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Christopher Fee, MD; February-March 2009
Interrupted during a telephone handoff, an ED physician, despite limited information, must treat a patient in respiratory arrest. The patient is stabilized and transferred to the ICU with a presumed diagnosis of aspiration pneumonia and septic shock. Later, ICU physicians obtain further history that leads to the correct diagnosis: pulmonary embolism.
Journal Article > Study
Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator-associated pneumonia?
Johnson V, Mangram A, Mitchell C, Lorenzo M, Howard D, Dunn E. Am Surg. 2009;75:1171-1174.
Journal Article > Review
Prompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?
Weiss CH, Wunderink RG. Curr Opin Crit Care. 2013;19:448-452
Journal Article > Study
The value of adding a verbal report to written handoffs on early readmission following prolonged respiratory failure.
Hess DR, Tokarczyk A, O’Malley M, Gavaghan S, Sullivan J, Schmidt U. Chest. 2010;138:1475-1479.
Teamwork and communication failures are a continued threat to patient safety. Intensive care units (ICU) have demonstrated the impact of different strategies to address these failures and improve patient outcomes. This study, targeting patients with prolonged respiratory failure, involved adding a verbal telephone report to an existing written one during transfer from the ICU. While the strengthened handoff process was associated with a trend toward reduced readmissions, its most impressive impact was on the total cost of care per patient, which fell significantly. Investigators estimated that nearly $185,000 was saved per 100 discharges, arguing that their intervention represents an improvement in the value of care (quality divided by cost) for this population. An accompanying editorial [see link below] discusses the implications of these findings and the broader role of poor communication in medical errors.
Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit.
Berenholtz SM, Pham JC, Thompson DA, et al. Infect Control Hosp Epidemiol. 2011;32:305-314.
The landmark Keystone ICU project, a statewide quality improvement initiative that used interventions grounded in safety culture and human factors engineering to improve safety in the intensive care unit, stands as one of the seminal achievements of the patient safety field. The success of the Keystone ICU project at reducing central line–associated bloodstream infections has been widely publicized, and this study reports a similar success in reducing rates of ventilator-associated pneumonia. As with the prior results, this article emphasizes that the success of the study was attributable to the multifaceted quality improvement approach used and the cultural change it engendered in participating ICUs.