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Concerned about the privacy offered to patients at a large teaching hospital in the west Midlands, staff established a multidisciplinary group to benchmark privacy and dignity. They have ensured a high standard of care for patients through the benchmarking process. This article details the steps taken by the group and illustrates how Essence of core has successfully provided a framework to support quality improvements.
Since The Essence of Care (Department of Health, 2001) was launched there have been many publications about the document and the process of benchmarking. This paper will focus specifically on the implementation of the benchmark for pressure ulcers.
This study was performed to test the validity of manual and automated HER2 tests in one hundred routinely formalin-fixed and paraffin-embedded diagnostic breast carcinoma tissues. Immunohistochemical (IHC) and fluorescence in situ hybridization (FISH) assays for HER2 were separately carried out in two institutes of pathology specialised in diagnostics of breast diseases. Manual immunostaining was performed by the Dako-HercepTest. Automated IHC and FISH were carried out in the Ventana BenchMark platform by using the Pathway-CB11 antibody and the INFORM(R) HER2 probe, respectively. Positivity rates varied between HercepTest (26%), automated CB11 IHC (23%) and automated FISH (22%). Overall concordance between positive (2+, 3+) and negative (0; 1+) results of manual and automated IHC was 97%, between automated FISH and IHC 92%, and between automated FISH and HercepTest 89%. The frequency of 2+ IHC scores was 13% using the BenchMark and 14% with the HercepTest; 6/12 and 8/14 of the respective cases were not amplified by FISH. Automated FISH was not interpretable in 11 of 100 specimens. In the 89 informative cases, automated IHC resulted in increased specificity (92% vs. 88%), increased positive predictive value (73% vs. 64%) and increased efficiency (92% vs. 89%). We conclude that automation improves the accuracy of HER2 detection in diagnostic breast carcinoma tissues and provides a new approach for the global standardization of clinical HER2 tests.
Essence of Care and its nine standards were introduced in February 2001 (Department of Health, 2001). These standards require a lot of work from benchmarking groups in clinical areas, and the translation of the national guidance into workable local practice is proving demanding for most organisations. This article describes one trust's use of an electronic toolkit for benchmarking.
An Austrian research project focused on the development of process indicators for treatment plants with different process and operation modes. The whole treatment scheme was subdivided into four processes, i.e. mechanical pretreatment (Process 1), mechanical-biological waste water treatment (Process 2), sludge thickening and stabilisation (Process 3) and further sludge treatment and disposal (Process 4). In order to get comparable process indicators it was necessary to subdivide the sample of 76 individual treatment plants all over Austria into five groups according to their mean organic load (COD) in the influent. The specific total yearly costs, the yearly operating costs and the yearly capital costs of the four processes have been related to the yearly average of the measured organic load expressed in COD (110 g COD/pe/d). The specific investment costs for the whole treatment plant and for Process 2 have been related to a calculated standard design capacity of the mechanical-biological part of the treatment plant expressed in COD. The capital costs of processes 1, 3 and 4 have been related to the design capacity of the treatment plant. For each group (related to the size of the plant) a benchmark band has been defined for the total yearly costs, the total yearly operational costs and the total yearly capital costs. For the operational costs of the Processes 1 to 4 one benchmark ([see symbol in text] per pe/year) has been defined for each group. In addition a theoretical cost reduction potential has been calculated. The cost efficiency in regard to water protection and some special sub-processes such as aeration and sludge dewatering has been analysed.
Occupational health nurses are in a unique position to influence medical absence costs through their focus on health promotion and restoration. Corporate management looks to occupational health nurses to maximize employee productivity and reduce costs through lowered disability claims, fewer on-the-job injuries, and improved absentee rates. Benchmarking provides the occupational health nurse with the diagnostic tools to measure and manage productivity, demonstrate results, and justify the resources needed to accomplish desired outcomes. Benchmarking assists the occupational health nurse in all standards of practice outlined by the AAOHN: Assessment, diagnosis, outcome identification, planning, implementation, evaluation, resource management, professional development, collaboration, research, and ethics.
Regional clinical Audit, guideline Targets and local and regional Benchmarks In order to improve the quality of dialysis treatment, we have devised some routines, particularly suitable for electronic data management systems. First, we suggest a systematic monthly analysis of 10 common clinical performance measures (CPM), with the following guideline based targets: predialysis systolic blood pressure (SBP) < 140 mmHg; session length >/= 240 min; dialysis dose (spKt/V) >/=1.3; normalized protein catabolic rate (NPCR) >/=1.2 g/kg/d; hemoglobin (Hb) >/=11 g/dL; serum calcium (Ca) 8.4-9.5 mg/dL; serum phosphorus (P) 3.5-5.5 mg/dL; Ca x P </=55 mg 2 /dL 2 ; serum bicarbonate (HCO3) >/=20 mmol/L; serum potassium (K) 3.5-6.0 mmol/L. The Hb target should be reached in at least 85% of all maintenance hemodialysis (HD) patients in the unit; for all other targets, an arbitrary >/=80% is proposed. Since the above percentages are quite difficult to reach on a short-term basis, an intermediate local or regional standard (benchmark) could be devised as an average of the percentage of patients who actually reach the targets for each CPM at any dialysis unit in a given regional area; and therefore, from truly comparable patients. As an example, we simulated a regional audit by using the above targets with available data from 398 patients from southern Italy. A further step in this process was to find the cause(s) of failure in each patient who did not reach the targets. To this end, we suggest a systematic search of the well-known factors that could affect each CPM, for each failed patient. As an example, we screened all patients with Hb < 11 g/dL at a single unit, to establish the presence/absence of any common cause associated with inadequate response to epoetin treatment. Moreover, by using criteria for prescribing iron therapy or increasing epoetin dose, we found that some patients did not receive the appropriate therapy after blood sampling results. To avoid this possible common problem, we suggest the need for a monthly report of failure cases for any particular CPM and a check that the appropriate treatment has been delivered to all patients at the dialysis unit. This should also favor guideline implementation.
BACKGROUND: The aim of this study was to compare the outcomes of carotid endarterectomy (CEA) in the current practice of our department of vascular surgery with international benchmarks. METHODS: In-patient data from 488 CEA performed in both symptomatic 145 (29.7%) and asymptomatic 343 (70.3%) patients with a > or = 60% stenosis at the level of the internal carotid artery. Comprehensive retrospective review of the records for all the CEAs performed during a 2-year period. The main outcome measures were death rate, and fatal and non-fatal stroke rates perioperatively, and at 30 and 180 days. RESULTS: The fatal and non-fatal stroke rates of symptomatic patients were: 0.7% perioperatively, 0.7% at 30 days, and 0.7% at 180 days. The fatal and non-fatal stroke rates of asymptomatic patients were: 0.6% perioperatively, 0.6% at 30 days, and 0.3% at 180 days. The death rates of symptomatic patients were 0% for all time periods. The death rates of asymptomatic patients were: 0% perioperatively, 0% at 30 days, and 0.3% at 180 days. CONCLUSIONS: The present comprehensive audit shows that our surgeons achieve CEA outcomes comparable with international benchmarks.
Thirty-nine municipalities in the Netherlands conducted a pilot study to develop and try out a methodology to compare the quality of their sewerage management. The participants chose a multidimensional benchmarking with an emphasis on the aim of improving the working processes within sewerage management. A second goal was accountability to the stakeholders. The benchmarking methodology was based as well on analysing data within a "balanced-score-card" system as on intensive exchange of knowledge and experiences. The pilot resulted in a state of the art overview of the quality of sewerage management in the Netherlands. However, above all, it resulted in the shocking fact that the work is carried out in many different ways which cannot be explained by technical reasons or local circumstances. To pinpoint best practices and actually implement these improvements the learning process must continue after the analysis and presentation of the data. A start has been made to form regional specialist networks for further discussion and exchange of experiences.
A new benchmark for health promotion has been added to Essence of Care, the government strategy to improve the quality of the fundamental aspects of nursing care. The benchmark provides a tool for making health promotion part of everyday practice and is designed to be applicable to any area.
OBJECTIVE: This article presents some limited results from the Medical Library Association (MLA) Benchmarking Network survey conducted in 2002. Other uses of the data are also presented. METHODS: After several years of development and testing, a Web-based survey opened for data input in December 2001. Three hundred eighty-five MLA members entered data on the size of their institutions and the activities of their libraries. The data from 344 hospital libraries were edited and selected for reporting in aggregate tables and on an interactive site in the Members-Only area of MLANET. The data represent a 16% to 23% return rate and have a 95% confidence level. RESULTS: Specific questions can be answered using the reports. The data can be used to review internal processes, perform outcomes benchmarking, retest a hypothesis, refute a previous survey findings, or develop library standards. The data can be used to compare to current surveys or look for trends by comparing the data to past surveys. CONCLUSIONS: The impact of this project on MLA will reach into areas of research and advocacy. The data will be useful in the everyday working of small health sciences libraries as well as provide concrete data on the current practices of health sciences libraries.
Benchmarking in industry has been around for nearly a century, helping companies in nearly every sector imaginable improve their overall performance. Benchmarking's importance in health care, and specifically the clinical laboratory, can be summed up in one simple phrase--"If you cannot measure it, you cannot improve it." Here is why.
The editors are providing this Executive Summary by the University HealthSystem Consortium of their Adult ICU Benchmarking Project. The report has been reviewed by the participating members listed at the end of the summary. The summary report provides both an interesting account of how a benchmarking project of considerable magnitude can be accomplished but also indicates how important comparative data can be used to improve individual programs.
An individual program's viewpoint on the overall benchmarking process for critical care medicine and how this process can provide a conceptual understanding of how benchmarking can be beneficial.
The editors are providing this Executive Summary by the University HealthSystem Consortium of their Emergency Department Benchmarking Project. The report has been reviewed by the participating members listed at the end of the summary. The summary report provides both an interesting account of how a benchmarking project of considerable magnitude can be accomplished but also indicates how important comparative data can be used to improve individual programs.
Benchmarking is one of the methods used in continuous quality improvement and other fiscal and clinical effectiveness programs. This article was prepared as a resource for nurses in practice. It provides an overview of benchmarking, including definitions, process, and nursing practice considerations.
To obtain a set of consistent benchmark potential energy surfaces (PES) for the two archetypal nucleophilic substitution reactions of the chloride anion at carbon in chloromethane (S(N)2@C) and at silicon in chlorosilane (S(N)2@Si), we have explored these PESes using a hierarchical series of ab initio methods [HF, MP2, MP4SDQ, CCSD, CCSD(T)] in combination with a hierarchical series of six Gaussian-type basis sets, up to g polarization. Relative energies of stationary points are converged to within 0.01 to 0.56 kcal/mol as a function of the basis-set size. Our best estimate, at CCSD(T)/aug-cc-pVQZ, for the relative energies of the [Cl(-), CH(3)Cl] reactant complex, the [Cl-CH(3)-Cl](-) transition state and the stable [Cl-SiH(3)-Cl](-) transition complex is -10.42, +2.52, and -27.10 kcal/mol, respectively. Furthermore, we have investigated the performance for these reactions of four popular density functionals, namely, BP86, BLYP, B3LYP, and OLYP, in combination with a large doubly polarized Slater-type basis set of triple-zeta quality (TZ2P). Best overall agreement with our CCSD(T)/aug-cc-pVQZ benchmark is obtained with OLYP and B3LYP. However, OLYP performs better for the S(N)2@C overall and central barriers, which it underestimates by 2.65 and 4.05 kcal/mol, respectively. The other DFT approaches underestimate these barriers by some 4.8 (B3LYP) to 9.0 kcal/mol (BLYP).
We have developed a nonredundant benchmark for testing protein-protein docking algorithms. Currently it contains 59 test cases: 22 enzyme-inhibitor complexes, 19 antibody-antigen complexes, 11 other complexes, and 7 difficult test cases. Thirty-one of the test cases, for which the unbound structures of both the receptor and ligand are available, are classified as follows: 16 enzyme-inhibitor, 5 antibody-antigen, 5 others, and 5 difficult. Such a centralized resource should benefit the docking community not only as a large curated test set but also as a common ground for comparing different algorithms. The benchmark is available at (http://zlab.bu.edu/~rong/dock/benchmark.shtml).