emergency departments to receive treatment. Following a performance improvement analysis, clinicians at UCSF developed an emergency department–based team who work with the community to provide care for this challenging population. Hemal Kanzaria, M…
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QI Mentor Conversation: Engaging the Whole Team
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16:00In this episode, QI Mentors Cindy Gilman from Carroll County Memorial Hospital in Carrollton Missouri, and Christy Mintah from Avera Holy Family Hospital in Estherville, Iowa discuss how to engage the whole hospital team in quality improvement.
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Improving Management of Elevated Liver Function Tests in Post Liver Transplant Patients
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17:22There are hundreds of thousands of liver transplant patients, all of whom will be seen in general clinical practices. It is common for them to develop elevated liver enzymes—a potentially serious problem that may be a sign that the transplanted liver is failing. Traditionally, patients with these findings are sent to a liver transplant center for a…
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QI Mentor Conversation: The Impact of COVID-19 on Quality Improvement
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14:19In this episode, Mariah Hesse from, Sparrow Clinton Hospital in St. Johns, Michigan, and Ben Power from Barrett Hospital & HealthCare in Dillon, Montana, discuss the impact COVID-19 had on their hospitals with regards to quality improvement (QI), and how they adapted their QI work accordingly.
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The Aging Clinician: When Should Older Clinicians' Cognitive Abilities Be Evaluated?, Part 2
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9:08As physicians age, they experience the inevitable decline of cognitive and physical function. It is not clear how that affects clinical practice. Jeffrey Saver, MD, vice chair of neurology at UCLA and a JAMA Associate Editor, discusses how to best assess the clinical performance of aging physicians. The Aging Clinician: When Should Older Clinicians…
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QI Mentor Conversation: Becoming a Quality Improvement Leader
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13:11In this session of Quality Time: Sharing PIE, Cindy Gilman from Carrol County Memorial Hospital in Carrolton Missouri, and Karen Hooker from Kit Carson County Health Service District in Burlington Colorado, healthcare professionals from very different backgrounds, talk about how they became quality leaders.…
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The Aging Clinician: When Should Older Clinicians' Cognitive Abilities Be Evaluated?, Part 1
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32:39More than a third of the physician workforce is older than 60 years, and 10% are older than 70 years. Cognitive abilities may decline with age but how cognition affects clinical practice is unknown. It is also not clear how clinicians’ cognitive ability can be measured and acted upon when diminished without committing age discrimination. Two major …
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How to Reduce Emergency Department Dwell Time
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24:27Chaos in the emergency department is common. How to fix it is not always clear. Mary P. Mercer, MD, MPH, from the University of California, San Francisco, discusses how they successfully fixed their long dwell times at the emergency department at San Francisco General Hospital. Their solution was to create a fast-track unit that managed low-acuity …
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Poof – It’s Gone – The Disappearing Order That Led to a Patient Getting an Unnecessary Procedure
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20:55Electronic health records are the bane of most clinicians’ existence. They were supposed to help us but not only have they made life more difficult for clinicians, they are the cause of medical errors. Described here is a case of the patient receiving an unnecessary procedure because an order was not canceled in an EHR where it had disappeared from…
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EMRs Gone Bad: How Order Sets Can Result in Medication Errors
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25:27One promise of electronic medical records (EMRs) was to reduce medication errors. That may not have occurred since one type of error, illegible orders, has been replaced by another: Order sets may incorrectly match a patient and necessary treatments. In this JAMA Performance Improvement podcast, we review a case in which guideline-based care was in…
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The Not-So-Good Idea of Sedating Patients Who Have Obstructive Sleep Apnea
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26:24One-third of the US population is obese. Obesity is a major risk factor for obstructive sleep apnea. This condition is very common, and patients with sleep apnea are at risk of major complications from sedation. This JAMA Performance Improvement podcast reviews a case of a patient who did poorly after he was sedated for a medical procedure. Intervi…
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What to Do When There Is an Overdose of Insulin
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32:07It is very easy to confuse drug concentrations and vials containing different amounts of drugs in the hospital setting. It is not uncommon to have dosing errors occur. In this podcast, we discuss how to manage an overdose of insulin and also how to implement preventive measures in the hospital environment to minimize the risk of drug dosing errors.…
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There are about 500 wrong-site surgeries performed in the United States every year. Simple maneuvers can minimize the risk for these occurring. This JAMA Performance Improvement podcast reviews a case of wrong-site surgery and discusses potential ways to avoid it. Interviewees include Armando Giuliano, MD, Harry Sax, MD, Kathryn Englehart, MD, and …
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Medication Errors in Hospitals–-It’s Everyone’s Fault
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18:37A patient was admitted to the hospital and got three times their normal dose of phenytoin resulting in phenytoin toxicity and a long hospital stay. Analysis of the error revealed problems with hospital organization, supervision issues and having an environment that facilitates errors. Errors don’t occur simply because one clinician makes a mistake—…
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Retained Foreign Body From a Sheared Off Lumbar Drain
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19:33A resident is asked to remove a drain that was placed in the lumbar space during an operation. Having never seen this sort of drain before not having removed one, the resident proceeded to remove the catheter. Several days later, the patient complained of persistent drainage. An 11-cm segment of retained catheter was removed. This JAMA Performance …
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Managing Patients With a Latex Allergy
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32:21Latex allergy is common and usually benign but at times can be life-threatening. What can clinicians do to minimize the risk of serious complications attributable to latex allergy? We interview Cynthia Barnard, PhD, MBA, MSJS, and Erin Slade-Smith, MSN, RN, CNOR, both from Northwestern Memorial Hospital in Chicago, Illinois, and David W. Baker, MD,…
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Ensuring Staff Safety Against Violent Patients
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30:51Violence against health care workers is increasing. With fewer mental health services available, health care workers have disproportionate exposure to potentially dangerous patients. This article reviews the experience of one nurse who was severely injured by a patient and the lessons learned by the hospital where the incident occurred regarding mi…
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What to do when the wrong procedure is performed? In this first installment of JAMA Performance Improvement: Do No Harm we explore the options for dealing with this very difficult problem with Tami Minnier, RN, MSN, Paul Phrampus, MD, Linda Waddell, RN, MSN, and David Baker, MD, MPH, FACP. Air traffic audio courtesy of LiveATC.net, used with permis…
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