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Evidence%20Based%20Medicine%20for%20Hug

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Title: Evidence Based Medicine for Hug Author: Mayer Brezis Last modified by: Administrator Created Date: 2/13/2001 5:25:43 AM Document presentation format – PowerPoint PPT presentation

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Title: Evidence%20Based%20Medicine%20for%20Hug


1
Quality Safety at Hadassah A Progress Report
Mayer Brezis, MD MPH Professor of Medicine,
Center of Quality SafetyChairman, Quality
Safety Committee
Yoel Donchin, MD, Nurit Porat, RN
2
Quality Safety at Hadassah
  • Students Projects
  • Institution-wide Projects
  • Educational Activities
  • National Impact

3
Making Health Care Safer A Critical Analysis of
Patient Safety Practices Evidence Report Agency
for Healthcare Research Quality
www.ahrq.gov/clinic/ptsafety
4
Venous Thromboembolism in Neurosurgery
  • Dr. G. Rosenthal, S. Goldman RN, Prof. F.
    Umanski, Prof. D. Varone, Dr. Y Weiss
  • Departments of Neurosurgery, Hematology, Central
    Management, Center for Quality Safety
  • Hadassah University Hospital
  • Jerusalem, Israel

5
  • 58 year-old woman underwent resection of
    meningioma
  • On post-op day 2, sudden onset of respiratory
    distress
  • Chest CT demonstrates massive pulmonary embolism
  • Vena cava filter inserted anticoagulation
    initiated
  • On post-op day 6 sudden onset of severe headache
    and vomiting

6
Post-op CT
Follow-up CT
7
  • 5 months (2003)
  • 10 cases of thromboembolism
  • 7 vena cava filters inserted
  • Extended ICU hospital stays

Cases of thrombo-embolism
Control
8
July 2003 Introduction of intermittent pneumatic
compression devices
Cases of thrombo-embolism
Control
Intervention
9
Cases of thrombo-embolism
Control
Intervention
10
Cases of thrombo-embolism
Control
Intervention
Control
Control
Intervention
11
Conclusion
Quality can reduce morbidity save costs
12
Quality indicators for the management of
myocardial infarction
  • M. Cohen, Dr. A. Pollack, Prof. A. Weiss, Prof.
    C. Lotan
  • Intensive Cardiac Units, Division of Cardiology
    Department of Medicine, Mt. Scopus Ein Kerem
  • Hadassah University Hospital
  • Jerusalem, Israel

13
Quality indicators for myocardial infarction,
Hadassah vs. US data
14
Peterson R, JAMA 2004291195
15
Quality in Health Care
  • Evidence-based
  • System-minded

16
Will the pathology result get lost?
plt0.05
Percent of patients having received the result of
their skin biopsy
A clinic-based intervention (led by the head
nurse, involving both physicians patients) An
institution-wide intervention electronic alerts
sent to physicians computer whenever a pathology
report is ready
17
This quality improvement project, awarded prize
of best poster at the meeting of the Israeli
Society for Quality in Medicine, is posted at the
dermatology clinic as a reminder for both
patients, nurses and physicians
18
Quality Safety Committee Subcommittee for
Medication Errors
19
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20
Specific labels for lines to patients - to avoid
mix up
21
Interactive software to learn prescribing for new
physicians
22
Quality in Health Care
  • Evidence-based
  • System-minded
  • Patient-centered

23
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24
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25
Palliative Care in General Internal Medicine A
successful pilot intervention among elderly
patients with life threatening illness and
impaired cognition S. Gottsman, RN, MA et
al. Head Nurse, Medicine B, Mt Scopus
26
Intervention
Staff-initiated meetings with relatives, to
communicate information on patients condition
to listen to their questions and to their
preferences based on patients prior wishes if
any had been expressed and finally to attempt
shared goal setting and decision making
Control ward no intervention
27
Intervention
Percent of relatives agreeing with negative
statements
Control
13 60 Staff did not really consider my opinions
23 57 I felt not involved in decision making
10 43 It upset me that I did not know what was happening
20 57 I did not receive explanations about alternatives
3 53 Relatives problems were not explained
10 53 I felt uncomfortable with asking questions
17 60 I was not asked to participate in decisions
17 43 I felt alone and without support
7 27 I felt pressured to make decisions
28
Is the X-ray interpretation by the junior staff
on duty correct?
Emerging methods for quality evaluation
  • Dr. Y. Mintz, Dr. D. Kisselgoff, Y. Gronowitz, A.
    Shaham, R. Hefez, Dr. D. Shaham
  • Departments of Surgery, Radiology, and Center for
    Quality Safety

29
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30
Frontal bone fracture
31
Validity of X-ray Interpretations in Trauma
Sensitivity () Specificity () Positive predictive value () Negative predictive value ()
Chest (n54) 92 (65-100) 93 (82-98) 79 (52-94) 97 (88-100)
Neck (n19) 100 (5-100) 100 (85-100) 100 (5-100) 100 (85-100)
Pelvis (n27) 60 (18-93) 100 (87-100) 100 (37-100) 92 (75-99)
CTs(n75) 94 (81-99) 95 (85-99) 94 (81-99) 95 (85-99)
mean 95 CI (confidence interval)
32
Reliability of X-ray Interpretation on Duty
mean 95 confidence intervals Inter-observer variability Resident vs. Specialist Inter-observer variability Resident vs. Specialist
mean 95 confidence intervals Percent agreement Kappa Coefficient
Surgery 77 0.60 (0.4-0.8)
Pulmonary Embolism 95 0.84 (0.7-1.0)
33
A Senior Resident in Radiology Concluded We
need to look at ourselves
34
Summary Conclusion
  • Students Projects
  • Institution-wide Projects
  • Educational Activities
  • National Impact

Diverse projects attempt to make healthcare at
Hadassah more patient-centered, more
evidence-based and more system-minded. Increased
accountability by department heads for quality
and safety may be a key to further successes.
35
How would an open disclosure policy about
mistakes affect hospital image in publics eyes?
MD student Zivan Beer
Damage Image
No Change
Improve Image
36
How would an open disclosure policy about
mistakes affect hospital image in publics eyes?
N115
N570
plt0.001
MD student Zivan Beer
Damage Image
No Change
Improve Image
37
Tell the truth and tell it fast N. Augustine.
Crisis Management Harvard Business Review (2000)
Risk management Extreme honesty may be the best
policy (The V.A. Experience) Annals of Internal
Medicine 99
New position statement by the Ethics Board of the
Israeli Medical Association supports transparency
(May 2004)
38
IMA Ethics Board Position Paper
The physician has an obligation to disclose to
the patient that a mishap has happened
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