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Are Quality Improvement Outcomes Sustainable within a Dynamic Clinical Environment?

Sterrett, Emily C, M.D.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470752684

Abstract Details

2016, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Methods A retrospective study of patients with long-bone extremity fractures using electronic medical record data from 2007 to 2014. The primary outcome was the proportion of patients receiving timely IV opioids. Control charts and time series models were used to determine if changes in the clinical microenvironment were associated with changes in the outcome measure. Long-term unintended consequences included patients receiving potentially unnecessary IVs and the process being applied to patients without long-bone extremity fractures. Results Improved timeliness of IV opioids was sustained. The type of physician who staffed the process and faculty physician staffing hours were associated with a 9.6% decrease, and 11.8% increase in timely IV opioids. Implementation of the IV opioid process was not associated with an increase in potentially unnecessary IV placement. Of patients receiving the IV opioid process, 22% did not have a long-bone extremity fracture, of whom 91% were diagnosed with another painful injury. Conclusion Improving IV opioid timeliness was robust despite changes in the clinical microenvironment. Changes in physician staffing and responsibilities in a PED may be especially important to consider when planning future improvement initiatives. Our findings support the importance of higher reliability interventions, such as identification and utilization of existing patterns of behavior, as being particularly high-yield for improvement teams striving to achieve sustained outcomes.
Erin Nicole Haynes (Committee Chair)
Terri L. Byczkowski| (Committee Member)
Eileen Murtagh Kurowski (Committee Member)
24 p.
Immunology; Surgery
quality improvement; sustainability; unintended consequences; emergency medicine; pediatrics; pain

Recommended Citations

Citations

  • Sterrett, M.D., E. C. (2016). Are Quality Improvement Outcomes Sustainable within a Dynamic Clinical Environment? [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470752684

    APA Style (7th edition)

  • Sterrett, M.D., Emily. Are Quality Improvement Outcomes Sustainable within a Dynamic Clinical Environment? 2016. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470752684.

    MLA Style (8th edition)

  • Sterrett, M.D., Emily. "Are Quality Improvement Outcomes Sustainable within a Dynamic Clinical Environment?" Master's thesis, University of Cincinnati, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1470752684

    Chicago Manual of Style (17th edition)

ucin1470752684
288
© 2016, some rights reserved.Creative Commons License Are Quality Improvement Outcomes Sustainable within a Dynamic Clinical Environment? by Emily C Sterrett M.D. is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by University of Cincinnati and OhioLINK.