Search

Background: Missed prevention opportunities are a financial burden to the US health care system and result in excess consumption of resources, reduced quality of life, increased morbidity, and premature death. Local Problem: High staff turnover and inefficient practices at a local health department caused long patient wait times and missed opportunities for preventive health care. The project aim was to improve timeliness through Right Care in a lower socioeconomic reproductive health clinic while decreasing patient cycle time by 10% in 90 days. Methods: We used four plan‐do‐study‐act cycles incorporating tests of change that focused on team and patient engagement and two process changes. The interventions included a care coordination huddle, an infant feeding decision aid to better understand patient values, a sexual health screening tool to identify prevention opportunities, and a redesigned patient‐centered discharge process to improve efficiency. Results: Over 90 days, the receipt of Right Care increased while patient cycle time decreased by 2.6%. The team improved function with a mean huddle effectiveness score increase from 2 to 4.4 (1‐5 Likert scale). Intent to breastfeed increased by 49% (35%‐52%), and identification of preventive care needs increased by 320% (15%‐63%). Preventive care follow‐up remained unchanged at 26% with the new discharge process, identifying weaknesses in the health department referral systems. Conclusions: Standardized tools and processes improved primary prevention opportunities at a local health department while reducing patient cycle time. The tools improved documentation of intent to exclusively breastfeed, increased preventive care identification, and streamlined the discharge process; while demonstrating a systems‐level gap for long‐term follow‐up. [ABSTRACT FROM AUTHOR]

Clostridium difficile causes nearly 500 000 annual infections in the USA. A total of 15 000-30 000 US deaths annually and greater than US$4.8 billion dollars are related to Clostridium difficile infection (CDI). Length of hospital stay is 2.8 -5.5 additional days and inpatient costs are estimated at US$3000-US$15 400 per episode. One major cause of CDI is misuse and overuse of antibiotics. The Centers for Disease Control and Prevention reports that 30%-50% of antibiotics prescribed in hospitals are unnecessary or inappropriate. Patients with unexplained or three or greater unformed stools in 24 hours are candidates for testing of CDI.Prior to implementation, an analysis at the local level was conducted to determine possible causes of CDI influence. Chart auditing at this urban hospital revealed that 1 out of 23 (4%) providers were treating UTIs according to hospital protocol (A. Richmond, personal communication, 6 March 2018). The standardized infection ratio in 2017, which compares the predicted to the actual infection rate, at this hospital was 1.266 for CDI. Having a solid antibiotic stewardship in place is imperative to limit antibiotic related and resistant infections. During an observational study, only one out of nine (11%) staff followed contact precaution policies at this hospital., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)