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Search results for "General Hospitals"

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Newspaper/Magazine Article

The best medical care in the U.S.

Arnst C. Business Week. July 17, 2006.

This article discusses improvements made at U.S. Veterans Affairs' hospitals as well as unique elements of the system that support safe and high-quality care.

Journal Article > Study

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records.

Walker AS, Mason A, Quan TP, et al. Lancet. 2017 May 9; [Epub ahead of print].

The weekend effect (higher mortality for patients in acute care settings on weekends compared to weekdays) has led to widespread concerns about hospital staffing. This retrospective study examined whether mortality for emergency admissions at four hospitals in the United Kingdom differed on weekends compared to weekdays. Unlike prior studies of the weekend effect, this study included multiple specific markers of patients' illness severity as well as hospital workload. Investigators found higher mortality associated with being admitted to the hospital during weekends compared to weekdays, but a significant proportion of the observed weekend effect was explained by severity of patient illness. They used three measures to approximate hospital workload: total number of admissions, net admissions (subtracting discharges from admissions), and percentage of beds occupied. None of these workload measures was associated with mortality. The authors conclude that differences in illness severity rather than health care team staffing explain the weekend effect. A recent PSNet interview discussed the weekend effect in health care.

Journal Article > Study

Association between elements of electronic health record systems and the weekend effect in urgent general surgery.

Kothari AN, Brownlee SA, Blackwell RH, et al. JAMA Surg. 2017;152:602-603.

This statewide, retrospective cross-sectional study identified longer than expected length of stay for urgent surgical procedures on the weekend compared to weekdays. Hospitals with electronic operating room scheduling and electronic bed management systems were less likely to demonstrate the weekend effect. These results suggest that health information technology can be employed to mitigate the weekend effect.

Journal Article > Review

Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis.

Prgomet M, Li L, Niazkhani Z, Georgiou A, Westbrook JI. J Am Med Inform Assoc. 2017;24:413-422.

While prior research has shown that computerized provider order entry and clinical decision support systems have the potential to improve patient safety, less is known about the impact of such systems in intensive care units. In this systematic review and meta-analysis, investigators found an 85% decrease in prescribing errors and a 12% reduction in ICU mortality rates in critical care units that converted from paper orders to commercially available computerized provider order entry systems.

Journal Article > Study

Medication safety in two intensive care units of a community teaching hospital after electronic health record implementation: sociotechnical and human factors engineering considerations.

Carayon P, Wetterneck TB, Cartmill R, et al. J Patient Saf. 2017 Feb 28; [Epub ahead of print].

This human factors study examined how electronic health record (EHR) implementation affected medication safety. Researchers encountered improvements in transcription, dispensing, and administration errors after EHR introduction. Several types of medication prescribing errors, including choosing the wrong drug, duplicate orders, or orders with incorrect information, increased with EHR use. This study adds to the evidence suggesting EHR implementation has mixed effects on medication safety.

Journal Article > Study

Evaluation of medication-related clinical decision support alert overrides in the intensive care unit.

Wong A, Amato MG, Seger DL, et al. J Crit Care. 2017;39:156-161.

This retrospective study reviewed more than 47,000 overridden medication alerts and found that the vast majority of overrides were clinically appropriate and did not cause harm. From this sample, 7 adverse drug events were identified, and these events were more likely when the alerts were overridden in error. This study demonstrates the challenge of identifying clinically important alerts in a setting where alert fatigue is common.

Journal Article > Study

EHR-related medication errors in two ICUs.

Carayon P, Du S, Brown R, Cartmill R, Johnson M, Wetterneck TB. J Healthc Risk Manag. 2017;36:6-15.

Despite the demonstrated success of technology in reducing medication errors, preventable adverse drug events remain a significant source of harm to patients. Researchers analyzed data on medication safety events in 2 ICUs at a medical center and found 1622 preventable adverse drug events among 624 patients. About one third of these events were related to electronic health record use, including duplicate orders.

Journal Article > Commentary

Medication safety in the neonatal intensive care unit: big measures for our smallest patients.

Rostas SE. J Perinat Neonatal Nurs. 2017;31:15-19.

Medication errors are common in the neonatal intensive care unit. This commentary outlines various strategies one teaching hospital has utilized to reduce risks of medication errors in this care setting, such as use of computerized provider order entry and smart pumps.

Journal Article > Review

Medication safety in the operating room: literature and expert-based recommendations.

Wahr JA, Abernathy JH III, Lazarra EH, et al. Br J Anaesth. 2017;118:32-43.

This Delphi study examined 138 recommendations, generated from a review of 74 studies, regarding medication safety in the operating room. Using a consensus process, investigators determined 35 practices that can be implemented in the operative setting, including medication reconciliation and barcoding.

Journal Article > Study

Microanalysis of video from the operating room: an underused approach to patient safety research.

Bezemer J, Cope A, Korkiakangas T, et al. BMJ Qual Saf. 2017;26:583-587.

Increased use of video technology in the health care setting may represent an opportunity to improve patient safety. The authors introduce a framework for using video data in patient safety research, present insights from numerous studies, and outline opportunities for further study.

Journal Article > Study

Computer-assisted process modeling to enhance intraoperative safety in cardiac surgery.

Tarola CL, Quin JA, Haime ME, et al. JAMA Surg. 2016;151:1183-1186.

Communication breakdowns in the operating room are associated with preventable adverse events. This study examined the potential of a novel workflow management system—a computerized system which used voice recognition and built-in algorithms to ensure important procedural steps were undertaken appropriately—to improve patient safety. The system was able to detect when intraoperative tasks were being performed and successfully identified omitted steps as well.

Cases & Commentaries

Lapse in Antibiotics Leads to Sepsis

  • Web M&M

Mitchell Levy, MD; October 2016

Administered antibiotics in the emergency department and rushed to the operating room for emergent cesarean delivery, a pregnant woman was found to have an infection of the amniotic sac. After delivery, she was transferred to the hospital floor without a continuation order for antibiotics. Within 24 hours, the inpatient team realized she had developed septic shock.

Journal Article > Study

Accuracy of laboratory data communication on ICU daily rounds using an electronic health record.

Artis KA, Dyer E, Mohan V, Gold JA. Crit Care Med. 2017;45:179-186.

Information provided at bedside rounds is critical for clinical decision-making in inpatient settings. This direct observation study found that laboratory data reported at rounds is prone to error, most often omissions. The authors suggest that inaccurately communicated laboratory data is a prevalent and underrecognized patient safety concern.

Journal Article > Commentary

Patient safety in the emergency department.

Farmer BM. Emerg Med. 2016;48:396-404.

Emergency departments are high-risk environments due to the urgency of care needs and complexity of communication. This commentary explores challenges associated with medication administration, handoffs, discharge processes, and electronic health records in emergency medicine and recommends strategies to reduce risks.

Journal Article > Study

The role of radio frequency detection system embedded surgical sponges in preventing retained surgical sponges: a prospective evaluation in patients undergoing emergency surgery.

Inaba K, Okoye O, Aksoy H, et al. Ann Surg. 2016;264:599-604.

Retained surgical items are considered a preventable patient safety problem. In this implementation study, investigators used sponges embedded with radio frequency detection (RFD) in emergency surgeries. The RFD system identified sponges that would not have been detected, either because the sponge and instrument count was incorrect or because the count was not performed. These results argue for expanding the use of RFD sponges for emergency surgery.

Cases & Commentaries

Getting the (Right) Doctor, Right Away

  • Web M&M

Kiran Gupta, MD, MPH, and Raman Khanna, MD; July/August 2016

A woman with a history of chronic obstructive pulmonary disease underwent hip surgery and experienced shortness of breath postoperatively. A chest radiograph showed a pneumothorax, but the radiologist was unable to locate the first call physician to page about this critical finding.

Journal Article > Commentary

Health information technologies: from hazardous to the dark side.

Saunders C, Rutkowski AF, Pluyter J, Spanjers R. J Assoc Inf Sci Technol. 2016;67:1767-1772.

It is important to consider unintended consequences when implementing tools, such has health information technology (IT). This commentary highlights five areas of focus to reduce risks associated with introducing health IT in surgery and recommends systematic training and detailed credentialing to ensure safe use of new technologies.

Journal Article > Study

Frequency of passive EHR alerts in the ICU: another form of alert fatigue?

Kizzier-Carnahan V, Artis KA, Mohan V, Gold JA. J Patient Saf. 2016 Jun 22; [Epub ahead of print].

This study found that laboratory values designated as "abnormal" or "panic" in the electronic health record, which are considered passive alerts, are very common for patients in the intensive care unit. The authors suggest that these passive alerts contribute to the pervasive problem of alert fatigue in the intensive care unit.

Cases & Commentaries

The Case of Mistaken Intubation

  • Spotlight Case
  • CME/CEU
  • Web M&M

Maria J. Silveira, MD, MA, MPH; June 2016

An older man with multiple medical conditions was found hypoxic, hypotensive, and tachycardic. He was taken to the hospital. Providers there were unable to determine the patient's wishes for life-sustaining care, and, unaware that he had previously completed a DNR/DNI order, they placed him on a mechanical ventilator.

Journal Article > Study

Incidence of speech recognition errors in the emergency department.

Goss FR, Zhou L, Weiner SG. Int J Med Inform. 2016;93:70-73.

The adoption of new technology in health care often produces unintended consequences, which can be mitigated by applying human factors engineering principles to user interface design. Due to efficiency gains, the use of speech recognition technology among physicians has grown in recent years. Investigators analyzed notes dictated by emergency medicine physicians and found that 71% of the notes contained errors. Given that 15% of the errors were considered critical, the authors suggest speech recognition technology may create miscommunication that could adversely affect patient care.

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