Relevant bibliographies by topics / Evidence-Based Care Bundles

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters

Academic literature on the topic 'Evidence-Based Care Bundles'

Author: Grafiati
Published: 4 June 2021
Last updated: 9 February 2022

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Journal articles on the topic "Evidence-Based Care Bundles"

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Damon, Amy L., Carmen D. Parrotta, Lindsey A. Wallace, and William Riley. "The effectiveness of providing evidenced-based perinatal practice to low-income populations providing perinatal care: Does patient income influence the delivery of quality care?" Journal of Hospital Administration 2, no. 4 (June 8, 2013): 82. http://dx.doi.org/10.5430/jha.v2n4p82.

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Background: This study examines a national perinatal quality improvement collaborative designed to create high reliability through the use of evidence-based perinatal care bundles. The objective of this study is to determine whether hospitals serving low-income patient populations experienced lower compliance with perinatal care bundles than hospitals serving higher-income patient populations Objective: We investigated the relationship between the rate of perinatal bundle compliance within a hospital and the economic characteristics of the patients and surrounding community. We hypothesized a negative relationship between poverty and care bundle compliance. Methods: Using prospective data from 131,847 births over 34 months within 16 hospitals located in cities across the United States, we examined the relationship between compliance with evidence-based obstetrical care bundles and three measures of the poverty status of the patient population served and the hospital service area: 1) proportion of the obstetrical patients with Medicaid as the primary payer, 2) median income in the hospital service area, and 3) poverty rate in the hospital’s service area. Results: The findings indicate no difference in bundle compliance rates in relation to the economic characteristics of the participating hospitals and their patients. Conclusions: While previous research has indicated that patients of lower socioeconomic status are less likely to receive high quality care, the findings in this study indicate that hospital compliance with evidence-based perinatal care bundles did not differ by economic characteristics of the hospital service area. These results indicate uniformity of care across hospitals irrespective of patient economic characteristics.
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Gómez-Angelats, Elisenda, and Carolina Sánchez. "Care Bundles after Discharging Patients with Chronic Obstructive Pulmonary Disease Exacerbation from the Emergency Department." Medical Sciences 6, no. 3 (August 7, 2018): 63. http://dx.doi.org/10.3390/medsci6030063.

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Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that nearly a third of COPD admissions could be avoided through the implementation of evidence-based care interventions. A COPD discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from AE COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, although there is a lack of consensus of what interventions should be implemented. On the other hand, the implementation of those interventions also involves different challenges. Important care gaps remain regarding discharge care bundles for patients with acute exacerbation of COPD discharged from EDs There is an urgent need for investigations to guide future implementation of care bundles for those patients discharged from EDs.
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Shaw, Ali, Katherine Morton, Anna King, Melanie Chalder, James Calvert, Sue Jenkins, and Sarah Purdy. "Using and implementing care bundles for patients with acute admission for COPD: qualitative study of healthcare professionals’ experience in four hospitals in England." BMJ Open Respiratory Research 7, no. 1 (March 2020): e000515. http://dx.doi.org/10.1136/bmjresp-2019-000515.

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BackgroundCare bundles are sets of evidence-based interventions to improve quality of hospital care at admission and discharge. Within a wider multi-method evaluation of care bundles for adults with an emergency admission for acute exacerbations of chronic obstructive pulmonary disease, a qualitative study was conducted. The aim was to evaluate how bundles were used, and healthcare professionals’ experiences of the impact of bundles on the process of care delivery.MethodsWithin the wider evaluation, four acute hospitals that were using COPD care bundles were purposefully sampled for geographical variation. Qualitative data were gathered through non-participant observation of patient care and interviews with healthcare professionals, patients and carers. This paper reports a thematic analysis of data from observation and interviews with professionals.ResultsHealthcare professionals generally experienced care bundles as positive for standardising working practices and patient care, valuing how bundles could support a clear care pathway for patients, enable transitions between settings and identify postdischarge support required by patients. Successful use of bundles was perceived as more likely with the presence of either (or both) a clinical champion for bundles and system-based initiatives such as financial incentives, within a local culture of quality improvement. Challenges in accurately diagnosing COPD hampered bundle use, including delivery of bundles to those subsequently considered ineligible, or missed opportunities to deliver admission bundles to those with COPD.ConclusionCare bundles shape admission and discharge care processes for patients with COPD, from the perspective of staff involved in their delivery. However, different organisational, staff and clinical factors aid or hinder bundle use in an acute hospital context, suggesting potentially resolvable reasons for variable implementation of bundles. Finally, bundles may enhance staff experience of care delivery, even if the impact on patient outcomes remains uncertain.
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Fulbrook, Paul, and Sharon Mooney. "Care bundles in critical care: a practical approach to evidence-based practice." Nursing in Critical Care 8, no. 6 (December 2003): 249–55. http://dx.doi.org/10.1111/j.1362-1017.2003.00039.x.

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Plata-Menchaca, Erika P., Juan Carlos Ruiz-Rodríguez, and Ricard Ferrer. "Evidence for the Application of Sepsis Bundles in 2021." Seminars in Respiratory and Critical Care Medicine 42, no. 05 (September 20, 2021): 706–16. http://dx.doi.org/10.1055/s-0041-1733899.

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AbstractSepsis represents a severe condition that predisposes patients to a high risk of death if its progression is not ended. As with other time-dependent conditions, the performance of determinant interventions has led to significant survival benefits and quality-of-care improvements in acute emergency care. Thus, the initial interventions in sepsis are a cornerstone for prognosis in most patients. Even though the evidence supporting the hour-1 bundle is perfectible, real-life application of thoughtful and organized sepsis care has improved survival and quality of care in settings promoting compliance to evidence-based treatments. Current evidence for implementing the Surviving Sepsis Campaign bundles for early sepsis management is moving forward to better approaches as more substantial evidence evolves.
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Weavind, Liza M., Nahel Saied, J. D. Hall, and Pratik P. Pandharipande. "Care Bundles in the Adult ICU: Is It Evidence-Based Medicine?" Current Anesthesiology Reports 3, no. 2 (March 26, 2013): 79–88. http://dx.doi.org/10.1007/s40140-013-0017-6.

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Dixon, Padraig, William Hollingworth, Jonathan Benger, James Calvert, Melanie Chalder, Anna King, Stephanie MacNeill, Katherine Morton, Emily Sanderson, and Sarah Purdy. "Observational Cost-Effectiveness Analysis Using Routine Data: Admission and Discharge Care Bundles for Patients with Chronic Obstructive Pulmonary Disease." PharmacoEconomics - Open 4, no. 4 (March 25, 2020): 657–67. http://dx.doi.org/10.1007/s41669-020-00207-w.

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Abstract Background Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease, and accounts for a substantial proportion of unplanned hospital admissions. Care bundles for COPD are a set of standardised, evidence-based interventions that may improve outcomes in hospitalised COPD patients. We estimated the cost effectiveness of care bundles for acute exacerbations of COPD using routinely collected observational data. Methods Data were collected from implementation (n = 7) and comparator (n = 7) acute hospitals located in England and Wales. We conducted a difference-in-difference cost-effectiveness analysis using a secondary care (i.e. hospital) perspective to examine the effect on National Health Service (NHS) costs and 90-day mortality of implementing care bundles compared with usual care for patients admitted to hospital with an acute exacerbation of COPD. Adjusted models included as covariates patient age, sex, deprivation, ethnicity and seasonal effects and mixed effects for site. Results Outcomes and baseline characteristics of up to 12,532 patients were analysed using both complete case and multiply imputed models. Implementation of bundles varied. COPD care bundles were associated with slightly lower secondary care costs, but there was no evidence that they improved outcomes once adjustments were made for site and baseline covariates. Care bundles were unlikely to be cost effective for the NHS with an estimated net monetary benefit per 90-day death avoided from an adjusted multiply imputed model of −£1231 (95% confidence interval − £2428 to − £35) at a high cost-effectiveness threshold of £50,000 per 90-day death avoided. Conclusion and Recommendations Care bundles for COPD did not appear to be cost effective, although this finding may have been influenced by unmeasured variations in bundle implementation and other potential confounding factors.
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Borgert, Marjon, Jan Binnekade, Frederique Paulus, Astrid Goossens, and Dave Dongelmans. "A flowchart for building evidence-based care bundles in intensive care: based on a systematic review." International Journal for Quality in Health Care 29, no. 2 (February 2, 2017): 163–75. http://dx.doi.org/10.1093/intqhc/mzx009.

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Siau, Keith, Sarah Hearnshaw, Adrian J. Stanley, Lise Estcourt, Ashraf Rasheed, Andrew Walden, Mo Thoufeeq, et al. "British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding." Frontline Gastroenterology 11, no. 4 (March 27, 2020): 311–23. http://dx.doi.org/10.1136/flgastro-2019-101395.

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Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB.Commissioned by the British Society of Gastroenterology (BSG), a UK multisociety task force was assembled to produce an evidence-based and consensus-based care bundle detailing key interventions to be performed within 24 hours of presentation with AUGIB. A modified Delphi process was conducted with stakeholder representation from BSG, Association of Upper Gastrointestinal Surgeons, Society for Acute Medicine and the National Blood Transfusion Service of the UK. A formal literature search was conducted and international AUGIB guidelines reviewed. Evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation tool and statements were formulated and subjected to anonymous electronic voting to achieve consensus. Accepted statements were eligible for incorporation into the final bundle after a separate round of voting. The final version of the care bundle was reviewed by the BSG Clinical Services and Standards Committee and approved by all stakeholder groups.Consensus was reached on 19 statements; these culminated in 14 corresponding care bundle items, contained within 6 management domains: Recognition, Resuscitation, Risk assessment, Rx (Treatment), Refer and Review.A multisociety care bundle for AUGIB has been developed to facilitate timely delivery of evidence-based interventions and drive quality improvement and patient outcomes in AUGIB.
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Yamada, Koji, Hiroaki Abe, Akiro Higashikawa, Juichi Tonosu, Takashi Kuniya, Koji Nakajima, Haruko Fujii, et al. "Evidence-based Care Bundles for Preventing Surgical Site Infections in Spinal Instrumentation Surgery." SPINE 43, no. 24 (December 2018): 1765–73. http://dx.doi.org/10.1097/brs.0000000000002709.

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Dissertations / Theses on the topic "Evidence-Based Care Bundles"

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Jones, Sharon Scardina. "Evaluating a Discharge Bundle for Chronic Obstructive Pulmonary Disease." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4861.

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Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the leading causes of hospital readmissions within 30 days. Frequent readmissions negatively affect hospital reimbursements and patient outcomes. Creative strategies, such as COPD care bundles, have been shown to reduce readmission rates according to existing studies. A COPD discharge bundle was developed and implemented at 1 community hospital in response to an identified problem with COPD readmissions. Evaluation of this quality improvement initiative was the purpose of this project study. The practice-focused question was: Have 30-day readmission rates changed following the implementation of a COPD discharge bundle prior to transitioning from hospital to home? The framework selected for this project was the model for improvement. Sources of evidence included existing hospital data to evaluate the change in readmissions. The chi-square test of independence was used to assess the difference in frequency of 30-day readmissions. Pre and post-bundle implementation comparisons of readmission rates showed a decrease for 3 out of the 4 groups compared; these results were not statistically significant. Analysis of the post-bundle intervention groups revealed lower 30-day readmissions for individuals who were bundle compliant versus noncompliant and for those who spoke with a pharmacist within 48 hours of discharge opposed to those who did not; these results were statistically significant. Continued use of the bundle and maintaining the role of the pharmacist was recommended. Reduction of readmissions within 30-days has positive social implications for hospitals through financial gains and for the COPD population by improving overall health outcomes.
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Watson, Sherry. "Implementation of Evidence-based COPD Education." Mount St. Joseph University Dept. of Nursing / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn1588248198588369.

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McCormick, Jill S. "Hospital costs for acute myocardial infarction patients receiving perfect compliance of evidence-based care bundle." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/JMcCormick2008.pdf.

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Aggarwal, G., C. J. Peden, Mohammed A. Mohammed, A. Pullyblank, B. Williams, T. Stephens, S. Kellett, J. Kirkby-Bott, and N. Quiney. "Evaluation of the Collaborative Use of an Evidence-Based Care Bundle in Emergency Laparotomy." 2018. http://hdl.handle.net/10454/16914.

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Yes
IMPORTANCE Patients undergoing emergency laparotomy have high mortality, but few studies exist to improve outcomes for these patients. OBJECTIVE To assess whether a collaborative approach to implement a 6-point care bundle is associated with reduction in mortality and length of stay and improvement in the delivery of standards of care across a group of hospitals. DESIGN, SETTING, AND PARTICIPANTS The Emergency Laparotomy Collaborative (ELC) was a UK-based prospective quality improvement study of the implementation of a care bundle provided to patients requiring emergency laparotomy between October 1, 2015, and September 30, 2017. Participants were 28 National Health Service hospitals and emergency surgical patients who were treated at these hospitals and whose data were entered into the National Emergency Laparotomy Audit (NELA) database. Post-ELC implementation outcomes were compared with baseline data from July 1, 2014, to September 30, 2015. Data entry and collection were performed through the NELA. INTERVENTIONS A 6-point, evidence-based care bundle was used. The bundle included prompt measurement of blood lactate levels, early review and treatment for sepsis, transfer to the operating room within defined time goals after the decision to operate, use of goal-directed fluid therapy, postoperative admission to an intensive care unit, and multidisciplinary involvement of senior clinicians in the decision and delivery of perioperative care. Change management and leadership coaching were provided to ELC leadership teams. MAIN OUTCOME AND MEASURES Primary outcomes were in-hospital mortality, both crude and Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) risk-adjusted, and length of stay. Secondary outcomes were the changes after implementation of the separate metrics in the care bundle. RESULTS A total of 28 hospitals participated in the ELC and completed the project. The baseline group included 5562 patients (2937 female [52.8%] and a mean [range] age of 65.3 [18.0-114.0] years), whereas the post-ELC group had 9247 patients (4911 female [53.1%] and a mean [range] age of 65.0 [18.0-99.0] years). Unadjusted mortality rate decreased from 9.8% at baseline to 8.3% in year 2 of the project, and so did risk-adjusted mortality from a baseline of 5.3% to 4.5% post-ELC. Mean length of stay decreased from 20.1 days during year 1 to 18.9 days during year 2. Significant changes in 5 of the 6 metrics in the care bundle were achieved. CONCLUSIONS AND RELEVANCE A collaborative approach using a quality improvement methodology and a care bundle appeared to be effective in reducing mortality and length of stay in emergency laparotomy, suggesting that hospitals should adopt such an approach to see better patient outcomes and care delivery performance.
This study was funded by The Health Foundation, United Kingdom, as part of a Scaling Up Award.
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WEI, HSIU-HUI, and 魏秀慧. "To Develop the Bundle Care of the Incontinence Associated Dermatitis in Disabled Patients: A Evidence- Based Framework." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/07216689295588551154.

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碩士
長榮大學
護理學系碩士班
105
Background: Incontinence-associated dermatitis (IAD) is a prevalent cause of skin damage in clinical settings. IAD may cause burn heat sensation, pru- ritus, pain, and infection .It may prolong hospital stay and increase healthcare costs. Objective: The aim of this study was to develop a bundle care of the incontinence associated dermatitis based on the evidence- based framework in the disabled patients. Method: According to the steps of developing a bundle care, 9 steps were conducted. A multidisciplinary task group was established at a medical center in southern Taiwan. The steps included systematic review of the literature, a draft of IAD budle care, consensus of hospital nursing staff and clinical experts, evaluation of methodology experts. Results: The initial guideline was consensused by thirty nurses and seven clinical experts (two runs) to achieve above 80% agreement. Three methodology experts evaluated the quality of development process as a use recommendation. The IAD Bundle care consisted of 4 elements with 19 interventions, including skin assessment, skin cleanse, skin protect, and supportive interventions. The IAD bundle care was standardized and evidence- based clinical guideline. Conclusion: The result was the development of IAD bundle care, which integrating systematic literature review and the opinions of nurse staff, clinical experts, and methodology experts. Thus, these Bundle care are recommended for clinical application. Further studies will be implemented to test the effectiveness of IAD bundle care.
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Books on the topic "Evidence-Based Care Bundles"

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Mazer, Jeffrey, and Mitchell M. Levy. Policies, bundles, and protocols in critical care. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0017.

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Recently, the medicine community has been driven to think about patient safety in new ways, and with this new found interest in patient safety, large health care systems and individual institutions have been forced to develop mechanisms to track and measure performance. There is ample evidence that physicians and systems can do better. The tools of this new craft include checklists, protocols, guidelines, and bundles. These tools help to decrease variability in care and enhance the translation of evidence-based medicine to bedside care. Ongoing measurement of both performance and clinical outcomes is central to this movement. This allows for rapid detection of both successes and possible unintended consequences associated with the rapid translation of evidence into practice. As hospitals and intensive care units (ICU) worldwide have embraced the field of quality improvement (QI), many lessons have been learned about the process. QI includes four essential phases—development, implementation, evaluation, and maintenance. Essential to the QI process and each of these QI phases is that the project must be tailored to each individual ICU and/or Institution. A one-size-fits-all project is less efficient, less effective, and at times unnecessary compare with a locally-driven process.
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Book chapters on the topic "Evidence-Based Care Bundles"

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Smith, Stephanie J., and Martina N. Cummins. "Tools in Infection Prevention and Control." In Tutorial Topics in Infection for the Combined Infection Training Programme. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198801740.003.0029.

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The Health Act (2008) Code of Practice on the Prevention and Control of Infections and Related Guidance provides a legal statutory requirement to which all hospital trusts in England should abide to ensure the safety of patients and healthcare workers. There are similar laws in both Scotland and Wales. Prevention and control of healthcare- associated infections (HCAI) remains integral to provide safe, quality patient care and requires an effective management team to implement the Act. In July 2015, a revised Code of Practice was introduced for the prevention and control of HCAI. The Code of Practice is also referred to as the ‘Hygiene Code’ and is regulated by the Care Quality Commission (CQC). A requirement of this Act is that the board of directors receive an annual report from the Director of Infection Prevention & Control (DIPC), with acknowledgement of the report and approval of a proposed programme of delivery prior to public release and implementation. All trusts must register with the CQC, whose role is to regulate and inspect care services in the public, private, and voluntary sectors in England. Part of the CQC assessment against the Act includes Outcome 8: Cleanliness and Infection Control. Under this outcome the trust is required to demonstrate compliance. The DIPC within an organization will assume responsibility to provide assurances that criteria are met by ensuring regular committee meetings to discuss compliance with standards, monitoring of trends, and provide strategies to reduce HCAI. The trust has to be made accountable for any infection control issues for their staff and patients and have evidence of a clear framework to provide assurances that safety has been met. The IPC Team will implement a plan across their trust that requires quarterly and annual reports to ensure implementation and remedial actions listed and acted on as appropriate. A care bundle is a set of evidence-based interventions that are grouped together to ensure that patients receive optimal management consistently. Ideally, each part of the bundle should be based on evidence from at least one systematic review composed of multiple randomized control trials. Care bundles have been implemented in England since June 2005.
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Rabai, Ferenc, Michol A. Cooper, and Derek B. Covington. "Postoperative Management of Vascular Surgery Patients and Complications." In Vascular Anesthesia Procedures, 241–58. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197506073.003.0017.

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Vascular surgery carries an increased risk of a variety of complications in the immediate and extended postoperative periods. Major vascular operations, such as thoracoabdominal aortic aneurysm repairs and limb revascularizations, are commonly associated with prolonged operative time, ischemic reperfusion injuries, large blood losses, and systemic inflammatory response syndrome. Additionally, vascular patients usually present with a high burden of comorbidities. These factors increase the risk of multiple organ systems failing postoperatively. Myocardial injury, postoperative pulmonary complications, acute kidney injury, and neurovascular complications are relatively common and have been shown to increase morbidity and mortality. Close monitoring and an appropriate level of care ensure a safe transition into the postoperative phase. Recent data suggest that risk stratification with modern diagnostic tools and laboratory tests using sensitive biomarkers play pivotal roles in the early detection of deteriorating organ function and initiation of timely intervention. Evidence-based postoperative management guidelines and care bundles (e.g., prehabilitation, enhanced screening for myocardial injury, lung-protective ventilator management, kidney protection strategies, and enhanced recovery protocols) show promise in preventing, mitigating, and effectively treating complications with an overarching goal of optimizing postoperative outcomes and ensuring that patients recover successfully.
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Rueckmann, Erik. "Out of Hospital Cardiac Arrest." In Acute Care Casebook, edited by Jeremy T. Cushman, 89–93. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190865412.003.0019.

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The management of out-of-hospital, atraumatic cardiac arrest has changed over the past decade. This case details the evidence-based changes in care that optimize the chance of neurologically intact survival. The key factors include immediate, continuous, high-quality cardiopulmonary resuscitation with minimal interruptions, early defibrillation, and the use of capnography to assess resuscitative efforts. The orchestration of resuscitative efforts is a bundle of care that must all be met to provide the patient the best chance of survival. Furthermore, this case illustrates the key points of postarrest care and touches on termination of resuscitation. This chapter examines the case of emergency medical services call for an unresponsive patient in cardiac arrest on arrival.
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Duggan, Maria Carlo, Kwame Frimpong, and E. Wesley Ely. "Critical illness and intensive care." In Oxford Textbook of Geriatric Medicine, 237–46. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198701590.003.0033.

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Older adults constitute the majority of intensive care unit (ICU) patients, and are increasing in both absolute and relative numbers. Critical care for elderly people should be tailored to their unique physiology, susceptibilities to complications, social circumstances, values, and goals for their care. Knowledge of the short and long-term outcomes of critical illness should guide therapy and goals of care. With a growing number of elderly ICU survivors, the functional, cognitive, and psychological consequences of critical illness and ICU exposure will become a more prominent problem to address. In this chapter, we will discuss morbidity and mortality of elderly ICU patients, provide an evidence-based bundle for the management of pain, agitation, and delirium that has been developed with the vulnerabilities of older patients in mind (though it is also being applied broadly to younger patients as well), and explore the long-term physical, cognitive, and psychological consequences that ICU survivors face.
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Maxey-Jones, Courtney, and Edward Bittner. "An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU." In 50 Studies Every Intensivist Should Know, edited by Edward A. Bittner and Michael E. Hochman, 287–92. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190467654.003.0047.

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As part of the Keystone Intensive Care Unit project a bundle of evidence-based interventions was introduced in ICUs across the state of Michigan with the goal of decreasing catheter-related bloodstream infections (CRBI). The bundle included (1) hand washing, (2) full barrier precautions during placement of central venous catheters, (3) skin cleaning with chlorhexidine, (4) if possible, avoidance of femoral site, and (5) removing unnecessary central venous catheters. Post implementation rates of catheter-related bloodstream infections were compared to baseline data. The results showed a decrease from a baseline median rate of 2.7 infections per 1000 catheter-days to a median rate of 0 infections per 1000 catheter-days, which was sustained over 18 months of follow-up.
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McAnally, Heath B. "Rationale and Process Overview for Preoperative Optimization of Chronic Pain." In Preoperative Optimization of the Chronic Pain Patient, 19–38. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190920142.003.0002.

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The previous chapter demonstrated that preoperative chronic pain and its many associated comorbidities pose significant risk of suboptimal and adverse outcomes after surgery. Morbidity and economic data clearly indicate room for improvement in the arena of preoperative preparation/optimization of these factors prior to elective surgery. Many have called for a better system of identifying patients at risk and intervening at various stages (preoperative, intraoperative, and postoperative) with multidisciplinary/multimodal approaches in an attempt to mitigate this growing problem. Principles of evidence-based standards of care and wise allocation of resources/fiscal responsibility require that in high-impact and high-prevalence conditions such as chronic pain, benefits clearly outweigh risks and justify the costs. The federal government is increasingly implementing drastic overhaul to the reimbursement system and one of those changes particularly relevant to the perioperative arena is the advent of bundled and capitated payments which further incentivizes quality care with minimization of both postoperative complications and costs involved in preventing and treating them.
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Okunoye, Gbemisola, and Justin C. Konje. "Antepartum haemorrhage." In Oxford Textbook of Obstetrics and Gynaecology, edited by Sabaratnam Arulkumaran, William Ledger, Lynette Denny, and Stergios Doumouchtsis, 284–94. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198766360.003.0022.

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Antepartum haemorrhage (APH) remains a leading cause of maternal and perinatal morbidity and mortality across the world. As a key component of obstetric haemorrhage, it features high on the list of near-miss obstetric events; thus highlighting the continued importance of developing strategies aimed at reducing the negative impact on maternal and fetal outcome. The causes of APH include placenta praevia, placenta accreta, placenta abruption, vasa praevia, and local genital causes. Some cases of APH would be retrospectively classified as of unknown origin. Placenta praevia, placenta abruption, and vasa praevia have the greatest impact on maternal and fetal morbidity and mortality. The impact of APH on pregnancy outcome is more pronounced in low-resourced countries when compared to developed economies; therefore, a system-oriented approach based on sound evidence and multidisciplinary involvement with regularly rehearsed drills is required to drive a sustained improvement in the management of APH across the world. The rising incidence of placenta accreta, with the associated risk and complexity, presents an ongoing challenge, and the adoption of a composite care bundle that incorporates key components of multidisciplinary care is highly recommended.
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Meddings, Jennifer, Vineet Chopra, and Sanjay Saint. "Committing to an Infection Prevention Initiative." In Preventing Hospital Infections, 10–23. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197509159.003.0002.

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What motivates a hospital administration to take on an infection prevention initiative? It may simply reflect a hospital’s culture of excellence, a commitment to patient safety, though that may be combined with a determination to keep up with competing institutions or to avoid federal financial penalties. Quality initiatives can drain staff time and energy but save substantial dollars in the long run. Once the decision to proceed with the catheter-associated urinary tract infection initiative is made, hospital leaders start a team-building process, choosing an executive sponsor with experience on the wards, the project’s main venue. The sponsor in turn selects a project manager, who will find physician and nurse champions to carry the goals and content of the initiative to the staff. The initiative calls for the adoption of a bundle of evidence-based behaviors—in this case, to reduce the unnecessary use of indwelling urinary catheters known as Foleys.
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