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Search results for "United States of America"

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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 > 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 > Study

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

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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 > 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 > 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 > Study

Rapidly increasing rapid response team activation rates.

Braaten JS, deGunst G, Bilys K. Jt Comm J Qual Patient Saf. 2015;41:421-427.

This report of a quality improvement project to increase use of the rapid response team resulted in more frequent rapid response activation and a nonsignificant decrease in the number of code blue events occurring outside the intensive care unit. This intervention demonstrated staff behavior change, but its effect on patient outcomes remains unclear, adding to the mixed evidence about rapid response systems.

Journal Article > Review

Rapid response systems.

Howell MD, Stevens JP. UpToDate. June 29, 2016.

Although rapid response programs have been advocated as promising patient safety strategies, the evidence regarding their benefits is mixed. This review provides an overview of rapid response systems, including key components and goals of the intervention. Further research is needed to provide justification on their use for adult patients.

Journal Article > Study

Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital.

Mathukia C, Fan W, Vadyak K, Biege C, Krishnamurthy M. J Community Hosp Intern Med Perspect. 2015;5:26716.

The introduction of a modified early warning system at a community academic medical center was associated with more rapid response team activations (from 0.24 to 0.48 per 100 patient-days), but fewer code blues and a decline in overall inpatient mortality (from 2.3% in 2011 to 1.5% in 2013).

Journal Article > Study

Deployment of rapid response teams by 31 hospitals in a statewide collaborative.

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Stolldorf DP, Jones CB. Jt Comm J Qual Patient Saf. 2015;41:186-192.

Rapid response teams (RRTs) have been strongly endorsed by organizations including the Institute for Healthcare Improvement, largely based on early results that showed impressive benefits (although later studies were less positive). This study describes RRT programs in hospitals participating in a statewide collaborative that was established to help implement, evaluate, and sustain RRTs at acute care hospitals. Of the 56 hospitals in the collaborative, 31 hospitals responded to the survey, yielding a response rate of 55%. The authors describe the different organizational characteristics and RRT structures at these hospitals. Most of the teams included a critical care nurse and respiratory therapist. About 30% had a hospitalist and 23% reported the presence of a dedicated RRT nurse. Some best practices for safety, process improvement, and oversight were lacking in many of the programs. A prior AHRQ WebM&M perspective explored early lessons from RRTs.

Journal Article > Study

Hospital system barriers to rapid response team activation: a cognitive work analysis.

Braaten JS. Am J Nurs. 2015;115:22-32.

Using case stories and direct quotes from frontline nurses, this study explores the barriers to appropriately activating rapid response teams. For example, the nurses in this study suggested that calling a rapid response is felt to only be justifiable in extreme situations rather than beforehand, which severely limits the potential effectiveness of this intervention.

Journal Article > Study

Developing and evaluating the success of a family activated medical emergency team: a quality improvement report.

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Brady PW, Zix J, Brilli R, et al. BMJ Qual Saf. 2015;24:203-211.

Allowing families to activate medical emergency teams (METs) may aid in the early detection of clinical deterioration. However, physicians have expressed concerns that families do not understand when an MET is necessary and that this responsibility could present an undue stress on family members. This study reports on the experience of family-activated MET calls over a 6-year period at an academic children's hospital. There were 83 family-activated MET calls, representing less than 3% of all MET responses at this hospital. Families most frequently requested METs for concerns regarding clinical deterioration, but less than one-quarter of these calls resulted in patients being transferred to an intensive care unit, compared to 60% of clinician-activated METs. Since families called METs only between one to two times per month, the program was not felt to pose a substantial burden. The authors also point out that some family-activated METs identified other clinically relevant information that may not have otherwise been shared with the primary clinical team, as well as important communication issues that could have led to adverse events.

Journal Article > Study

Rapid response team implementation and in-hospital mortality.

Salvatierra G, Bindler RC, Corbett C, Roll J, Daratha KB. Crit Care Med. 2014;42:2001-2006.

This before-and-after analysis revealed a decline in inpatient mortality following implementation of rapid response teams, but due to the overall trend of decreasing hospital mortality the authors could not definitively attribute this result to the rapid response team. This work demonstrates the ongoing challenge of assessing the effect of rapid response systems, which remain controversial.

Journal Article > Study

Cost-benefit analysis of a medical emergency team in a children's hospital.

Bonafide CP, Localio AR, Song L, et al. Pediatrics. 2014;134:235-241.

Medical emergency teams (METs) have been widely implemented in hospitals, with some evidence suggesting that they may be effective at reducing serious clinical deteriorations. This study aimed to create a financial model to determine the potential benefits and costs of operating an MET at a children's hospital. Relying on various derived calculations, the authors estimate that the care of patients who experience a critical deterioration during hospitalization costs nearly $100,000 more following the event compared with other patients who transfer to an intensive care unit. The annual costs of operating an MET range widely, anywhere from $287,000 to $2.3 million, depending on who is staffed and whether the team has concurrent responsibilities or is freestanding. Under a bundled payment system—where a health system is paid a fixed reimbursement for a hospitalization—most MET team configurations would prove cost-effective if they successfully avoid a modest number of critical deteriorations each year. A prior AHRQ WebM&M perspective discusses early lessons of medical emergency teams.

Journal Article > Commentary

Improving safety and quality of care with enhanced teamwork through operating room briefings.

Hicks CW, Rosen M, Hobson DB, Ko C, Wick EC. JAMA Surg. 2014;149:863-868.

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.

Journal Article > Study

A retrospective review of crisis events in diagnostic radiology: an analysis of frequency, demographics, etiologies, and outcomes.

Tindel MS, Darby JM, Simmons RL. J Patient Saf. 2014;10:111-116.

This study reviewed medical emergency response team activations in a radiology department. Radiology accidents accounted for 10% of events. The majority of clinical deteriorations occurred within 48 hours of admission, often while the patient was undergoing imaging to help diagnose an unknown underlying illness.

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