The evidence promoting the core measure or care process was described in more complete text and then condensed into a tabular format (Table (Table22). To Err Is Human: Building a Safer Health System. Hennekens CH, Albert CM, Godfried SL, Gaziano JM, Buring JE. The Worcester DVT Study. To address this limitation, a curriculum is in development for a brief training session (24 hours) designed to help BHCS clinical staff better interpret statistical descriptions in the literature. Careers. Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection. National Library of Medicine Sutton JC, Standen PJ, Wallace WA. An evaluation of the impact of the ventilator care bundle. Improving care for the ventilated patient. In Shojania KG, Duncan BW, McDonald KM, Wachter RM, eds. Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Lane-Trultt T. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. HHS Vulnerability Disclosure, Help Deep vein thrombosis and its prevention in critically ill adults. Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Geerts W, Selby R. Prevention of venous thromboembolism in the ICU. Federal government websites often end in .gov or .mil. FOIA Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. Lastly, although a core measure such as congestive heart failure discharge education may be identified as having been completed, it does not necessarily follow that the patient understands these instructions in a meaningful way that would prevent rehospitalization (106). Boockvar KS, Carlson LaCorte H, Giambanco V, Fridman B, Siu A. Combined results from 12 studies with 2 to 10 years of follow up indicate that one life is saved for every 13 patients who can stop smoking (, The patient's lipid profile should be assessed and treatment administered if necessary. The What's the relative risk? Based on the guiding principles of the Best Care Committee, ABC Baylor, and identified BHCS needs, this article aims to emphasize the evidence link between hospital-based core measures and safety goals as they relate to patient outcomes. ACE-Inhibitor Myocardial Infarction Collaborative Group. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Zhang J, Yu KF. Berenholtz SM, Milanovich S, Faircloth A, Prow DT, Earsing K, Lipsett P, Dorman T, Pronovost PJ. Saint S. Prevention of intravascular catheter-associated infections. In many cases, it is not practical to generate level 1 evidence (e.g., it would be unethical to randomize heart disease patients to a study arm that requires smoking). If angioplasty within 90 to 120 minutes is not possible, administration of thrombolytic drugs within 30 minutes after hospital arrival reduces the risk of death by 18% compared with no treatment with thrombolytics (, Beta-blockers can reduce the risk of death 13% to 23% in patients without contraindications (e.g., bradycardia, heart block, hypotension). This committee oversees the clinical implementation of STEEEP objectives by planning and enacting initiatives to improve the quality and safety of care throughout BHCS (21). Kress JP, Pohlman AS, O'Connor MF, Hall JB. Coleman EA, Parry C, Chalmers S, Min SJ. Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, Turpie AG, Egberts JF, Lensing AW, ARTEMIS Investigators Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ. Prophylactic antibiotics in surgery and surgical wound infections. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. Bradley EH, Curry LA, Webster TR, Mattera JA, Roumanis SA, Radford MJ, McNamara RL, Barton BA, Berg DN, Krumholz HM. Malenka DJ, O'Connor GT, Northern New England Cardiovascular Study Group A regional collaborative effort for CQI in cardiovascular disease. Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study. Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, Avezum A. Excess length of stay, extra costs, and attributable mortality. Part 2: Measuring quality of care. sharing sensitive information, make sure youre on a federal Polk HC, Jr, Christmas AB. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL. The article is not intended to be a comprehensive review of all aspects of the core measures and safety goals, but rather a readily available summary for use by clinical staff and process change leaders. Murin S, Bilello KS. Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Medical Center), http://www.jointcommission.org/NR/rdonlyres/48DFC95A-9C05-4A44-AB05-1769D5253014/0/AComprehensiveReviewofDevelopmentforCoreMeasures.pdf, http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/, http://www.ihi.org/IHI/Programs/Campaign/, http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals, Evidence obtained from at least one properly randomized controlled trial or from meta-analyses of multiple randomized controlled trials, Evidence obtained from well-designed controlled trials without randomization, Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group, Evidence obtained from multiple time series with or without the intervention. Strategies for reducing the door-to-balloon time in acute myocardial infarction. PMC legacy view Accessibility The site is secure. Core measures' and safety goals' level of evidence and impact on patient outcomes. Preen DB, Bailey BE, Wright A, Kendall P, Phillips M, Hung J, Hendriks R, Mather A, Williams E. Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial. Hospital quality for acute myocardial infarction: correlation among process measures and relationship with short-term mortality. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Buist M, Bernard S, Nguyen TV, Moore G, Anderson J. In order to facilitate staff comprehension of the linking evidence, articles that originally reported their findings in odds ratios were approximated to percentage reductions or increases in relative event risk (22). Targeting heightened compliance with core measures and safety goals as an isolated objective in the absence of more wide-ranging improvements in inpatient care processes and staff education appears to have limited benefit and in some cases can result in undesirable consequences. Clinicians may be motivated to comply with these practices if they are educated about the usefulness of the interventions and believe they will improve patient outcomes (20, 103, 104). Buist M, Harrison J, Abaloz E, Van Dyke S. Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. Thus, efforts to drive performance of this core measure need to be concurrent with care pathways that include prompt diagnostic workup, disease recognition, and appropriate treatment. 
The strongest evidence for these measures is found in patients with systolic dysfunction and EF <40%. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease catheter-related bloodstream infections in the ICU. Anderson FA, Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A. The supportive evidence given for core measures and selected safety goals is meant to facilitate delivery of evidence-based practices to the bedside. Conrad SA, Gabrielli A, Margolis B, Quartin A, Hata JS, Frank WO, Bagin RG, Rock JA, Hepburn B, Laine L. Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Joint Commission on Accreditation of Healthcare Organizations. Investigators have found varying correlations between compliance with acute myocardial infarction care guidelines and short-term outcomes, with Bradley et al demonstrating that delivering the composite bundle of acute myocardial infarction core measures accounted for only 6% of the hospital-level variation in risk-standardized 30-day mortality rates (12, 104). The incidence of surgical site infection increases 2 to 3 times with worsening hyperglycemia (, Hair should be removed by clipping. EF results indicate severity of heart failure, help determine treatment, and correlate with mortality and morbidity risk. Eliminating catheter-related bloodstream infections in the intensive care unit. The objective in portraying these associations is to create added, perceptible incentives for performance of these care processes and thereby further encourage improved health care quality within our organization. There is a 50% reduction in the rate of pneumonia, hospitalization, or death in patients receiving influenza vaccination (, Intubated patients who develop ventilator-associated pneumonia have a 30% higher risk of death (, Elevating the head of the bed 30 to 45 degrees reduces the risk of developing ventilator-associated pneumonia by 70% (, Peptic ulcer disease prophylaxis (with an H2 blocker or proton pump inhibitor) in at-risk critically ill (mechanical ventilation, coagulopathy) patients reduces the incidence of upper gastrointestinal bleeding by up to 50% (, It is estimated that 10% to 35% of intensive care unit patients develop deep vein thrombosis (DVT) (, Daily interruption of sedation/awakening trials can reduce the length of mechanical ventilation by up to 2 days (, Surgical site infections account for 15% of all hospital-acquired infections (, Preoperative antibiotics given within 1 hour of incision optimize drug levels in the tissues and are more effective than prophylactic antibiotics administered during or after the operation (, Appropriately chosen antibiotics provide effective protection against bacteria common at surgical sites without giving excessively broad coverage (, Antibiotics should be discontinued within 24 hours postoperatively. Preen DB, Bailey BE, Wright A. The inconsistent relationships among core measures, safety goals, and outcomes in larger populations on recent retrospective analyses do not undermine their importance. Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Ventilator-associated pneumonia prevention bundle. Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Recognizing the challenges in undertaking quality improvement within a large, multihospital environment and in response to the 2001 Institute of Medicine report calling for health care delivery that is safe, timely, effective, efficient, equitable, and patient-centered (STEEEP), Baylor Health Care System (BHCS) has developed a systemwide Best Care Committee. Elements from the 2008 Joint Commission hospital core measures (3) and Joint Commission National Patient Safety Goals (7) were selected to develop the summary. Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. As a type of clinical decision support, the summary card to be developed from this article can aid delivery of these care processes directly to patients. It should be given upon hospital arrival and prescribed at discharge (, Angiotensin-converting enzyme (ACE) inhibitors reduce the risk of death 10% to 20%. Percutaneous transluminal coronary angioplasty decreases the risk of death by 15% to 25% compared with thrombolytic drug treatment for acute ST elevation myocardial infarction if angioplasty is performed in <90 minutes after hospital arrival (, Thrombolytics should be administered if necessary. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JM, Wun CC, Davis BR, Braunwald E, Cholesterol and Recurrent Events Trial investigators The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Fall prevention programs involve medication adjustment of predisposing drug classes, scheduled mobilization and toileting, balance and gait training, and use of bed rails. Willingness of general practitioners to participate in enhanced primary care discharge care planning. Hospitals collaborate to decrease surgical site infections. Patients with risk factors (e.g., malignancy, immobility, pelvic surgery, joint replacement, previous DVT, hypercoagulable state) have a higher incidence of DVTs (, Pulmonary embolism can be a fatal complication of DVT. Beta-blockers (e.g., bisoprolol, metoprolol XL, carvedilol) reduce the risk of death by 30% to 35% (, ACE inhibitors reduce the risk of death by 15% to 25%. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Level 1 evidence is generally from randomized, controlled trials; level 2 studies are usually observational or retrospective. Evidence summaries and practice guidelines for inpatient core measures and safety goals. Smokers are 2 to 3 times more likely to get pneumonia than nonsmokers and are at risk of more severe disease (, Pneumonia vaccination should be administered to patients meeting criteria. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? Pittet D, Tarara D, Wenzel RP. The reference card being developed to summarize the results presented in this article addresses the issue of accessibility to evidence without impeding workflow. Rello J, Bodi M, Mariscal D, Navarro M, Diaz E, Gallego M, Valles J. Microbiological testing and outcome of patients with severe community-acquired pneumonia. Reported in terms of relative risk change or time (sedation vacation, care coordination). Bratzler DW, Houck PM. government site. Fonarow GC, Yancy CW, Heywood JT. Before Finally, successful performance of a core measure or safety goal is driven by many factors that this tool alone would not be able to address (e.g., delayed antibiotic administration in pneumonia due to issues of drug availability). official website and that any information you provide is encrypted Since we planned to prepare a synopsis of the evidence on a pocket-sized card, we could not list all of the hospital-based core measures or safety goals. Nosocomial bloodstream infection in critically ill patients. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R, et al.ADE Prevention Study Group Incidence of adverse drug events and potential adverse drug events. Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O'Connor CM, Pieper K, Sun JL, Yancy C, Young JB, OPTIMIZE-HF Investigators and Hospitals Association between performance measures and clinical outcomes for patients hospitalized with heart failure. Longer durations of antibiotics have been shown to offer no benefit and may increase a patient's risk of developing resistant bacteria (, Glucose levels should be controlled. Jencks SF, Huff ED, Cuerdon T. Change in the quality of care delivered to Medicare beneficiaries, 19981999 to 20002001. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America. Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Medication safety: one organization's approach to the challenge. Shekelle PG, Rich MW, Morton SC, Atkinson CS, Suttorp M, Tu W, Heidenreich P, Gubens M, Maglione M, Jungvig L, Roth E, Newberry S. Flather MD, Yusuf S, Kber L, Pfeffer M, Hall A, Murray G, Torp-Pedersen C, Ball S, Pogue J, Moy L, Braunwald E. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients.