McCullough, Sullivan, Banning, Goldfield, and Hughes report on a study conducted to determine the feasibility of combining laboratory data with claims-based information. The purpose was to identify those laboratory data elements that significantly improved the effectiveness of the All-Patient Refined DRGs (APR-DRGs) in estimating risk of mortality. The databases used in the research came from 15 Florida hospitals that supplied electronic laboratory data and administrative data that could be merged at the level of the individual patient. The researchers evaluated the ability of the merged data to improve all-patient refined diagnosis-related groups risk of mortality predictions.
It is usually more fun to initiate a new project or program than to sustain it after it has been under way for a while-right? You know the feeling. Early in the project or program, everyone (well, almost) is buoyed by the excitement and the anticipation of sparkling successes, kudos from colleagues and top management, and the sheer stimulation of exploring. After a while, you are just slogging along, dealing all-too frequently with the glitches that have now become predictable. Eventually, enthusiasm fades, backsliding is more comfortable, and the changes become blurred or disappear. Ford, Krahn, Wise, and Oliver address the question of how attributes affecting the sustainability of a process improvement project within the Veterans Administration mental health system differed across organizational components and by staff characteristics. On the basis of the findings, they offer proposals for bolstering the sustainability of a transforming project.
The potential of intervention research for promoting and improving high-quality health and social services care is the issue addressed by McWilliams and Oudshoorn. In response to the methodologic and practical questions surrounding intervention research, the authors propose an unconventional approach-"intravention research." They argue that certain important participatory dimensions of quality care, including the consumer's voice, are often contraindicated in the process of conventional intervention research.
Following the lead suggested in the surgical safety checklist published by the World Health Organization, clinical staff at a hospital in Shiraz, Iran, developed their own list and conducted an interventional study of surgical patients over 2 time periods. Clinical personnel, including physicians, participated in a prestudy instructional program featuring a World Health Organization film on the use of surgical safety lists. The authors, Michael Askarian, Farideh Kouchak, and Charles John Palenik, report that the postintervention surgical complication rate decreased by 57%.
Two groups of authors in this issue address issues in blood and transfusion management. One issue, the prevention of inappropriate transfusions, is explored by Mohandas, Foley, Doria, and Nash, using a literature search as their vehicle. The authors contend that the absence of standard, evidence-based guidelines has resulted in the wide variability that characterizes transfusion practices among hospitals. They point to the relative effectiveness of combination strategies that include preoperative, intraoperative, and postoperative bleeding management steps to avoid the need for transfusion. Kumar, Figueroa, Gowans, Parker, and their coauthors point to the fact that local shortages in hospital blood inventories are interfering with patient care at the same time that donations are exceeding transfusions by nearly 8%. They propose the development of improved blood management policies and procedures to remedy the observed disconnect. Such policies would include the adoption of evidence-based practice guidelines, a change that will depend on the collection of high-level evidence supporting guideline development. The authors discuss the extreme importance of leadership in developing an effective blood management program.
The impact of temporarily reducing access to beds upon the risks of hospital-associated complications and upon emergency department operations is the focus of a study reported by Crilly, Kejzers, Krahn, Steele, Green, and Freeman. The access reduction (or "block") was the result of a 3-week closure of a ward in a Queensland, Australia, regional teaching hospital. The authors point to the findings as evidence of the need for meticulous planning with an eye to clinical consequences whenever access to beds is temporarily restricted.
Development of a computerized decision support tool in the interest of optimal transport staffing and deployment along with promptness and patient safety during transport is the topic of the case study presented by Kuchera and Rohleder. While the system to be developed was ultimately to be available at the Mayo Clinic's Rochester, Scottsdale, and Jacksonville, Florida centers, the Rochester center was used for the case study reported. Here, the new system had to be able to respond effectively to a workload ranging from 7000 to 9000 transport requests per month. Enhancing the complexity of the task of designing and implementing an effective planning and scheduling tool is the well-known variation in service demand by hour, day of the week, and month, plus the Poisson distribution of emergencies. The authors provide a full report of the design and execution of the prototype tool.
Sophie Hsieh presents a case study based on the experience of a teaching hospital in Taiwan that was dealing with patient complaints on a case-by-case basis in the absence of a comprehensive quality management plan that would incorporate patient input. She outlines the basic features of such a plan, urging that its design incorporate systematic ways to use patient complaints in the service of effective quality management.
Jean Gayton Carroll, PhD
Editor