Jafarifiroozabadi R, Zhang C, Parker S
… +4 more, Pankey V, Patel H, Gautam N, Hsu CC
Am J Med Qual
· 2026 May-Jun 01 · PMID 41961101
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Limited research has examined safety features in nonhospital settings for adolescents experiencing behavioral health crises, including the crisis stabilization unit (CSU). This mixed-methods study investigated safety thr...Limited research has examined safety features in nonhospital settings for adolescents experiencing behavioral health crises, including the crisis stabilization unit (CSU). This mixed-methods study investigated safety through design features (eg, open versus semi-enclosed nursing stations) in an adolescent CSU with experts (clinicians and health care designers) and design trainees (N = 17) using physical mock-up simulations and artificial intelligence (AI). Participants' feedback was obtained using questionnaires and focus groups. Simulations were video-recorded, manually coded, and an AI-driven tool was developed for automatic, real-time analysis of videos. Findings revealed that experts rated the semi-enclosed nursing station higher in visibility, whereas design trainees reported significantly higher perceived privacy in the open nursing station ( P = 0.036). AI-driven video analyses demonstrated high-accuracy performance in detecting and tracking participants (>80%) when compared with manual data. This study proposed a methodology to improve safety in future adolescent CSUs by integrating AI-driven tools and clinical mock-up simulations during the design process.
Mitchell E, Waraich RK, Goldman S
… +3 more, Luty JT, Gold J, Smeraglio A
Am J Med Qual
· 2026 Jul-Aug 01 · PMID 41961085
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Hospitals use security emergency response codes (SERCs) to manage security threats. This study explored the demographics of SERCs in an academic hospital setting in the Pacific Northwest. A retrospective chart review of...Hospitals use security emergency response codes (SERCs) to manage security threats. This study explored the demographics of SERCs in an academic hospital setting in the Pacific Northwest. A retrospective chart review of all adult emergency department and inpatient encounters between January 2022 and July 2023 was performed. Age-adjusted standardized event ratios were calculated for each racial category and compared using a standardized rate ratio (SRR). Among the 60 957 eligible encounters over the study period, 411 SERCs occurred across 273 (0.45%) encounters. Compared with the demographics of all hospital encounters, SERCs occurred more frequently with patients who were male (n = 2313, 76.2%), English-speaking (n = 402, 97.8%), and younger (18-70 years old, n = 331, 80.6%). A total of 348 SERCs occurred among white individuals, 34 among Black individuals, and 29 among individuals of other racial groups. The age-adjusted standardized event ratio was 1.66 for Black individuals, 0.98 for white individuals, and 0.82 for individuals of other racial groups. The SRR (Black vs white) was 1.70 (95% CI, 1.20-2.40; P = 0.003), indicating a 70% higher standardized event rate among Black individuals compared with White individuals. The SRR (Black vs other racial groups) was 2.02, indicating a 202% higher standardized event rate among Black individuals compared with individuals of other racial groups. This study demonstrates disparities in the frequency of SERC utilization against Black patients. Further investigation into the etiologies leading to SERCs and improved mechanisms of SERC tracking should be undertaken.
Tan N, Rohila V, Reyes C
… +6 more, Lawrence A, Phan H, Cox MD, Gomes AM, Ma C, Moreno Franco P
Am J Med Qual
· 2026 May-Jun 01 · PMID 41961077
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We examined outcomes of a quality improvement (QI) culture implemented through Mayo Clinic Quality Academy by retrospectively reviewing data from QI projects credited from 2019 to 2024. Data analyzed included roles, memb...We examined outcomes of a quality improvement (QI) culture implemented through Mayo Clinic Quality Academy by retrospectively reviewing data from QI projects credited from 2019 to 2024. Data analyzed included roles, member count, region, project details, priorities, financial outcomes, methodologies, and lessons learned. During the study period, Mayo Clinic Quality Academy credited 1106 projects involving 10 063 members (median, 8 members per project). Physicians participated in 52.4% of projects, allied health professionals in 83.6%, and nurses in 55.2%. Among all projects, teamwork (54.0%) and efficiency (52.8%) were the most common organizational priorities; among National Academy of Medicine priorities, efficiency was the most common (32.2%), followed by safety (20.7%) and patient-centeredness (18.9%). Model for improvement was the most prevalent QI methodology (29.2%). Most participants (93%) believed the QI project changed the way they work. Cultivating a QI culture influences health care delivery by emphasizing efficiency, teamwork, operational performance, patient outcomes, satisfaction, and financial benefits.
Daoudi S, Jewell C, Carlozzi M
… +7 more, Harrington E, Williams C, Quinlan S, Drummond C, Bergeron L, Gallant C, Zimetbaum P
Am J Med Qual
· 2026 May-Jun 01 · PMID 41873736
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This pilot study in the Interventional Cardiology and Electrophysiology units at Beth Israel Deaconess Medical Center (BIDMC) identified gaps in patient experience through follow-up phone surveys. Responses were collecte...This pilot study in the Interventional Cardiology and Electrophysiology units at Beth Israel Deaconess Medical Center (BIDMC) identified gaps in patient experience through follow-up phone surveys. Responses were collected from 104 patients using an unvalidated survey instrument to generate hypotheses and inform future quality improvement initiatives. Findings revealed high satisfaction with pain management and procedural comfort, but persistent concerns regarding postprocedural communication and wait times, with notable differences in satisfaction between patients who underwent electrophysiology procedures versus catheterization or structural interventions. Qualitative responses were coded by 2 independent reviewers (Cohen's κ = 0.80). Key themes included physician-patient communication, perceived wait times, and family involvement in care. Findings are contextualized within the broader literature on patient experience and quality improvement in cardiac procedural settings. Building on strategies from national and international studies, evidence-informed recommendations are offered to guide improvements, including targeted enhancements in communication and scheduling.
Ali T, McConnell A, Gill CR
… +2 more, Powell T, Stangl KA
Am J Med Qual
· 2026 May-Jun 01 · PMID 41873735
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Misalignment between physicians and hospital administrators has long challenged US healthcare systems. The COVID-19 pandemic magnified these tensions, with physicians reporting increased burnout and administrators grappl...Misalignment between physicians and hospital administrators has long challenged US healthcare systems. The COVID-19 pandemic magnified these tensions, with physicians reporting increased burnout and administrators grappling with severe financial pressures. This narrative review synthesizes findings from peer-reviewed studies, national surveys, organizational case examples, and policy reports to evaluate physician-administrator relationships. The analysis identifies 6 thematic areas: shared vision and transparency, governance engagement, incentive alignment, administrative burden, physician well-being, technology and innovation, and organizational trust and culture. The literature consistently documents the persistence of misalignment: physicians cite loss of autonomy and administrative overload, while administrators must manage costs and ensure compliance. Evidence from health systems such as Mayo Clinic, Cleveland Clinic, and rural hospitals demonstrates that structured engagement strategies can mitigate these divides. Bridging the physician-administrator divide is critical for value-based care. In rural areas where hospital closures and workforce shortages are acute, collaborative models are urgently needed. The proposed framework highlights actionable strategies to reduce burnout, enhance retention, and strengthen patient-centered outcomes.
Srivatsa S, Glauser G, Gross A
… +5 more, Nimylowycz K, Gentle C, Moyse T, Claus S, Augustin T
Am J Med Qual
· 2026 May-Jun 01 · PMID 41873734
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Aspiration-related cardiopulmonary arrests (CPAs) in hospitalized patients have a survival rate under 10%, representing a serious preventable complication. In October 2023, a multidisciplinary group of physicians, nurses...Aspiration-related cardiopulmonary arrests (CPAs) in hospitalized patients have a survival rate under 10%, representing a serious preventable complication. In October 2023, a multidisciplinary group of physicians, nurses, and safety specialists was formed. Review of aspiration cases from 2020 to 2024 and root cause analysis identified 3 factors: unrecognized risk, refusal of nasogastric (NG) tubes, and inconsistent application of aspiration precautions. Targeted interventions included nurse and resident education, expanded swallow screens, revised NG tubes management, and new signage to flag high-risk patients. From 2020 to 2023, there were 72 aspiration-related CPAs. Following the implementation of the countermeasures, aspiration-related CPAs decreased by 52% between 2023 and 2024 (27 events vs 13 events). Statistical process control analysis using a c-chart demonstrated a significant shift below the median with 12 consecutive points under the centerline. A multipronged, multidisciplinary approach effectively reduced fatal aspiration events, suggesting comprehensive education, improved screening, and standardized precautions can lower the incidence of aspiration-related CPAs.
Refaey A, Deogaonkar A, Ruiz ME
… +2 more, Bandaru M, Borum ML
Am J Med Qual
· 2026 May-Jun 01 · PMID 41859768
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INTRODUCTION: Stigmatizing language in medical documentation can erode patient trust and worsen health disparities. Gastroenterology (GI) notes often include descriptions of weight, substance use, bowel preparation, and...INTRODUCTION: Stigmatizing language in medical documentation can erode patient trust and worsen health disparities. Gastroenterology (GI) notes often include descriptions of weight, substance use, bowel preparation, and adherence, making them prone to biased phrasing. METHODS: In this retrospective quality improvement study at an urban academic center, 3417 outpatient and colonoscopy records were reviewed over 4 months (pre- and postintervention). Clinicians received a single educational session promoting evidence-based, patient-centered terminology (eg, body mass index instead of adjectival "obesity," Boston Bowel Preparation Scale instead of "poor prep," person-first substance use language). Frequencies of stigmatizing versus recommended terms were compared using Fisher exact test, stratified by race and gender. RESULTS: Use of adjectival "obesity" declined from 5.6% to 3.6% ( P = 0.012), while body mass index documentation increased from 8.8% to 16.6% ( P < 0.001). "Poor prep" decreased from 51.5% to 23.2% ( P = 0.002), and Boston Bowel Preparation Scale use rose from 48.5% to 76.8% ( P = 0.001). Racial disparities improved; gender differences persisted. DISCUSSION: A single educational session was associated with reductions in certain stigmatizing or subjective terms and increased use of objective alternatives in gastroenterology documentation, though changes varied across domains. Sustained training may further improve equity and patient-centered care.
Am J Med Qual
· 2026 May-Jun 01 · PMID 41734351
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Diabetic eye exams are essential for the detection of diabetic retinopathy (DR); however, screening rates remain below the Healthy People 2030 target of 70%. At Northwestern Medicine, screening rates for DR were as low a...Diabetic eye exams are essential for the detection of diabetic retinopathy (DR); however, screening rates remain below the Healthy People 2030 target of 70%. At Northwestern Medicine, screening rates for DR were as low as 49.7%, highlighting care gaps in Chicagoland. A qualitative improvement initiative informed through Plan-Do-Study-Act cycles, root cause analysis, and data-driven decision-making was implemented. Key interventions included point-of-care retinal imaging, previsit questionnaires, practice advisory tools, clinical decision support updates, and community health worker integration. Screening rates of DR significantly increased from 49.7% to 57% within a 22-month period by improving patient access and care coordination. Same-day exam availability, seamless referrals, and targeted outreach addressed barriers to care while closing gaps effectively. This article offers interventions for elevating diabetic eye exam screening rates while sharing lessons learned and resources to adopt best practices that benefit patient outcomes and health care systems.
Graziano FD, Jiang CZ, Pollack BL
… +7 more, Roberts A, Campbell AC, Shammas RL, Boe LA, Mehrara BJ, Nelson JA, Stern CS
Am J Med Qual
· 2026 Mar-Apr 01 · PMID 41734293
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Manual recording of surgical adverse events (AEs) is often incomplete and inconsistent. Automated systems linking structured notes to surgical secondary events (SSE) databases may improve accuracy and efficiency. We retr...Manual recording of surgical adverse events (AEs) is often incomplete and inconsistent. Automated systems linking structured notes to surgical secondary events (SSE) databases may improve accuracy and efficiency. We retrospectively compared surgeries from October 2021 to April 2022 (manual reporting) and January to July 2023 (automated reporting). In the automated cohort, AEs were captured via a structured note-linked SSE database. Outcomes included completeness-the proportion of AEs in notes also recorded in the SSE database-and accuracy, defined by concordance for procedure, complication type/grade, and management. Baseline demographics were similar between cohorts. Completeness improved from 20% to 94% ( P < 0.001). Minor AE capture increased from 7% to 96% ( P < 0.001), and major AE capture from 29% to 92% ( P < 0.001). Automated SSE reporting substantially improved the completeness and accuracy of surgical AE documentation, particularly for minor events, supporting more reliable surgical quality data collection.
Spada M, Gianneski C, Hariharan S
… +10 more, Ejinaka C, Chou S, Krans E, Schlesinger A, Joseph HM, Glance JB, Sirianni B, Boast A, Ferguson R, Gopalan P
Am J Med Qual
· 2026 Mar-Apr 01 · PMID 41734289
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The authors conducted a stakeholder survey to inform the development of a regional perinatal access program. Sixty-one (22.4%) stakeholders in total completed the survey. Ninety-two percent agreed that their perinatal pa...The authors conducted a stakeholder survey to inform the development of a regional perinatal access program. Sixty-one (22.4%) stakeholders in total completed the survey. Ninety-two percent agreed that their perinatal patients would benefit from the availability of a perinatal access program, and 90% agreed or strongly agreed that they would utilize a perinatal access program if available. The survey also showed that stakeholders indicated relative comfort with anxiety and depression and its management, and low comfort with more complex psychiatric topics. When the program opened services to the region, after the first 100 calls, 21 satisfaction surveys were completed (21%) following telephone consultation with a perinatal psychiatrist. The program was universally rated as 5/5 stars, suggesting that stakeholder needs are being met.
Berger RE, Safford MM, Lee JI
… +4 more, Rajan M, McNairy ML, Card A, Kern LM
Am J Med Qual
· 2026 Mar-Apr 01 · PMID 41705869
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There are well-documented racial disparities in the provision of end-of-life care and advance care planning (ACP). It is unclear whether these observed disparities are explained by other variables. This analysis sought t...There are well-documented racial disparities in the provision of end-of-life care and advance care planning (ACP). It is unclear whether these observed disparities are explained by other variables. This analysis sought to determine whether any apparent racial disparities among general medicine inpatients in the provision of ACP services persisted after adjustment for potential confounders. The authors conducted a secondary analysis of electronic health records data collected as baseline data for a quality improvement program. The analysis included all patients who were discharged by hospitalists at an academic medical center from 4 general medicine inpatient units from July 2022 to June 2023, and who were identified as having limited life expectancy. The independent variables were demographic and clinical characteristics. The dependent variable was a composite of 4 ACP process measures (palliative care consultation, hospice discharge, comfort care status, or ACP note). Poisson regression was used to determine the association between patient characteristics and any ACP service. The analysis included 580 hospitalizations for 552 eligible patients. Patients had an average age of 73.8 years (SD 17.1), 54.5% were female, 51.3% were non-Hispanic White, 74.6% had Medicare, 43.8% had cancer, 20.5% had dementia, and 7.8% had heart failure. In unadjusted analyses, non-Hispanic Black patients were less likely to receive ACP services. However, when adjusted for age, sex, insurance, and medical conditions, the apparent racial disparity did not persist. To accurately assess health disparities in the context of quality improvement, adjustment for potential confounders may be needed.