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These are the Commission on Accreditation of Rehabilitation Facilities (CARF) standards (copyrighted by CARF in the 2003 standards manuals) that are new for every type of facility:
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Case managers are no strangers to quality improvement (QI) tools; for many years they have used a number of QI tools to improve processes and to help them meet accreditation standards.
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A multidisciplinary program staffed by nurse practitioner case managers and social workers has resulted in dramatic decreases in admissions, lengths of stay, and emergency department visits among indigent patients cared for at the University of Iowa Hospitals and Clinics in Iowa City.
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The approximately 4,000 indigent patients in the University of Iowa Hospital and Clinics Care Management program (CMPUI) in Iowa City make up 3% of patients but utilize 6.5% of hospital resources and represent 6.4% of acute admissions.
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At Griffin Hospital in Derby, CT, the patients care is managed by their primary care nurse, their case manager, and by the patients themselves. As a result, the nonprofit hospitals lengths of stay are at or below the averages reported by the Centers for Medicare & Medicaid Services.
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Griffin Hospital in Derby, CT, routinely gets a 97% to 100% patient satisfaction rating on a monthly telephone survey of about 15% of discharged patients. More than 80% of patients say they are willing to return to Griffin Hospital and would recommend the services to their family and friends.
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A multimodal education program to teach nursing and respiratory therapy staffs about improved techniques has led to a significant reduction in the incidence of ventilator-associated pneumonia (VAP).
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In the best of all worlds, there wouldnt be research conflicts of interest. Investigators would be focused on the intent of research uncovering previously unknown information. However, the reality falls a little short of the ideal, which is why many IRBs have had to deal with conflict of interest issues in addition to their primary goals and duties.
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Changes to federal regulations regarding research protections for pregnant women and fetuses now require investigators to obtain the informed consent of a fetus or neonates father before certain types of research may proceed.
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Certain broad categories of research are exempt from full review of an institutional review board. Though federal regulations regarding exemptions are spelled out for investigators and IRBs alike, IRBs still are responsible for reviewing proposed protocols and approving exemptions.
