The Permanente journal
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The Permanente journal · Jan 2013
Elimination of admission hypothermia in preterm very low-birth-weight infants by standardization of delivery room management.
Temperature instability is a serious but potentially preventable morbidity in preterm infants. Admission temperatures below 36°C are associated with increased mortality and late onset sepsis. ⋯ We reduced hypothermia in very low-birth-weight infants using a standardized protocol, multidisciplinary team approach, and continuous feedback. Sustaining improvement is a challenge that requires real-time progress evaluation of outcomes and ongoing staff education.
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The Permanente journal · Jan 2013
Establishing a portfolio of quality-improvement projects in pediatric surgery through advanced improvement leadership systems.
Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. ⋯ In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division's efficiency and effectiveness in pursing the QI mission that is integral at our hospital.
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The Permanente journal · Jan 2013
Nonbeneficial treatment and conflict resolution: building consensus.
We established a fair and explicit nonbeneficial treatment and conflict resolution policy at our medical center. The policy was designed to help us acknowledge and respect both patients and clinicians involved in treatment planning and decision making. ⋯ A fair and explicit nonbeneficial treatment and conflict resolution policy can result in a high level of consensus between patients/surrogates and the treatment teams responsible for their care when treatment is withheld or withdrawn.
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The Permanente journal · Jan 2013
Inpatient palliative care consultation: describing patient satisfaction.
This study identified and measured common patterns of patients' positive care experiences during inpatient palliative consultation, and helped better understand how the journey of discovery experienced by both patients and life-care consult teams can be used to improve the quality of care. ⋯ We were encouraged by our findings: the feedback from patients and families showed us we were effective, from their perspective, in helping them shape their treatment journey. It also emphasized where we could have been even more effective in improving our communication.
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The Permanente journal · Jan 2013
Effects and linguistic analysis of written traumatic emotional disclosure in an eating-disordered population.
In previous studies, writing about traumatic life events produced positive physical and psychological outcomes in various populations. Specific linguistic trends, such as increasing insight and cognitive words, have paralleled health benefits. ⋯ Whereas the expected linguistic trends were evident in the disclosure group writings, no correlating health benefits could be found between the disclosure and control groups. Eating-disordered populations, often alexithymic, may have difficulty engaging with the disclosure task and could potentially benefit from guidance in processing traumatic events and their affective states.