Search results for "United States of America"

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.

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

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.

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.

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.

This study describes the relationship between the configuration of health systems and their adoption of safety initiatives such as computerized physician order entry (CPOE) and intensive care unit staffing.

The authors report the results of implementing two strategies to eliminate preventable deaths: tight glycemic control and deployment of rapid response teams.

This supplement covers issues related to safety indicators, fatigue, electronic medical records, infection, and disclosure of medical errors in the care of critically ill children.

The authors surveyed intensive care unit (ICU) directors on the adoption of the Leapfrog Group's ICU staffing requirement and discuss reasons for the lack of implementation.

The authors summarize several initiatives being implemented in intensive care units to help ensure patient safety.

This article discusses why adding intensivists to the health care team, a top safety initiative adopted by The Leapfrog Group nearly 5 years ago, can improve outcomes for patients in the intensive care unit.

This study assessed a representative group of hospitals to evaluate their perception and priority of each of the National Quality Forum's (NQF) 30 "safe practices." Investigators analyzed responses from 100 hospitals and determined higher ratings for priority than for progress of the practices overall. They noted the largest discrepancy between priority and progress in creating a safety culture with the highest progress rating for increasing safe medication use. Based on evaluating individual hospital characteristics, the authors also identified 20 safe practices not associated with measures of hospital structure, capacity, or resources. These particular findings may guide other organizations trying to develop strategic safety plans with respect to NQF safety recommendations.

This website offers resources related to the Leapfrog Hospital Survey investigating hospitals' progress in implementing specific patient safety practices. Updates to the survey include increased time allotted to complete computerized provider order entry evaluation, staffing of critical care physicians on intensive care units, and use of tools to measure safety culture. Reports discussing the results are segmented into specific areas of focus such as health care–associated infections and medication errors.