The official journal of the National Association for Healthcare Quality

JHQ 166 - Sustaining a Best-Care Practice in a Nursing Home
Cornelia Beck, Patricia Heacock, Susan O. Mercer, Rebecca Doan, Patricia S. O’Sullivan, Jerry G. Stevenson, John F. Schnelle, Jan Gray Hoskins
This study tested whether an action research organizational intervention fostering participatory management practices would sustain a nursing best-care practice protocol in a nursing home.

JHQ 167 - Evaluation and Recommendations from a Study of a Critical-Care Waiting Room
Lynn Deitrick, Daniel Ray, Glenn Stern, Cathy Fuhrman, Tamara Masiado, Sandra L. Yaich, Thomas Wasser
A quality improvement evaluation of an intensive care unit waiting room suggested that the role of the receptionist and access to food and other services were important to families of critically ill patients.

Acute Myocardial Infarction Following a Negative Evaluation of Chest Pain
Radhika Varada, Scott Manaker, Jeffrey Rohrbach, Daniel Kolansky
Abstract: Patients readmitted to the hospital with acute myocardial infarction within 90 days after a cardiac evaluation were examined to identify potential errors in management that may have led to readmission. Only six of 2,340 patients met criteria for AMI after a negative work-up.

Quality Research Toolbox: CAN’T MISS—Part 7. Statistical Process Control: x–s Control Charts
John P. Hansen
Abstract: Abstract: Statistical process control (SPC) can be thought of as the frequent monitoring of processes using inferential statistics. The feature that distinguishes SPC from the typical use of inferential statistics for analyzing populations is that in the former frequent samples are taken over time, whereas in inferential statistics a single sample is generally taken before and after some intervention or treatment. An x–s control chart is used to monitor a continuous variable that reflects the output of a process. The x–s control chart is a graph that includes serial sample means (x) as the variables of interest, a centerline that represents the grand mean of the samples (x), and upper control limit (UCL) and lower control limit (LCL) that represent three standard errors (SE_x) above and below the centerline. An x–s control chart is used to estimate with 99.7% confidence that the population mean of a continuous output variable was within the interval defined by the UCL and LCL during a period of baseline monitoring. It is further assumed that if the process remains stable, future population means will remain between the control limits for additional process outputs. Control charts allow the evaluation of both common- and special-cause variation. Analysis of the common-cause variation allows an assessment of the current process performance. Special-cause variation is identified when there is a sample mean that is beyond the UCL or LCL.

Quality Research Toolbox: CAN’T MISS—Part 8. Statistical Process Control: n, np, c, u Control Charts
John P. Hansen
Abstract: Abstract: A p control chart is used to monitor a proportion from a binomial variable that reflects the output of a process. The p control chart is a graph that includes serial sample proportions (p) as the variables of interest, a centerline that represents the overall proportion of the samples (p, and upper control limits (UCLs) and lower control limits (LCLs) that represent three standard errors (SE_p) above and below the centerline. We use a p control chart to estimate with 99.7% confidence that the population proportion of an output variable was within the interval defined by the UCLs and LCLs during a period of baseline monitoring. We further assume that if the process remains stable, the values of future population proportions will remain between the established control limits. An np control chart simply plots the numerators of the sample proportions as the variables of interest. A u control chart is used to monitor ratios. In u control charts, ratios are quantities in which the numerator can have one or more occurrences in reference to the denominator. A c control chart is analogous to an np control chart in that it graphs the numerators from the ratios.

Brief Report: Does Your Patient Know Your Name? An Approach to Enhancing Patients’ Awareness of Their Caretaker’s Name
Amgad N. Makaryus, Eli A. Friedman
Abstract: Simple interventions such as providing patients with their caretaker’s name in writing and emphasizing the importance of knowing it result in a significantly greater percentage of caretaker-name recall.

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