Initiative Glossary

Below are descriptions of various initiatives Duke is undertaking to improve the quality and safety of patient care.

Antibiotic prescribing tools are used by physicians to prescribe the appropriate medicines to treat existing infections and prevent surgical infections. For example, in 2006 the Durham Regional Hospital Surgical Care Improvement Project Team introduced the Perioperative Antibiotic Order Sheet, which lists recommended antibiotics by surgery type.

Balanced scorecard metrics help divisions and departments within Duke University Health System (DUHS) define and measure their goals. Balanced scorecards set goals and milestones for employees, individual divisions, and the health system at large. They allow different groups within DUHS to ensure that their goals are linked or aligned with the organization as a whole.

Computerized physician order entry (CPOE) is an electronic system, available at Duke University Hospital and Durham Regional Hospital, which replaces handwritten physician orders with electronic orders to improve order accuracy. It also provides important medication-prescribing information and standardized order sets for specific medical conditions.

Electronic medical records (EMR) comprise a computer-based system that doctors and nurses use to access patient medical histories, manage prescriptions, order diagnostic tests, and view report results.

Evidence-based medicine (EBM) is a way of delivering health care that applies evidence gained from scientific study. Researchers at Duke conduct hundreds of clinical trials and outcome studies each year to prove which medications, procedures, and devices are most effective. The results of these research studies, in combination with medical literature and best practice guidelines, are used to provide the highest quality patient care. EBM is the foundation of our CPOE order sets.

HealthView patient portal is an online tool that allows patients to view lab results and appointment and account information, as well as pay bills. Patients can create online accounts at HealthView.dukehealth.org.

Heart attack-specific discharge instructions and patient education information are composed of a 30-minute discharge video, a resource guide given to patients to help them manage their care at home, and one-on-one instructions from nurses before patients leave the hospital. The information answers questions heart patients may have regarding medications, risk factors, signs and symptoms of problems, and resources available at Duke.

Heart failure-specific discharge instructions and patient education information are composed of a 30-minute discharge video, a resource guide given to patients to help them manage their care at home, and one-on-one instructions from nurses before patients leave the hospital. The information answers questions heart patients may have regarding medications, risk factors, signs and symptoms of problems, and resources available at Duke.

Nursing and physician education trains nurses and physicians in specific best practices for patient care throughout their career at Duke. Periodic educational sessions are also provided when a care practice is updated or changed.

OR View is an electronic database application used by the Department of Surgery at Duke University Hospital to document activities related to surgery such as surgery case scheduling, tracking of patient readiness for surgery, and recording patient assessments during the post-operative period.

Patient advocacy and support groups encourage patients and families to participate as active members of the health care team. Local patient advocacy groups, such as the Cancer Support Group, provide support to families and patients with specialized needs and concerns. The Duke Patient Advocacy Council is a group of patient volunteers who meet with Duke leadership on a routine basis. The Council’s mission is to provide patient perspectives and voices to Duke Medicine with the goals of enhancing patient-centered care; respecting the needs of the human spirit; and bringing together patients and their caregivers as partners in healing, education, and research.

Patient-centered service training consists of customer service training for all incoming staff during orientation and each year thereafter. Specific programs include a customer service module during the "Managing at Duke University Hospital" course for hospital managers and the "Exceeding Expectations" service training for personnel and volunteers at Duke Raleigh Hospital.

Patient communication boards in patient rooms tell patients who is assigned to their care on every shift and how to contact their caregivers for assistance. The boards may also show other information related to the patient’s care, such as daily procedures.

Patient education materials consist of pamphlets, videos, and other sources of information that help patients manage their care and live healthier lifestyles.

Patient rounding calls for a hospital unit or department leader to visit each patient within the first 24 hours of admission or transfer. The visits give patients the opportunity to provide feedback and resolve any problems they may have with their treatment.

Patient safety and clinical quality committees were created to address safety and quality issues at unit, department, and hospital levels. Hospital administration and medical leadership provide general oversight at each Duke hospital, and the Office of Safety and Quality provides global oversight across our hospitals and clinics. The work of these local- and system-level committees and offices is reported to a special Patient Safety and Quality Committee of the Duke University Health System Board of Directors.

Patient satisfaction surveys are given to patients on discharge to help us understand what patients liked and didn’t like about their hospital experience.

PCI protocols are evidence-based protocols and orders used by the physicians, nurses, and health care team for heart attack patients who need a percutaneous coronary intervention (PCI), a procedure in which a balloon or stent is used to treat a blockage in one or more of the arteries of the heart.

Pneumonia-specific discharge instructions and patient education materials have been created by the Duke health care team for patients who are receiving treatment for pneumonia. Health care providers discuss these educational materials with patients and their families during their hospital stay and before they are discharged.

Six Sigma is a scientific approach to problem-solving that uses analytical tools to assess and identify problems, defects, and breakdowns in processes, drawing on that information to redesign the system or process. Professional health care experts trained in this methodology use the DMAIC (define, measure, analyze, improve, and control) process to improve systems and enhance the delivery of patient care.

Standardized order sets are evidence-based medicine physician orders developed for specific diseases and conditions.

Smoking cessation programs and patient education materials make it easier for patients to quit their tobacco use. They may include resource materials, classes, counseling sessions, and/or nicotine replacement therapy.

Surgery-specific discharge instructions and patient education materials have been created by the Duke health care team for specific types of surgeries. Health care providers discuss these educational materials with patients and families during their hospital course and before they are discharged.

Surgical Care Improvement Project (SCIP) is an initiative that implements changes to improve surgical care. The SCIP Team at each hospital, which includes more than a dozen doctors and nurses, introduces surgical care initiatives. For example, Durham Regional Hospital introduced antibiotic prescribing tools in 2006 to help reduce surgical site infections.

Tobacco-free campus prohibits smoking in or around any of Duke Medicine’s facilities, including the campuses of its three hospitals. Duke enacted this policy in July 2007 to promote the health and wellness of patients and hospital staff. To support the initiative, Duke expanded its roster of smoking cessation programs.