Search results for "Hospitals"

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.

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.

To determine the impact of the Comprehensive Unit-Based Safety Program (CUSP) on patient safety, this study compared intensive care units participating in the program with units not participating. Although safety culture improved in units with CUSP implementation, the intervention did not reduce incidence of central line–associated bloodstream infections. These findings demonstrate that teamwork training approaches, while helpful, may not be sufficient to augment patient outcomes. Further study characterizing sites that improved versus those that did not may elucidate facilitators and barriers to achieving patient safety goals.

Patients in the intensive care unit (ICU) are particularly vulnerable to medical errors, and the inherently stressful nature of the work may adversely affect providers as well. A prior study found a high incidence of burnout in neonatal ICU staff and demonstrated that increased rates of burnout were associated with worsened perceived safety culture. This prospective observational study, conducted in 31 ICUs in France, sought to examine the relationship between burnout, depression, safety culture, and adverse events. The investigators found that more than 30% of staff met objective criteria for being burned out, and more than 15% met clinical criteria for depression, which was an independent risk factor for medical errors. Overall safety culture was only fair, and better perceived safety culture did not attenuate the relationship between depression and medical errors. This study adds support for the belief that enhancing resilience in clinicians is a cornerstone of safety efforts, as articulated by safety expert Dr. J. Bryan Sexton in a past AHRQ WebM&M interview.

Formal transition programs for patients being discharged from the intensive care unit (ICU) to general wards, which generally involved proactive surveillance by a nurse or physician, were associated with a decreased risk of readmission to the ICU.

Surgical specialists report frequently experiencing conflict with intensive care unit physicians and nurses regarding goals of care when patients experience poor postoperative outcomes.

This Saudi Arabian study describes a rapid response team implementation consisting of an intensive care physician, critical care nurse, and respiratory therapist. Over a 3-year period, the introduction of the team was associated with fewer cardiopulmonary arrests and improved hospital mortality.

This commentary discusses areas of risk in the intensive care unit along with interventions to mitigate them, including isolation precautions to lower infection rates and staffing intensivists to improve patient outcomes.

Exploring the impact of 24-hour intensivist coverage on patient safety, this piece advocates for research to understand how a nocturnal intensivist program can influence staffing needs and medical education.

A rapid response system led by a dedicated intensivist did not improve mortality for patients admitted to the ICU at a Canadian tertiary care hospital.

This commentary describes a formal assessment, consultation, and follow-up initiative led by a clinical nurse specialist to improve patient transfer from the intensive care unit (ICU) to medical wards.

Admitted to the trauma service following severe injuries, a man is transferred to the ICU for mechanical ventilation. After 6 weeks of hospitalization, the patient's initial shoulder injury progressed to involve significantly limited mobility and pain, prompting concern that physical therapy should have been initiated earlier.

This survey of Canadian intensive care units found that larger units and units directed by full-time intensivists had more positive safety culture scores.

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.

This news announcement highlights the 45 urban, children's, and rural hospitals recognized for highly efficient performance and continuous improvement in patient safety based on the 2009 Leapfrog Hospital Survey results.

Rapid response systems function within a variety of structures, but they ultimately remain a mechanism to manage a clinically deteriorating patient. This prospective study demonstrated that implementation of an intensivist physician and nurse–based team led to improvements in cardiac arrest rates and adjusted hospital mortality.

This article explains intensive care unit (ICU) staffing models in the context of current practice and evidence on how intensivist staffing affects patient outcomes.

This announcement highlights the 33 hospitals recognized for high performance and continuous improvement in patient safety based on the 2008 Leapfrog Hospital Survey results.

The Leapfrog Group is a consortium of private and public employers who collectively purchase health care for more than 30 million Americans. Leapfrog recommends four evidence-based practices for implementation by hospitals: computerized provider order entry, intensivist coverage of critically ill patients, evidence-based hospital referral for high-risk patients, and adoption of the National Quality Forum's safe practices. This study found that hospitals that reported implementing at least one patient safety practice also provided slightly better care for myocardial infarction and congestive heart failure (as measured by publicly reported quality data), but not for pneumonia. The authors note that as the Leapfrog recommended practices are not directly tied to improving care quality for these specific conditions, implementation of Leapfrog patient safety practices likely indicates an overall commitment to providing higher-quality care.

Clinicians constantly encounter the challenge of how to ensure that appropriate patient safety measures are reliably carried out, especially in complex environments such as the intensive care unit (ICU). Preventable complications have been successfully reduced through the use of checklists, analogous to those used in aviation. This study used a "quality rounds checklist," which was completed by the ICU fellow, to ensure that trauma ICU patients received important patient safety interventions (including some recommendations of the 100,000 Lives campaign). Use of the tool resulted in significant reductions in ventilator-associated pneumonia and central line–associated bloodstream infections. A prior study implemented a similar tool to ensure multidisciplinary communication in the ICU.