***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To evaluate a matrix for determining the predominant type , cause category , and rate of medication prescribing errors , and to explore the effectiveness of hospital-based improvement initiatives among pediatric intensive care units ( PICUs ) . Design This study involved the prospect i ve identification of medication errors for categorization and evaluation by using a matrix methodology . A pretest-posttest design without a control group was used to explore the impact of initiatives employed to reduce medication error rates and severity . Setting PICUs in nine freest and ing , collaborating tertiary care children ’s hospitals that participated in both baseline and postintervention analyses . Methods We evaluated 12,026 PICU medication orders at baseline and 9,187 orders postintervention for prescribing errors , excluding resuscitation orders .  A st and ardized tool and process captured error type , cause category , and severity for 2 wks before and after intervention . Three levels of error detection were used and included pharmacy order entry , PICU nurse order transcription , and team-based overview . Site-specific interventions were implemented , which included predominantly provider education as well as informational ( 47 % ) and dosing “ assists ” via preprinted orders , forcing functions , or prompts ( 39 % ) . Results Of baseline orders , 11.1 % had at least one prescribing error . The interception of prescribing errors improved 30.9 % ( 1.6 % of all orders at baseline , 2.0 % post intervention ) . Preventable adverse drug events were uncommon ( 0.6 % of all medication errors ) and of low severity at baseline ; most were wrong dose errors . The implementation of improvement initiatives , specific for each facility , result ed in a 31.6 % reduction in prescribing errors from 11.1 % to 7.6 % . However , site results varied considerably . Conclusions A benchmark for medication prescribing errors in the PICU was identified among nine children ’s hospitals . The methodology was successful in accounting for site-specific differences with regard to identifying and documenting errors as well as reporting results of improvement initiatives . Furthermore , the methodology employed was generalizable in the identification of predominant prescribing error types , which helped to track individual hospital improvement initiative development and implementation . Overall improvement in prescribing error rates was noted ; however , considerable variation in the success of improvement initiatives was noted and bears further attention BACKGROUND The adherence to evidence -based treatment guidelines for acute myocardial infa rct ion ( AMI ) is still suboptimal . Therefore , we design ed a study to evaluate the effects of a collaborative quality improvement ( QI ) intervention on the adherence to AMI guidelines . The intervention used a national web-based quality registry to generate local and regular real-time performance feedback . METHODS A 12-month baseline measurement of the adherence rates was retrospectively collected , comprising the period July 1 , 2001 , through June 30 , 2002 . During the intervention period of November 1 , 2002 , through April 30 , 2003 , multidisciplinary teams from 19 nonr and omized intervention hospitals were subjected to a multifaceted QI-oriented intervention .  Another 19 hospitals , unaware of their status as controls , were matched to the intervention hospitals . During the postintervention measurement period of May 1 , 2003 , through April 30 , 2004 , a total of 6726 consecutive patients were included at the intervention ( n = 3786 ) and control ( n = 2940 ) hospitals . The outcome measures comprised 5 Swedish national guideline -derived quality indicators , compared between baseline and postintervention levels in the control and QUICC intervention hospitals . RESULTS In the control and QI intervention hospitals , the mean absolute increase of patients receiving angiotensin-converting enzyme inhibitors was 1.4 % vs 12.6 % ( P = .002 ) , lipid-lowering therapy 2.3 % vs 7.2 % ( P = .065 ) , clopidogrel 26.3 % vs 41.2 % ( P = .010 ) , heparin/low-molecular weight heparin 5.3 % vs 16.3 % ( P = .010 ) , and coronary angiography 6.2 % vs 16.8 % ( P = .027 ) , respectively . The number of QI intervention hospitals reaching a treatment level of at least 70 % in 4 or 5 of the 5 indicators was 15 and 5 , respectively . In the control group , no hospital reached 70 % or more in just 4 of the 5 indicators . CONCLUSIONS By combining a systematic and multidisciplinary QI collaborative with a web-based national quality registry with functionality allowing real-time performance feedback , major improvements in the adherence to national AMI guidelines can be achieved Abstract Objective To test a multifaceted collaborative quality improvement intervention design ed to promote evidence based surfactant treatment for preterm infants of 23 - 29 weeks ' gestation . Design Cluster r and omised controlled trial Setting and participants 114 neonatal intensive care units ( which treated 6039 infants of 23 - 29 weeks gestation born in 2001 ) . Main outcome measures Process of care measures : proportion of infants receiving first surfactant in the delivery room  , proportion receiving first surfactant more than two hours after birth  , and median time from birth to first dose of surfactant . Clinical outcomes : death before discharge home , and pneumothorax . Intervention Multifaceted collaborative quality improvement advice including audit and feedback , evidence review s , an interactive training workshop , and ongoing faculty support via conference calls and email . Results Compared with those in control hospitals , infants in intervention hospitals were more likely to receive surfactant in the delivery room ( adjusted odds ratio 5.38 ( 95 % confidence interval 2.84 to 10.20 ) ) , were less likely to receive the first dose more than two hours after birth ( adjusted odds ratio 0.35 ( 0.24 to 0.53 ) ) , and received the first dose of surfactant sooner after birth ( median of 21 minutes v 78 minutes , P < 0.001 ) . The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth . There were no significant differences in mortality or pneumothorax . Conclusion A multifaceted intervention including audit and feedback , evidence review s , quality improvement training , and follow up support changed the behaviour of health professionals and promoted evidence based practice OBJECTIVES In August 1993 a group of house staff and nursing staff at MetroHealth Medical Center formed a quality improvement team to evaluate the process of medical care on the inpatient wards . Using st and ard continuous quality improvement ( CQI ) methods , a team of medical interns , nurses , and other health professionals involved in patient care on the medicine inpatient service design ed interdisciplinary , daily work rounds to improve the care of patients on the inpatient wards . METHODS The authors conducted a r and omized , controlled firm trial of the impact of interdisciplinary rounds on the inpatient medicine services . The trial lasted 6 months ( November 1993-April 1994 ) and included 1,102 admissions r and omly assigned to experimental or control teams by the pre-existing firm system . Of the 1,102 admissions included in the study , 535 were r and omized to medical services with traditional rounds and 567 to medical services with interdisciplinary rounds .  The outcomes studied included length of stay ( LOS ) , total hospital charges , provider satisfaction , and ancillary service efficiency . RESULTS Unadjusted analysis for log-transformed data showed lower length of stay and total charges for the interdisciplinary group . The mean LOS for interdisciplinary rounds was 5.46 days , compared with 6.06 days for traditional care ( P = 0.006 ) , whereas mean total charges were $ 6,681 and $ 8,090 ( P = 0.002 ) for the two groups , respectively . After multivariate regression analysis using a propensity score that included gender , age , marital status , admission source , diagnosis-related group ( DRG ) weight , and primary diagnosis by International Classification of Diseases , Ninth Revision ( ICD-9 ) cluster , these differences remained statistically significant . CONCLUSIONS Previous studies of interdisciplinary teams have failed to show statistically significant cost savings . This study involving more patients shows both cost and LOS decreases with the use of interdisciplinary teams . At the end of the 6-month trial , interdisciplinary rounds were instituted on all medicine inpatient services Background : Research into adverse events ( AEs ) has highlighted the need to improve patient safety . AEs are unintended injuries or complications result ing in death , disability or prolonged hospital stay that arise from health care management . We estimated the incidence of AEs among patients in Canadian acute care hospitals . Methods : We r and omly selected 1 teaching , 1 large community and 2 small community hospitals in each of 5 provinces ( British Columbia , Alberta , Ontario , Quebec and Nova Scotia ) and review ed a r and om sample of charts for nonpsychiatric , nonobstetric adult patients in each hospital for the fiscal year 2000 .  Trained review ers screened all eligible charts , and physicians review ed the positively screened charts to identify AEs and determine their preventability . Results : At least 1 screening criterion was identified in 1527 ( 40.8 % ) of 3745 charts . The physician review ers identified AEs in 255 of the charts . After adjustment for the sampling strategy , the AE rate was 7.5 per 100 hospital admissions ( 95 % confidence interval [ CI ] 5.7– 9.3 ) . Among the patients with AEs , events judged to be preventable occurred in 36.9 % ( 95 % CI 32.0%–41.8 % ) and death in 20.8 % ( 95 % CI 7.8%–33.8 % ) . Physician review ers estimated that 1521 additional hospital days were associated with AEs . Although men and women experienced equal rates of AEs , patients who had AEs were significantly older than those who did not ( mean age [ and st and ard deviation ] 64.9 [ 16.7 ] v. 62.0 [ 18.4 ] years ; p = 0.016 ) . Interpretation : The overall incidence rate of AEs of 7.5 % in our study suggests that , of the almost 2.5 million annual hospital admissions in Canada similar to the type studied , about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable In an era of chronic re source scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change . A commonly used research design , the single group pre-test/post-test design , provides little insight into whether quality improvement interventions cause measured outcomes . A re-evaluation of a quality improvement programme design ed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications . The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design . Moreover , the re-evaluation provided tangible evidence in support of the suggestion that more rigorous design s can and should be more widely employed to improve the causal interpretability of quality improvement efforts . Evaluation design s for quality improvement projects should be constructed to provide a reasonable opportunity , given available time and re sources , for causal interpretation of the results . Evaluators of quality improvement initiatives may infrequently have access to r and omised design s. Nonetheless , as shown here , other very rigorous research design s are available for improving causal interpretability . Unilateral method ological surrender need not be the only alternative to r and omised experiments BACKGROUND Brigham and Women 's Hospital , in Boston , and its major health maintenance organization ( HMO ) , Harvard Community Health Plan , collected data in spring 1994 which revealed that patients were less satisfied with hospital discharge planning  than with other elements of care . PROBLEM IDENTIFICATION PROCESS An interdisciplinary team , formed in November 1994 and composed of eight members from the hospital and HMO , used data from the hospital 's Patient Satisfaction Survey , flowcharting , and phone interviews with patients to identify discharge planning-related problems . For example , follow-up contact with patients after discharge was erratic and no clear signal of the successful " h and off " of care from the hospital team to the community team existed . IMPROVEMENT CYCLE 1 Eighty-three percent of the payer 's patients that received the improvement strategy developed by the interdisciplinary team-a concierge service-rated discharge planning as excellent or very good , compared to 63 % of control patients . IMPROVEMENT CYCLE 2 : PLAN SOLUTIONS/STRATEGIES FOR IMPROVING HOSPITAL DISCHARGE PLANNING : The results of the team 's Cycle 1 improvement provided information for the team to use in design ing a second cycle of incremental improvement activity . For example , to address the lack of clarity about who was responsible for making decisions about discharge and follow-up care , the attending physician was design ated the transition-of-care coordinator . Once all the improvements were implemented , Cycle 2 patients who received the intervention rated satisfaction with discharge higher ( 83 % versus 73 % ) than the control group . CONCLUSIONS Implication s of hospitalwide implementation of discharge planning-related services attempted on one unit are being considered OBJECTIVE To determine the effects of  hospital quality assurance interventions  on compliance with clinical st and ards , availability of essential drugs , client satisfaction , and utilization . DESIGN Quasi-experimental , prospect i ve study with four intervention hospitals 
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Findings revealed limited information about attributes of successful and unsuccessful team initiatives , barriers and facilitators to team initiatives , unique or combined contribution of selected interventions , or how to effectively establish these teams .
Conclusions Not unlike systematic review s of quality improvement collaboratives , this broad review revealed that while teams reported a number of positive results , there are many method ological issues .