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 Medical Orders for Life-Sustaining Treatment

MOLST is a standardized medical order form for use by clinicians caring for patients with serious advancing illnesses.

Effective July 1, 2014 the MOLST Project will transition to the MA Department of Public Health.
The many tools and resources on their website will continue to be accessible to health care institutions and individuals who are implementing MOLST or who would like to have information about MOLST.


Root Cause Analysis (RCA2) : Improving Root Cause Analyses and Actions to Prevent Harm -  National Patient Safety Foundation Report & Webinar

Root cause analysis (RCA) is a process widely used by health professionals to learn how and why errors occurred, but there have been inconsistencies in the success of these initiatives. With a grant from The Doctors Company Foundation, NPSF convened a panel of subject matter experts and stakeholders to examine best practices around RCAs and develop guidelines to help health professionals standardize the process and improve the way they investigate medical errors, adverse events, and near misses. Numerous organizations have endorsed the use of RCA2: Improving Root Cause Analyses and Actions to Prevent Harm as a valuable resource in efforts to create a more effective event analysis and improvement system.

Co-chairs of the panel that created the report, James Bagian, MD, PE, and Doug Bonacum, CSP, CPPS, discussed the NPSF report in a webcast on Wednesday, July 15.   NPSF developed the report and provided this complimentary webcast through the generous support of The Doctors Company Foundation, July 15, 2015

The full report and links to the webinar recording can be found here.


3M Heath Information Services Potentially Preventable Readmission (PPR) Reports Webinar

In 2013, MHA's Board of Trustees challenged acute care hospitals to reduce readmission rates by 20% over the next three years. To track progress toward that goal, MHA contracted with 3M to use its PPR Classification System. 3M recently provided MHA with a statewide acute care hospital 30-day risk-adjusted PPR rate and analysis for FY 2013 - the second such analysis. Last year, 3M produced a baseline analysis using FY 2012 data. Both analyses employed the Massachusetts acute care hospital discharge database obtained from the Center for Health Information and Analysis.

The contract with 3M also called for the production of hospital-specific PPR data reports to inform each hospital about their readmission profile and provide insights that may assist them with their readmission reduction efforts. Those reports were distributed by e-mail to acute care hospital CEOs on March 6, 2015 along with explanatory materials about the PPR methods and context about the statewide results. A recording of the April 17, 2015 webinar explaining the PPR methodology and review the content of the hospital-specific reports can be found here.


Equity of Care: A Toolkit for Eliminating Health Care Disparities

The partners of the National Call to Action to Eliminate Health Care Disparities are working to improve quality of care for all individuals by focusing on three core areas. To help you get started or complement your existing efforts, this Toolkit for Eliminating Health Care Disparities offers a framework for next steps paired with resources to guide your work.  


The Healthy Living Center of Excellence is founded and led by Elder Services of the Merrimack Valley and Hebrew SeniorLife. It is an innovative collaborative of more than 50 community and governmental organizations with a goal of improving health outcomes for adults through evidence-based programs. Along with our seven regional coalition partners, we offer community programs that promote health and prevent disease among adults with one or more chronic health conditions. Programs are held in community settings or within the healthcare delivery systems with the collaborative efforts of healthcare providers, healthcare plans, community-based organizations, government, foundations and for-profit partners.  Visit our website for a description of each program, to access the statewide workshop calendar or to make a referral. You can also call 978-946-1211 for more information or to register for a workshop. 


A Guide to help Acute Care Facilities Expand Their Current Medicaid Readmission Efforts is now Available from AHRQ.

The new resource, titled Hospital Guide to Reducing Medicaid Readmissions, can help acute care facilities accomplish the following:

  • Adapt or expand existing Medicaid readmission reduction efforts. It helps identify readmission risks, transitional care needs, and adapt best practices from proven strategies like AHRQ's Re-Engineered Discharge, the Institute for Healthcare Improvement's State Action on Avoidable Readmissions, and the Society of Hospital Medicine's Better Outcomes for Older Adults Safe Transitions to serve the transitional care requirements of Medicaid patients.
  • Develop your Medicaid reduction strategy using the guide's roadmap featuring 13 customizable online tools. The tools can be downloaded individually here.
    Comply with CMS' Conditions of Participation requirements for a standard, improved, and transitional care for all patients. National, state, and local data show high rates of non-obstetric Medicaid readmissions.
  • Develop partnerships across other settings of the healthcare continuum. The tool helps create an inventory of resources and processes to aid building multidisciplinary teams with organizations and facilities offering post-hospital Medicaid transitional services. 

The guide is the only federal tool available tailored for the adult Medicaid population. Hospitals at different stages of readmission reduction work can benefit from implementing this guide.

AHA issues antimicrobial stewardship toolkit for hospitals and patients

The American Hospital Association (AHA), along with six national partners, this week released a toolkit to help hospitals and health systems enhance their antimicrobial stewardship programs. The toolkit includes resources for hospital leaders, clinicians and patients, starting with a tool developed by the Centers for Disease Control and Prevention (CDC) to help hospitals assess their readiness for optimal antibiotic prescribing and use.


Undue Exposure to Radiation: Actions You Can Take to Reduce it Today

  • Create clear and measurable aims for reducing radiation exposure.
  • Use standardized nomenclature for radiology study names in patient records and computer systems (RadLex).
  • Utilize existing resources from the Image Gently and Image Wisely Campaigns
    Includes content from manufacturers about optimizing dose with their CT equipment
  • Utilize Patient Imaging History Record cards


  • Research shows that when patients are engaged in their health care, safety and quality can improve measurably. To promote stronger engagement, AHRQ developed the Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.
  • HPOE presents framework for leading improvement across the continuum
    A new guide from the AHA's Hospitals in Pursuit of Excellence initiative presents an improvement continuum framework and leadership action model to help hospital leaders execute a wide range of improvement activities. "Faced with many diverse improvement opportunities - from eliminating hospital-acquired infections to reducing community asthma rates - leaders need a way to categorize improvement efforts and identify effective strategies to lead many different projects simultaneously," the guide notes. "As health care transforms, leaders must develop the knowledge and skill sets to move beyond single improvement efforts and engage in multiple efforts across a continuum of improvement projects." HPOE is the AHA's strategic platform to accelerate performance improvement in hospitals. HRET's  Signature Leadership Series - Leading Improvement Across the Continuum: Skills, Tools and Teams for Success.
  • July 2013 - HRET recently published a guide that describes a three-step action plan from the On the CUSP: Stop CAUTI project that helps hospitals and care systems achieve and sustain reductions in CAUTI infection rates.  Click here



  • How to Talk to Families About Advanced Dementia, A Guide for Health Care Professionals. This training guide, a companion piece to the booklet "Advanced Dementia: A Guide for Families," is a user guide designed for healthcare providers who support families making treatment decisions for patients with advanced dementia. The booklet was created by an interdisciplinary team of Boston-based geriatric and palliative care physicians, nurses, and researchers from Hebrew SeniorLife(HSL) and Beth Israel Deaconess Medical Center in 2011.


  • Re-Engineered Discharge (RED) Toolkit from AHRQ: A variety of forces are pushing hospitals to improve their discharge processes to reduce readmissions. Researchers at the Boston University Medical Center (BUMC) developed and tested the Re-Engineered Discharge (RED). Research showed that the RED was effective at reducing readmissions and posthospital emergency department (ED) visits. The Agency for Healthcare Research and Quality contracted with BUMC to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED.


  • AHRQ Patient Safety Education and Training Catalog: The Patient Safety Education and Training Catalog consists of 333 patient safety programs available in the United States as of November 28, 2011. Developed by the American Institutes for Research (AIR) from internet searches in 2010 and 2011, the catalog captures a snapshot of available programs at the time. Because new programs are continually being developed, old ones retired, and others revised and improved, interested readers should check the relevant website for up-to-date information.


  • Hospitals in Pursuit of Excellence (HPOE) provides field-tested practices, tools, education and other networking resources to accelerate performance improvement in the nation's hospitals. HPOE's fundamental principles support the Institute of Medicine's Six Aims for Improvement- care that is Safe, Timely, Effective, Efficient, Equitable, and Patient-centered (STEEEP). 





  • HRET Guide on Workforce Practices to Drive Quality, Using Workforce Practices to Drive Quality Improvement: A Guide for Hospitals, was developed with support from the federal Agency for Healthcare Research and Quality to help hospitals implement work practices that drive quality improvement.  The guide helps hospital leaders and human resource professionals adopt 14 work practices shown to improve an organization's capacity to support a high-performing health care system. "This guide highlights the importance of a strong commitment by senior leaders when implementing high-performance work practices, and once again underscores the importance of creating an organizational culture that focuses on quality and safety," said AHA President and CEO Rich Umbdenstock. AHRQ Director Carolyn Clancy, M.D., said the guide "provides practical advice on introducing and sustaining work practices that have been shown to foster safe, high quality and efficient health care."


Robert Wood Johnson Foundation's (RWJF) Quality Report

The RWJF's Quality Report is a quarterly e-magazine from RWJF's Quality/Equality program area featuring the latest journal articles, research reports and other publications, as well as updates from the Aligning Forces for Quality initiative, the Foundation's core strategy in its longstanding commitment to improve the quality of health care that Americans receive.  Issues and links are archived below and updated when they are released. Read more....



Eliminate Harm Across the Board Posters

Thirty Massachusetts hospitals have been working together with other hospitals around the country in the Hospital Engagement Network (HEN) - an initiative led by the American Hospital Association's Partnership for Patients campaign through the Health Research and Educational Trust (HRET).

HEN assists hospitals with adopting new practices with the goal of reducing inpatient harm by 40% and readmissions by 20% by focusing on 10 targeted safety areas.

Now, HRET has harvested from hospitals across the country the Top 10 best practices in each of these 10 areas. 

Days Since Last ADE

Days Since Last CAUTI

Days Since Last CLABSI

Days Since Last Fall

Days Since Last OB Harm Event

Days Since Last Pressure Ulcer

Days Since Last Readmission 

Days Since Last SSI

Days Since Last VAE 

Days Since Last VTE

Staying Safe in the Hospital 



TeamSTEPPS Pocket Guide - Strategies & Tools to Enhance Performance & Patient Safety

TeamSTEPPS is comprised of four teachable-learnable skills: Leadership, Situation Monitoring, Mutual Support, and Communication; the core of the TeamSTEPPS framework. The red arrows depict a two-way dynamic interplay between the four skills and the team-related outcomes. Interaction between the outcomes and skills is the basis of a team striving to deliver safe, quality care. Encircling the four skills is the patient care team which not only represents the patient and direct caregivers, but those who play a supportive role within the healthcare delivery system..