Romig M, Goeschel C, Pronovost P, et al. Hosp Pract (1995). 2010;38:114-21.
This commentary discusses the Comprehensive Unit-Based Safety (CUSP) and Translating Evidence Into Practice (TRIP) models and how they prevent error through culture of safety and teamwork improvements.
Kim MM, Barnato AE, Angus DC, et al. Arch Intern Med. 2010;170:369-76.
Efforts to improve the care of complex patients in intensive care units (ICUs) focus on many factors, including unit-based initiatives. This retrospective study evaluated the relationship between daily multidisciplinary rounds and 30-day mortality. Investigators discovered that the presence of daily rounds was associated with lower mortality among medical ICU patients. In addition, the survival benefits observed with intensivist staffing were in part explained by the presence of multidisciplinary care models. A related commentary [see link below] discusses this study's findings and the concept of health engineering as a systems science to study how we optimize staffing and patient outcomes in the ICU.
After several pediatric visits, parents of a newborn with low output and weight loss contact a lactation consultant, who discovered that ankyloglossia (tongue-tie) was preventing the infant from receiving adequate intake from breastfeeding.
DeVita MA, Bellomo R, Hillman KM, et al. Crit Care Med. 2006;34.
This article defines the key components of a "rapid response system" (RRS), which the authors propose as a unifying term for medical emergency teams, rapid response teams, and other similar teams designed to intervene on clinically unstable inpatients. An RRS should consist of an "afferent limb," the mechanism by which team responses are triggered; an "efferent limb," the team of clinicians that responds to an event; an administrative arm responsible for team staffing, education, and implementation; and a quality improvement arm to assess effectiveness of the RRS and identify underlying quality of care issues. RRS effectiveness should be monitored by measuring mortality, cardiac arrests, and unplanned intensive care unit admissions. The authors did not endorse a specific model for the efferent limb, stating that physician-led or nurse-led models may both be appropriate depending on local circumstances. No consensus was reached on whether all hospitals should be mandated to institute an RRS.
Baker DP, Salas E, King HB, et al. Jt Comm J Qual Patient Saf. 2016;31:185-202.
The authors present the knowledge, skills, and attitudes that physicians need in order to be effective team participants. They suggest that professional organizations develop benchmarks to assess physician competence in these areas.
Simpson KR, Knox GE, Martin M, et al. Jt Comm J Qual Saf. 2016;37:544-551;AP3.
Building on the success of the Keystone ICU project model, this study also implemented a comprehensive unit-based safety program (CUSP) to improve safety culture and perinatal care processes in 15 Michigan hospitals.
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