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Clinical Quality Improvement, Consultation, and Technical Assistance

The Program in Clinical Quality Improvement, Consultation, and Technical Assistance provides technical and consultation assistance within the MU Health Care system (MUHC) in order to improve clinical quality and patient satisfaction by implementing evidence-based health care throughout MU Health Care. CHCQ has completed and is currently involved in multiple major consultation and technical assistance activities ranging from serving on standing committees and workgroups, conducting special studies, and providing specific logistical efforts in support of UMHC's mission to provide high quality and safe patient care. This program is directed by .

Education Innovation and Improvement

The Program in Education Innovation and Improvement, led by Linda Headrick, MD, MS and Les Hall, MD, develops, tests, and disseminates innovations in education to prepare learners, faculty, and staff to deliver high quality care and work continuously to improve it. This includes core learning experiences in the improvement of health care and advanced experiences in improvement and research. The Center for Health Care Quality is dedicated to leadership training and team building for MUHC. The Program emphasizes learning experiences that develop skills for interprofessional collaboration, since this is an essential element in the delivery of care.

Education Initiatives

Institute for Healthcare Leadership (IHL)
Achieving Competence Today (ACT)
Interprofessional Curriculum (IPC)
Clarion Team Sponsorship
Performance Improvement Leadership Development Program (PI-LDP)
Facilitator Training (PI-LDP2)


The Program in Improvement Sciences and Health Services Research increases the University of Missouri's faculty and staff research productivity and scholarly contributions to patient care quality, safety, and value improvement literature. CHCQ's efforts to enhance improvement and health services research have included provision of developmental and pilot support for grant and manuscript development, organizing study interest groups, identification and dissemination of potential grant funding opportunities related to improvement and health services research, pre-submission grant reviews and editorial assistance, and direct grant development and submission.

Admission Redesign

Admissions Journal Cover

For more information about this project, contact Eric Franks at .

"Verbal Order Policies, Occurrence, and Perceptions"
Grant Sponsored by the Agency for Healthcare Research and Quality
July 1, 2009 through March 30, 2011
Douglas Wakefield, PhD, PI
Bonnie Wakefield, PhD, Co-I
William Steinman, M.D., Co-I
Wade Davis, PhD, Co-I
Julie Brandt, PhD, Co-I


Face-to-face verbal and telephone orders (VOs) are commonly used in inpatient care settings. VOs hold substantial potential for miscommunication due to a variety of factors, including fatigue, workload, sound-alike medications, background noise, accents, dialects and different pronunciations. VO prescribers and receivers may also misspeak, miscommunicate, or not understand patient-specific information being exchanged (e.g., indicating the possible need for an order). These inherent dangers have been recognized by The Joint Commission (TJC), the National Quality Forum (NQF) and others. While VOs are commonly used, there has been little systematic study of the strategies and tactics used to ensure their appropriate use, or how to ensure that they are accurately communicated, correctly understood, initially documented and subsequently transcribed into the medical record, or ultimately carried out as intended.

The research proposed in this study was designed to make a significant contribution to understanding VOs by addressing several gaps in the existing literature.

Purpose: To evaluate systematically the use of verbal and telephone orders (VOs) through focused surveys of community hospitals and academic medical centers.

Scope: 1) Develop descriptive profiles and a typology of acute care hospitals' inpatient VO policies, strategies, tactics, and specific organizational structures and processes used to govern their use of and to minimize potential errors and adverse events; 2) develop estimates of inpatient VO frequency and occurrence; and 3) gain insight into the perceived advantages / disadvantages associated with the use of VOs, and the extent to which VO policies are followed and effective in preventing miscommunications and misunderstandings leading to patient care errors.

Methods: A mixed methods approach using document reviews and surveys were used to analyze VO policies in samples of acute care community hospitals in Iowa and Missouri, and a national sample of academic health centers. Final study sample include 13 Critical Access/Rural, 7 Rural Referral, 9 Urban, and 11 Academic Medical Centers. Analysis of hospital VO policies was limited to policies related to those authorized to give VOs, and Nursing and Pharmacy related VO policies.

Results: Analysis of the VO policy documents revealed a range of different types of health professionals authorized to give VOs, and a much wider range of health professionals authorized to receive a VO. Nearly all VO policies indicated requirements for documenting who gave, who received, and time and date of VO. While almost 100% of the policies identified specific time frames in which the VO must be counter-signed, many hospitals had different time frames listed in their VO-related policy documents. Few VO policies excluded specific types of VOs such as for chemotherapy. The surveys found that almost none of the study hospitals reported conducting any systematic monitoring of VOs, with the exception of tracking VOs that had not been counter signed within the approved time frame.

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