Joint Commission journal on quality and patient safety / Joint Commission Resources
-
Multiple, validated, evidence-based guidelines exist to inform the appropriate use of computed tomography (CT) to differentiate mild traumatic brain injury (MTBI) from clinically important brain injury and to prevent the overuse of CT. Yet, CT use is growing rapidly, potentially exposing patients to unnecessary ionizing radiation risk and costs. A study was conducted to quantify the overuse of CT in MTBI on the basis of current guideline recommendations. ⋯ Some 10%-35% of CTs obtained in the ED for MTBI were not recommended according to the guidelines. Successful implementation of existing guidelines could decrease CT use in MTBI by up to 35%, leading to a significant reduction in radiation-induced cancers and health care costs.
-
Jt Comm J Qual Patient Saf · Nov 2012
A case-control study of an intraoperative corneal abrasion prevention program: holding the gains made with a continuous quality improvement effort.
Corneal injury is the most frequent ocular complication during general anesthesia. Although prevention has appeared feasible, inconsistent use and timing of conventional eye ointment and eyelid tape had failed to adequately prevent intraoperative corneal injuries at a department of anesthesiology in an academic medical center. A continuous quality improvement (CQI) program was thus undertaken to prevent intraoperative corneal injury. PLAN-DO-CHECK-ACT: A departmentwide Plan-Do-Check-Act cycle, and specifically the Seven-Step Problem-Solving Model, were applied. The new standardized eye- protection method involved eye lubrication with aqueous-based gel and application of clear, square occlusive dressings that were large enough to cover the eyelids and surrounding skin. Standardized documentation of patient eye protection in the electronic anesthesia record was also implemented. A systematic approach maximized departmental awareness about this new eye-protection method and its documentation. Subsequent individual practitioner counseling and reinforcement was undertaken. ⋯ A simple and cost-effective method for preventing intraoperative corneal injuries was successfully identified, implemented, and sustained. The systematic approach involved a rigorous reiterative approach and resulted in a fundamental change in local practice pattern.