Hicks CW, Rosen M, Hobson DB, et al. JAMA Surg. 2014;149:863-8.
Operating room briefings or time-outs are mandated by The Joint Commission as a strategy to prevent wrong-site surgery. This commentary explores the use of briefings both before and after surgery, evidence regarding their impact, and how a comprehensive unit-based safety program (CUSP) initiative designed and implemented a briefing and debriefing process.
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.
Shaw KN, Ruddy RM, Olsen CS, et al. Pediatrics. 2009;124:485-93.
This survey of staff in 21 pediatric emergency departments found wide variations in perception of safety culture. Most departments surveyed did not have dedicated safety committees and did not conduct other structured safety activities.
Kalina M, Tinkoff G, Gleason W, et al. Ped Emerg Care. 2009;25:444-446.
This study implemented a multidisciplinary team to manage trauma patients from admission to discharge and found that the team's implementation led to decreased prescribing and administration errors compared with the usual care group.
Moldenhauer K, Sabel A, Chu ES, et al. Jt Comm J Qual Patient Saf. 2009;35:164-74.
A national campaign to save lives in the hospital setting initially catalyzed implementation of rapid response systems. Although past research led to controversy over their widespread adoption, the ability to identify at-risk patients and prevent them from clinically deteriorating remains important. This study developed a clinical triggers program that focused on systematic use of existing housestaff teams to respond to patients in distress. Rather than a dedicated and resource-intensive rapid response team, this hospital required nurses to trigger a call to the primary team based on specific physiologic parameters, and then required responding housestaff to complete a form following direct communication with the bedside nurse. The guidelines also required timely discussion with an attending physician, which ultimately led to a decrease in non-ICU cardiopulmonary arrests and ICU bounceback rates. While their model may apply only to similar teaching institutions, it does provide a unique prototype for addressing failure to rescue initiatives that leverage existing resources rather than creating new ones.
The Keystone ICU project is a landmark achievement in patient safety. This project, funded by AHRQ, represented a collaboration between patient safety experts at Johns Hopkins University and the Michigan Hospital Association to improve patient safety in 99 intensive care units (ICUs). This article discusses implementation of the comprehensive unit-based safety program, which was the cornerstone of the project, and provides detailed information on the organizational change model used as well as the interventions that were implemented. The remarkable successes achieved by this project include near-elimination of catheter-related bloodstream infections and a significant improvement in the safety culture in participating ICUs. The project's principal investigator, Dr. Peter Pronovost, was interviewed by AHRQ WebM&M near the project's conclusion in 2005.
Mistry KP, Turi J, Hueckel RM, et al. Clin Pediatr Emerg Med. 2006;7.
The authors discuss the implementation of a rapid response team for pediatric patient care and introduce the concept of a team that proactively monitors patients at risk of clinical deterioration rather than waiting to assess the patient when they have been alerted to a problem.
Hillman K, Chen J, Cretikos M, et al. Lancet. 2005;365:2091-7.
This study examined the impact of medical emergency teams (METs), also known as rapid response teams (RRTs), on cardiac arrests, transfers to an intensive care unit (ICU), and deaths. The 23-hospital Australian study evaluated the availability of METs at designated hospitals and collected data prior to and during the six months following implementation. Findings suggested more calls for the emergency team but no difference in primary or secondary outcomes. However, the authors point out that even at hospitals with METs in place, inadequate utilization occurred for patients who met clinical criteria. They conclude that despite similar outcomes in both hospital groups, system-based interventions can support a focus on improved monitoring of patients and appropriate response by clinicians.
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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