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Search results for "Hospitals"

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Journal Article > Study

Rapid response systems and collective (in)competence: an exploratory analysis of intraprofessional and interprofessional activation factors.

Kitto S, Marshall SD, McMillan SE, et al. J Interprof Care. 2015;29:340-346.

Clinical staff often fail to call rapid response teams to evaluate deteriorating patients, even when objective criteria for calling the team are met. This qualitative study of physicians and nurses at an Australian hospital found that an impaired culture of safety can result in failure to use the rapid response team when appropriate and can also lead to using the team as a workaround to compensate for poor interdisciplinary communication.

Meeting/Conference > Maryland Meeting/Conference

CUSP Implementation Workshop.

Armstrong Institute for Patient Safety and Quality. July 18, 2017; Constellation Energy Building Conference Center, Baltimore, MD.

The comprehensive unit-based safety program (CUSP) approach emphasizes improving safety culture through a continuous process of reporting and learning from errors, improving teamwork, and engaging staff at all levels in safety efforts. This conference will cover how to utilize CUSP, including understanding and addressing challenges to implementation.

Journal Article > Study

Organizational perspectives of nurse executives in 15 hospitals on the impact and effectiveness of rapid response teams.

Smith PL, McSweeney J. Jt Comm J Qual Patient Saf. 2017;43:289–298.

According to this survey of nursing leaders, they perceived that rapid response teams improve patient outcomes and safety culture. Evaluations of rapid response were usually informal and often did not capture standardized data. The authors advocate for future research to examine what different types of hospitals perceive as valuable in rapid response teams.

Journal Article > Review

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review.

Lambert V, Matthews A, MacDonell R, Fitzsimons J. BMJ Open. 2017;7:e014497.

This systematic review found that rapid response systems or teams are widely used, but comprehensive evaluation of these systems is lacking. The authors call for a sociotechnical evaluation of this complex intervention in order to truly characterize its impact on safety.

Journal Article > Review

Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review.

Albutt AK, O'Hara JK, Conner MT, Fletcher SJ, Lawton RJ. Health Expect. 2016 Oct 26; [Epub ahead of print].

This systematic review examined whether patient and family member activation of rapid response teams improved recognition of clinical deterioration. Studies demonstrated that patients and family members did not overwhelm rapid response capacity with frequent activations, but they did activate rapid response to convey concerns beyond clinical deterioration. The authors suggest further study is needed to determine how to best engage patients and families to detect clinical deterioration early.

Journal Article > Commentary

Improving safety for hospitalized patients: much progress but many challenges remain.

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Kronick R, Arnold S, Brady J. JAMA. 2016;316:489-490.

Patient safety challenges and successes have emerged since the publication of To Err Is Human. This commentary discusses examples of progress such as the wide-scale use of the Comprehensive Unit-based Safety Program and the decrease of hospital-acquired conditions. The authors suggest that future efforts focus on improving measures of adverse events and diagnostic error research.

Journal Article > Review

The impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital: a systematic review.

Gill FJ, Leslie GD, Marshall AP. Worldviews Evid Based Nurs. 2016;13:303-313.

Rapid response teams (RRTs) are a widely implemented safety intervention with a growing body of literature supporting their effectiveness. At some hospitals, families can activate the RRT if they are concerned. This systematic review identified successful implementation strategies for family-activated RRTs, but researchers found no clear evidence that this approach improves patient outcomes.

Journal Article > Study

A program to prevent catheter-associated urinary tract infection in acute care.

  • Classic

Saint S, Greene MT, Krein SL, et al. N Engl J Med. 2016;374:2111-2119.

The landmark Keystone ICU study, which achieved remarkable sustained reductions in central line–associated bloodstream infections in intensive care unit (ICU) patients, stands as one of the most prominent successes of the patient safety field. Although the use of a checklist gathered the most publicity, the study's key insight was that preventing health care–associated infections (HAIs) required extensive attention to improving safety culture by addressing the socioadaptive factors within hospitals that contributed to HAIs. In this new AHRQ funded national study, the Comprehensive Unit-based Safety Program was implemented at 603 hospitals in 32 states, with the goal of preventing catheter-associated urinary tract infections in ICU and ward patients. The effort involved socioadaptive interventions (various approaches shown to improve safety culture) and technical interventions (targeted training to reduce usage of indwelling urinary catheters and providing regular data feedback to participating units). Catheter usage and infection rates significantly decreased in ward patients, although no change was found in ICU patients. This study thus represents one of the few safety interventions that has achieved a sustainable improvement in a clinical outcome. An earlier article described the implementation of the program, which involved collaboration between state and national agencies and academic centers. In a 2008 PSNet interview, the study's lead author discussed his work on preventing HAIs.

Innovations to improve patient safety.

Agency for Healthcare Research and Quality. Health Care Innovations Exchange. May 18, 2016.

This issue highlights innovations that can be applied in a variety of health care environments to prevent hospital-acquired conditions. The resources include the Chartbook on Patient Safety and checklist, decision support, and screening programs.

Journal Article > Review

How to avoid catastrophic events on the ward.

Bein B, Seewald S, Gräsner JT. Best Pract Res Clin Anaesthesiol. 2016;30:237-245.

Hospitals require robust escalation of care processes to ensure that worsening conditions in critical patients are recognized and treated. This review discusses several strategies including rapid response teams and early warning systems to help prevent these situations from resulting in failure to rescue and preventable patient harm.

Journal Article

Rapid response teams improve outcomes—Part 1, Part 2, and Part 3.

Intensive Care Med. 2016;42:591-601.

This three-part commentary presents differing views on whether rapid response teams (RRTs) improve patient outcomes and recommends that further research is required to determine ideal RRT staffing, factors that contribute to the need for an RRT, and how rapid response affects the safety of hospitalized patients.

Journal Article > Commentary

The Sepsis Early Recognition and Response Initiative (SERRI).

Jones SL, Ashton CM, Kiehne L, et al. Jt Comm J Qual Patient Saf. 2016;42:122-138.

Early recognition of sepsis is a patient safety issue, due to the time-sensitive nature of delivering evidence-based treatments. This article describes a Centers for Medicare and Medicaid Services–funded initiative to improve sepsis management in 15 facilities in Texas. Components included convening a leadership committee for performance improvement, educating bedside nurses and other staff, developing a screening tool in the electronic health record (EHR), standardizing a second responder protocol (like a rapid response team) for possible sepsis, and conducting audit and feedback for participating institutions. The authors noted challenges given that participating institutions used different EHRs, but they were able to implement EHR-based screening across all systems. Positive screens were evaluated by a second responder, but it is difficult to estimate the amount of second responder time needed for this intervention. Planned outcome measures, which are not yet available, include mortality, length of stay, and costs. A recent WebM&M commentary describes common errors in the early management of sepsis.

Journal Article > Commentary

Direct oral anticoagulants: new drugs with practical problems. How can nurses help prevent patient harm?

Barras MA, Hughes D, Ullner M. Nurs Health Sci. 2016;18:408-411.

Anticoagulants are high-alert medications that require regular monitoring and adjustments to ensure prescriptions are safe for patients. This commentary discusses how multidisciplinary team management for patients using oral anticoagulants can help reduce risk of adverse events.

Journal Article > Study

Engaging frontline staff in performance improvement: the American Organization of Nurse Executives implementation of Transforming Care at the Bedside collaborative.

Needleman J, Pearson ML, Upenieks VV, Yee T, Wolstein J, Parkerton M. Jt Comm J Qual Patient Saf. 2016;42:61-74.

This evaluation of the Transforming Care at the Bedside initiative—a collaborative intended to drive engagement of bedside nurses in enhancing safety through unit-based quality improvement projects—found highly positive perceptions of the program and evidence of widespread implementation of new innovations.

Journal Article > Study

Reductions in sepsis mortality and costs after design and implementation of a nurse-based early recognition and response program.

Jones SL, Ashton CM, Kiehne L, et al. Jt Comm J Qual Patient Saf. 2015;41:483-491.

A protocolized early warning system to improve sepsis recognition and management was associated with a decrease in sepsis-related inpatient mortality. The protocol emphasized early recognition by nurses and escalation of care by a nurse practitioner when indicated. An AHRQ WebM&M commentary describes common errors in the early management of sepsis.

Journal Article > Study

Implementing an obstetric emergency team response system: overcoming barriers and sustaining response dose.

Richardson MG, Domaradzki KA, McWeeney DT. Jt Comm J Qual Patient Saf. 2015;41:514-521.

This study describes the introduction of a rapid response system (RRS) on a high-risk obstetric unit at a large academic medical center. The number of RRS activations over the first 3 years has steadily increased, which the researchers consider a marker of successful RRS integration.

Journal Article > Study

Delayed rapid response team activation is associated with increased hospital mortality, morbidity, and length of stay in a tertiary care institution.

Barwise A, Thongprayoon C, Gajic O, Jensen J, Herasevich V, Pickering BW. Crit Care Med. 2016;44:54-63.

Despite widespread implementation of rapid response systems, they remain controversial. This study showed that delayed activation of rapid response was associated with worse morbidity and higher mortality compared to timely rapid response implementation. This work adds to recent data suggesting that rapid response improves patient safety.

Journal Article > Review

Wound-care teams for preventing and treating pressure ulcers.

Moore ZEH, Webster J, Samuriwo R. Cochrane Database Syst Rev. 2015;9:CD011011.

Pressure ulcers are considered a never event for hospitals. In this systematic review, researchers sought to examine the impact of wound care teams in preventing and treating pressure ulcers in any health care setting, but failed to find a single randomized controlled trial that met their predefined inclusion criteria. Although wound care teams are increasingly prevalent, this study found there is a lack of robust evidence to support their effect.

Journal Article > Review

Consumer participation in early detection of the deteriorating patient and call activation to rapid response systems: a literature review.

Vorwerk J, King L. J Clin Nurs. 2016;25:38-52.

Engaging patients and their families to call rapid response teams (RRTs) has been promoted as a patient safety strategy. This literature review found that consumer education programs for RRT activation led to more RRT calls by both consumers and clinicians and decreased rates of patient mortality.

Journal Article > Study

Outcomes associated with the nationwide introduction of rapid response systems in the Netherlands.

Ludikhuize J, Brunsveld-Reinders AH, Dijkgraaf MG, et al; Cost and Outcomes of Medical Emergency Teams Study Group. 2015;43:2544-2551.

Rapid response teams have been championed as a strategy to improve hospital outcomes. However, evidence regarding their effectiveness is mixed, and rapid response teams remain controversial. In this pre-post study across multiple hospitals, the combined incidence of in-hospital death, cardiopulmonary arrest, and unplanned intensive care unit admission decreased following the introduction of rapid response teams compared to the pre-implementation time period. Although this study design does not offer definitive evidence that rapid response was the cause of the declining event rate, it does add support for the call in the National Patient Safety Goal to implement rapid response more widely. Barriers to rapid response team implementation include personnel costs as well as existing culture which may lead to reluctance to activate a rapid response.

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