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Mess EV, Kramer F, Krumme J, Kanelakis N, Teynor A. Use of Creative Frameworks in Health Care to Solve Data and Information Problems: Scoping Review. JMIR Hum Factors 2024; 11:e55182. [PMID: 39269739 DOI: 10.2196/55182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/26/2024] [Accepted: 06/27/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Digitization is vital for data management, especially in health care. However, problems still hinder health care stakeholders in their daily work while collecting, processing, and providing health data or information. Data are missing, incorrect, cannot be collected, or information is inadequately presented. These problems can be seen as data or information problems. A proven way to elicit requirements for (software) systems is by using creative frameworks (eg, user-centered design, design thinking, lean UX [user experience], or service design) or creative methods (eg, mind mapping, storyboarding, 6 thinking hats, or interaction room). However, to what extent they are used to solve data or information-related problems in health care is unclear. OBJECTIVE The primary objective of this scoping review is to investigate the use of creative frameworks in addressing data and information problems in health care. METHODS Following JBI guidelines and the PRISMA-ScR framework, this paper analyzes selected papers, answering whether creative frameworks addressed health care data or information problems. Focusing on data problems (elicitation or collection, processing) and information problems (provision or visualization), the review examined German and English papers published between 2018 and 2022 using keywords related to "data," "design," and "user-centered." The database SCOPUS was used. RESULTS Of the 898 query results, only 23 papers described a data or information problem and a creative method to solve it. These were included in the follow-up analysis and divided into different problem categories: data collection (n=7), data processing (n=1), information visualization (n=11), and mixed problems meaning data and information problem present (n=4). The analysis showed that most identified problems fall into the information visualization category. This could indicate that creative frameworks are particularly suitable for solving information or visualization problems and less for other, more abstract areas such as data problems. The results also showed that most researchers applied a creative framework after they knew what specific (data or information) problem they had (n=21). Only a minority chose a creative framework to identify a problem and realize it was a data or information problem (n=2). In response to these findings, the paper discusses the need for a new approach that addresses health care data and information challenges by promoting collaboration, iterative feedback, and user-centered development. CONCLUSIONS Although the potential of creative frameworks is undisputed, applying these in solving data and information problems is a minority. To harness this potential, a suitable method needs to be developed to support health care system stakeholders. This method could be the User-Centered Data Approach.
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Affiliation(s)
- Elisabeth Veronica Mess
- Institute for Agile Software Development, Technical University of Applied Sciences Augsburg, Augsburg, Germany
| | - Frank Kramer
- Chair of IT Infrastructure for Translational Medical Research, University of Augsburg, Augsburg, Germany
| | - Julia Krumme
- Institute for Agile Software Development, Technical University of Applied Sciences Augsburg, Augsburg, Germany
| | - Nico Kanelakis
- Technical University of Applied Sciences Augsburg, Augsburg, Germany
| | - Alexandra Teynor
- Institute for Agile Software Development, Technical University of Applied Sciences Augsburg, Augsburg, Germany
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Maertens B, Blot S, Huis In 't Veld D, Blot K, Koch A, Mignolet K, Pannier E, Sarens T, Temmerman W, Swinnen W. Stepwise implementation of prevention strategies and their impact on ventilator-associated pneumonia incidence: A 13-Year observational surveillance study. Intensive Crit Care Nurs 2024:103769. [PMID: 39043503 DOI: 10.1016/j.iccn.2024.103769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To describe the practice of ventilator-associated pneumonia (VAP) prevention and control through the incremental introduction of prevention strategies and assess the effect on VAP incidence. DESIGN Historical observational surveillance study conducted over 13 years. SETTING A 12-bed adult intensive care unit (ICU) in a general hospital in Belgium. PARTICIPANTS Patients admitted between 2007 and 2019, with ICU stays of ≥48 h. INTERVENTIONS Incremental introduction of VAP preventive measures from 2008, including head-of-bed elevation, cuff pressure control, endotracheal tubes with tapered cuffs, subglottic secretion drainage, chlorhexidine oral care, and daily sedation assessment. MEASUREMENTS AND MAIN RESULTS A significant decline in VAP incidence density rates was observed, from 18.3 to 2.6 cases per 1000 ventilator days from the baseline to the final period. CONCLUSIONS Systematic implementation of VAP preventive measures significantly reduced VAP incidence. However, this reduction did not translate into decreased overall ICU mortality. IMPLICATIONS FOR PRACTICE The study underscores the importance of continuous VAP surveillance and preventive measures in reducing VAP incidence.
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Affiliation(s)
- Bert Maertens
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; UQ Centre for Clinical Research, The University of Queensland, Faculty of Medicine, Herston, Queensland, Australia.
| | - Diana Huis In 't Veld
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Koen Blot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Annelies Koch
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Katrien Mignolet
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Elise Pannier
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Tom Sarens
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Werner Temmerman
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Walter Swinnen
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
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Trivedi KK, Schaffzin JK, Deloney VM, Aureden K, Carrico R, Garcia-Houchins S, Garrett JH, Glowicz J, Lee GM, Maragakis LL, Moody J, Pettis AM, Saint S, Schweizer ML, Yokoe DS, Berenholtz S. Implementing strategies to prevent infections in acute-care settings. Infect Control Hosp Epidemiol 2023; 44:1232-1246. [PMID: 37431239 PMCID: PMC10527889 DOI: 10.1017/ice.2023.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
This document introduces and explains common implementation concepts and frameworks relevant to healthcare epidemiology and infection prevention and control and can serve as a stand-alone guide or be paired with the "SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2022 Updates," which contain technical implementation guidance for specific healthcare-associated infections. This Compendium article focuses on broad behavioral and socio-adaptive concepts and suggests ways that infection prevention and control teams, healthcare epidemiologists, infection preventionists, and specialty groups may utilize them to deliver high-quality care. Implementation concepts, frameworks, and models can help bridge the "knowing-doing" gap, a term used to describe why practices in healthcare may diverge from those recommended according to evidence. It aims to guide the reader to think about implementation and to find resources suited for a specific setting and circumstances by describing strategies for implementation, including determinants and measurement, as well as the conceptual models and frameworks: 4Es, Behavior Change Wheel, CUSP, European and Mixed Methods, Getting to Outcomes, Model for Improvement, RE-AIM, REP, and Theoretical Domains.
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Affiliation(s)
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Valerie M. Deloney
- Society for Healthcare Epidemiology of America (SHEA), Arlington, Virginia
| | | | - Ruth Carrico
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
| | | | - J. Hudson Garrett
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Kentucky
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grace M. Lee
- Stanford Children’s Health, Stanford, California
| | | | - Julia Moody
- Clinical Services Group, HCA Healthcare, Nashville, Tennessee
| | | | - Sanjay Saint
- VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan
| | | | - Deborah S. Yokoe
- University of California San Francisco School of Medicine, UCSF Medical Center, San Francisco, California
| | - Sean Berenholtz
- Clinical Services Group, HCA Healthcare, Nashville, Tennessee
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Halverson CC, Scott Tilley D. Creating a culture of support for nursing surveillance. Nurs Forum 2022; 57:1204-1212. [PMID: 36308313 DOI: 10.1111/nuf.12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/26/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND An estimated 98,000 deaths annually result from medical errors. Preventing these deaths must be a US healthcare goal. Surveillance decreases adverse events. Surveillance is essential for patient safety. Creating a unit culture that supports surveillance requires attention to its antecedents (nurse education, nurse expertise, nurse staffing, as well as organizational culture). METHOD The current literature on topics salient to creating a culture of nursing surveillance including its antecedents and its attributes were reviewed. The findings are summarized and presented. DISCUSSION Suggestions and tools enhancing a culture of safety allow the transition from one set of behaviors to another. An organizational culture that strives for excellence promotes surveillance which results in improved patient outcomes and better qualified nurses. CONCLUSION Unit change resulting in support for surveillance can minimize failure to rescue and promote interruption of adverse events. The patient outcomes include decreased morbidity and mortality.
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Affiliation(s)
| | - Donna Scott Tilley
- Research and Clinical Scholarship, College of Nursing, Texas Woman's University, Denton, Texas, USA
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A Study of How Moral Courage and Moral Sensitivity Correlate with Safe Care in Special Care Nursing. ScientificWorldJournal 2022; 2022:9097995. [PMID: 35874846 PMCID: PMC9300363 DOI: 10.1155/2022/9097995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nursing is a caring profession, and nurses who have moral sensitivity and moral courage presumably can provide safe and better care for patients. This study aims at investigating how moral courage and moral sensitivity correlate with safe care in special care nursing. Methods This study is a descriptive work of research. The participants consisted of 524 nurses who were in practice in the ICU (intensive care unit), CCU (C\coronary care unit), post-CCU (postcoronary care unit), and dialysis of four hospitals located in the south of Iran selected via census sampling. Data were collected from April to September 2020 using the moral sensitivity questionnaire (MSQ), professional moral courage questionnaire (PMCQ), and the assessment of safe nursing care questionnaire (ASNCQ). The collected data were analyzed using descriptive statistics, t-test, chi-square, multiple regression analysis, and Pearson's correlation coefficient in SPSS v. 22. Results The mean ± SD of the nurses' age was 33.89 ± 6.91 years, and the mean ± SD of their work experience was 9.16 ± 4.67 years. The total mean score ± SD of the nurses' moral sensitivity was found to be 93.41 ± 2.68, the total mean score ± SD of their moral courage was found to be 96.38 ± 3.63, and the total mean score ± SD of their safe care scores was found to be 321.80 ± 9.76. The values of Pearson's correlation coefficients showed significant correlations between moral courage and safe care (r = 0.54, p < 0.001), moral sensitivity and safe care (r = 0.59, p < 0.001), and moral sensitivity and moral courage (r = 0.52, p < 0.001). Conclusion There is a positive correlation between moral sensitivity and moral courage. Both positively correlated with special care nursing. Accordingly, through effective planning, education, and giving their support, nurse administrators can promote the abovementioned ethical virtues in the nursing staff, thereby improving the quality of care.
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Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, Lee G, Maragakis LL, Powell K, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:687-713. [PMID: 35589091 PMCID: PMC10903147 DOI: 10.1017/ice.2022.88] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard Branson
- Department of Surgery, University of Cincinnati Medicine, Cincinnati, Ohio
| | - Kelly Cawcutt
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric C Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda R Greene
- Highland Hospital, University of Rochester, Rochester, New York
| | - Grace Lee
- Stanford University School of Medicine, Palo Alto, California
| | - Lisa L Maragakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Krista Powell
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory P Priebe
- Department of Anesthesiology, Critical Care and Pain Medicine; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Kathleen Speck
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah S Yokoe
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sean M Berenholtz
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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A Quality Improvement Evaluation of a Primary As-Needed Light Sedation Protocol in Mechanically Ventilated Adults. Crit Care Explor 2020; 2:e0264. [PMID: 33354671 PMCID: PMC7746207 DOI: 10.1097/cce.0000000000000264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives First, to implement successfully a light-sedation protocol, favoring initial as-needed (prioritizing as-needed) boluses over continuous infusion sedation, and second, to evaluate if this protocol was associated with differences in patient-level sedative requirements, clinical outcomes, and unit-level longitudinal changes in pharmacy charges for sedative medications. Design Retrospective review comparing patients who received the prioritizing as-needed sedation protocol to similar patients eligible for the prioritizing as-needed protocol but treated initially with continuous infusion sedation. Setting Thirty-two bed medical ICUs in a large academic medical center. Patients A total of 254 mechanical ventilated patients with a target Riker Sedation-Agitation Scale goal of 3 or 4 were evaluated over a 2-year period. Of the evaluable patients, 114 received the prioritizing as-needed sedation protocol and 140 received a primary continuous infusion approach. Interventions A multidisciplinary leadership team created and implemented a light-sedation protocol, focusing on avoiding initiation of continuous sedative infusions and prioritizing prioritizing as-needed sedation. Measurements and Main Results Overall, 42% of patients in the prioritizing as-needed group never received continuous infusion sedation. Compared with the continuous infusion sedation group, patients treated with the prioritizing as-needed protocol received significantly less opioid, propofol, and benzodiazepine. Patients in the prioritizing as-needed group experienced less delirium, shorter duration of mechanical ventilation, and shorter ICU length of stay. Adverse events were similar between the two groups. At the unit level, protocol implementation was associated with reductions in the use of continuous infusion sedative medications. Conclusions Implementation and use of a prioritizing as-needed protocol targeting light sedation appear to be safe and effective. These single-ICU retrospective findings require wider, prospective validation.
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van der Veer SN, Jager KJ, Peek N, de Keizer NF, Koetsier A. Control Charts in Healthcare Quality Improvement. Methods Inf Med 2018; 51:189-98. [DOI: 10.3414/me11-01-0055] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 03/05/2012] [Indexed: 11/09/2022]
Abstract
SummaryObjectives: Use of Shewhart control charts in quality improvement (QI) initiatives is increasing. These charts are typically used in one or more phases of the Plan Do Study Act (PDSA) cycle to monitor summaries of process and outcome data, abstracted from clinical information systems, over time. We summarize methodological criteria of Shewhart control charts and investigate adherence of published QI studies to these criteria.Methods: We searched Medline, Embase and CINAHL for studies using Shewhart control charts in QI processes in direct patient care. We extracted methodological criteria for Shewhart control charts, and for the use of these charts in PDSA cycles, from textbooks and methodological literature.Results: We included 34 studies, presenting 64 control charts of which 40 control charts plotted two phases of the PDSA cycle. The criterion to use 10–35 data points in a control chart was least adhered to (48.4% non-adherence). Other criteria were: transformation of the data in case of a skewed distribution (43.7% non adherence), when comparing data from two phases of the PDSA cycle the Plan phase (the first phase) needs to be stable (40.0% non-adherence), using a maximum of four different rules to detect special cause variation (14.1% non-adherence), and setting control limits at three standard deviations from the mean (all control charts adhered).Conclusion: There is room for improvement with regard to the methodological construction of Shewhart control charts used in QI processes. Higher adherence to all methodological criteria will decrease the risk of incorrect conclusions about the process being monitored.
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Eisenmann D, Stroben F, Gerken JD, Exadaktylos AK, Machner M, Hautz WE. Interprofessional Emergency Training Leads to Changes in the Workplace. West J Emerg Med 2018; 19:185-192. [PMID: 29383079 PMCID: PMC5785192 DOI: 10.5811/westjem.2017.11.35275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Preventable mistakes occur frequently and can lead to patient harm and death. The emergency department (ED) is notoriously prone to such errors, and evidence suggests that improving teamwork is a key aspect to reduce the rate of error in acute care settings. Only a few strategies are in place to train team skills and communication in interprofessional situations. Our goal was to conceptualize, implement, and evaluate a training module for students of three professions involved in emergency care. The objective was to sensitize participants to barriers for their team skills and communication across professional borders. METHODS We developed a longitudinal simulation-enhanced training format for interprofessional teams, consisting of final-year medical students, advanced trainees of emergency nursing and student paramedics. The training format consisted of several one-day training modules, which took place twice in 2016 and 2017. Each training module started with an introduction to share one's roles, professional self-concepts, common misconceptions, and communication barriers. Next, we conducted different simulated cases. Each case consisted of a prehospital section (for paramedics and medical students), a handover (everyone), and an ED section (medical students and emergency nurses). After each training module, we assessed participants' "Commitment to Change." In this questionnaire, students were anonymously asked to state up to three changes that they wished to implement as a result of the course, as well as the strength of their commitment to these changes. RESULTS In total, 64 of 80 participants (80.0%) made at least one commitment to change after participating in the training modules. The total of 123 commitments was evenly distributed over four emerging categories: communication, behavior, knowledge and attitude. Roughly one third of behavior- and attitude-related commitments were directly related to interprofessional topics (e.g., "acknowledge other professions' work"), and these were equally distributed among professions. At the two-month follow-up, 32 participants (50%) provided written feedback on their original commitments: 57 of 62 (91.9%) commitments were at least partly realized at the follow-up, and only five (8.1%) commitments lacked realization entirely. CONCLUSION A structured simulation-enhanced intervention was successful in promoting change to the practice of emergency care, while training teamwork and communication skills jointly.
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Affiliation(s)
- Dorothea Eisenmann
- Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Charité, Berlin, Germany
- Universitätsmedizin Berlin, Medical Skills Lab, Charité, Berlin, Germany
| | - Fabian Stroben
- Universitätsmedizin Berlin, Medical Skills Lab, Charité, Berlin, Germany
| | - Jan D. Gerken
- Universitätsmedizin Berlin, Medical Skills Lab, Charité, Berlin, Germany
| | | | | | - Wolf E. Hautz
- University Hospital Berne, Department of Emergency Medicine, Inselspital, Berne, Switzerland
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Morar PS, Hollingshead J, Bemelman W, Sevdalis N, Pinkney T, Wilson G, Dunlop M, Davies RJ, Guy R, Fearnhead N, Brown S, Warusavitarne J, Edwards C, Faiz O. Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study. J Crohns Colitis 2017; 11:1362-1368. [PMID: 28961891 PMCID: PMC5881772 DOI: 10.1093/ecco-jcc/jjx099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/18/2017] [Accepted: 07/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. METHODS This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. RESULTS A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. CONCLUSIONS This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality.
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Affiliation(s)
- Pritesh S Morar
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St. Mark’s Hospital and Academic Institute, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - James Hollingshead
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St. Mark’s Hospital and Academic Institute, London, United Kingdom
| | - Willem Bemelman
- Department of Surgery, Amsterdam Medical Centre, Amsterdam, Netherlands
| | - Nick Sevdalis
- Centre for Implementation Science, King’s College, London, United Kingdom
| | - Thomas Pinkney
- Inflammatory Bowel Disease (IBD) subcommittee of Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
| | - Graeme Wilson
- Inflammatory Bowel Disease (IBD) subcommittee of Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
| | - Malcolm Dunlop
- Inflammatory Bowel Disease (IBD) subcommittee of Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
| | - R Justin Davies
- Inflammatory Bowel Disease (IBD) subcommittee of Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
| | - Richard Guy
- Inflammatory Bowel Disease (IBD) subcommittee of Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
| | - Nicola Fearnhead
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
| | - Steven Brown
- Inflammatory Bowel Disease (IBD) subcommittee of Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
| | - Janindra Warusavitarne
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St. Mark’s Hospital and Academic Institute, London, United Kingdom
| | | | - Omar Faiz
- Surgical Epidemiology, Trials and Outcome Centre (SETOC), St. Mark’s Hospital and Academic Institute, London, United Kingdom
- Inflammatory Bowel Disease (IBD) subcommittee of Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
- Inflammatory Bowel Disease (IBD) Clinical Advisory Group (CAG), Association of Coloproctology of Great Britain and Ireland (ACPGBI), London, United Kingdom
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Diamantouros A, Kiss A, Papastavros T, U. D, Zwarenstein M, Geerts WH. The TOronto ThromboProphylaxis Patient Safety Initiative (TOPPS): A cluster randomised trial. Res Social Adm Pharm 2017; 13:997-1003. [DOI: 10.1016/j.sapharm.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 05/02/2017] [Accepted: 05/26/2017] [Indexed: 11/25/2022]
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Sauter TC, Hautz WE, Hostettler S, Brodmann-Maeder M, Martinolli L, Lehmann B, Exadaktylos AK, Haider DG. Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department. Scand J Trauma Resusc Emerg Med 2016; 24:97. [PMID: 27485431 PMCID: PMC4970284 DOI: 10.1186/s13049-016-0291-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. Methods All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen’s d was calculated as effect size for all statistically significant tests. Results Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (dz = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). Discussion Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. Conclusion An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED.
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Affiliation(s)
- Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Simone Hostettler
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Monika Brodmann-Maeder
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Luca Martinolli
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Beat Lehmann
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Dominik G Haider
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35:915-36. [DOI: 10.1086/677144] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates "Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Cuzco Cabellos C, Guasch Pomés N. [Application and evalauation of care plan for patients admitted to Intensive Care Units]. ENFERMERIA INTENSIVA 2015; 26:137-43. [PMID: 26340906 DOI: 10.1016/j.enfi.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 06/15/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Assess whether the use of the nursing care plans improves outcomes of nursing care to patients admitted to the intensive care unit (ICU). METHODS The study was conducted in a University Hospital of Barcelona in Spain, using a pre- and post-study design. A total of 61 patient records were analysed in the pre-intervention group. A care plan was applied to 55 patients in the post-intervention group. Specific quality indicators in a medical intensive care unit to assess the clinical practice of nursing were used. Fisher's exact test was used to compare the degree of association between quality indicators in the two groups. RESULTS A total of 116 records of 121 patients were evaluated: 61 pre-intervention and 55 post-intervention. Fisher test: The filling of nursing records, p=.0003. Checking cardiorespiratory arrest equipment, p <.001. Central vascular catheter related bacteraemia (B-CVC) p=.622. Ventilator associated pneumonia (VAP) p=.1000. Elevation of the head of the bed more than 30° p=.049, and the pain management in non-sedated patients p=.082. CONCLUSIONS The implementation of nursing care plans in patients admitted to the intensive care area may contribute to improvement in the outcomes of nursing care.
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Affiliation(s)
- C Cuzco Cabellos
- Diplomada en Enfermería, Máster Oficial Enfermo Crítico y Emergencias, Área de Vigilancia Intensiva, Hospital Clínic de Barcelona, Barcelona, España.
| | - N Guasch Pomés
- Coordinadora Asistencial de Enfermería, Máster Oficial Enfermo Crítico y Emergencias, Área de Vigilancia Intensiva Hospital Clínic de Barcelona, Barcelona, España
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Conroy KM, Elliott D, Burrell AR. Testing the implementation of an electronic process-of-care checklist for use during morning medical rounds in a tertiary intensive care unit: a prospective before-after study. Ann Intensive Care 2015; 5:60. [PMID: 26239145 PMCID: PMC4523566 DOI: 10.1186/s13613-015-0060-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 07/15/2015] [Indexed: 01/09/2023] Open
Abstract
Background To improve the delivery of important care processes in the ICU, morning ward round checklists have been implemented in a number of intensive care units (ICUs) internationally. Good quality evidence supporting their use as clinical support tools is lacking. With increased use of technology in clinical settings, integration of such tools into current work practices can be a challenge and requires evaluation. Having completed preliminary work revealing variations in practice and evidence supporting the construct validity of a process-of-care checklist, the need to develop, test and further validate an e(lectronic)-checklist in an ICU was identified. Methods A prospective, before–after study was conducted in a 19-bed general ICU within a tertiary hospital. Data collection occurred during baseline and intervention periods for 6 weeks each, with education and training conducted over a 4-week period prior to intervention. The e-checklist was used at baseline by ICU research nurses conducting post-ward round audits. During intervention, senior medical staff completed the e-checklist after patient assessments during the morning ward rounds, and research staff conducted post-ward round audits for validity testing (via concordance measurement). To examine changes in compliance over time, checklist-level data were analysed using generalised estimating equations that factored in confounding variables, and statistical process control charts were used to evaluate unit-level data. Established measures of concordance were used to evaluate e-checklist validity. Results Compliance with each care component improved significantly over time; the largest improvement was for pain management (42% increase; adjusted odds ratio = 23, p < 0.001), followed by glucose management (22% increase, p < 0.001) and head-of-bed elevation (19% increase, p < 0.001), both with odds ratios greater than 10. Most detected omissions were corrected by the following day. Control charts illustrated reduced variability in care compliance over time. There was good concordance between physician and auditor e-checklist responses; seven out of nine cares had kappa values above 0.8. Conclusion Improvements in the delivery of essential daily care processes were evidenced after the introduction of an e-checklist to the morning ward rounds in an ICU. High levels of agreement between physician and independent audit responses lend support to the validity of the e-checklist. Electronic supplementary material The online version of this article (doi:10.1186/s13613-015-0060-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karena M Conroy
- NSW Intensive Care Co-ordination and Monitoring Unit, Agency for Clinical Innovation, Chatswood, Australia,
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The TRANSFORM Patient Safety Project: a microsystem approach to improving outcomes on inpatient units. J Gen Intern Med 2015; 30:425-33. [PMID: 25348342 PMCID: PMC4370988 DOI: 10.1007/s11606-014-3067-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/28/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Improvements in hospital patient safety have been made, but innovative approaches are needed to accelerate progress. Evidence is emerging that microsystem approaches to quality and safety improvement in hospital care are effective. OBJECTIVE We aimed to evaluate the effects of a multifaceted, microsystem-level patient safety program on clinical outcomes and safety culture on inpatient units. DESIGN A 1-year prospective interventional study was conducted, followed by a 6-month sustainability phase. SETTING AND PARTICIPANTS Four medical and surgical inpatient units within an academic university medical center were included, with registered nurses and residents representing study participants. INTERVENTIONS In situ simulation training; debriefing of medical emergencies; monthly patient safety team meetings; patient safety champion role; interdisciplinary patient safety conferences; recognition program for exemplary teamwork. OUTCOMES Hospital-acquired severe sepsis/septic shock and acute respiratory failure; unplanned transfers to higher level of care (HLOC); weighted risk-adjusted mortality. Safety culture was measured using a widely accepted, validated survey. RESULTS Rates of hospital-acquired severe sepsis/septic shock and acute respiratory failure decreased on study units, from 1.78 to 0.64 (p = 0.04) and 2.44 to 0.43 per 1,000 unit discharges (p = 0.03), respectively. The mean number of days between cases of severe sepsis/septic shock increased from baseline to the intervention period (p = 0.03). Unplanned transfers to HLOC increased from 715 to 764 per 1,000 unit transfers (p = 0.08). The weighted risk-adjusted observed-to-expected mortality ratio on all study units decreased from 0.50 to 0.40 (p < 0.001). Overall scores of safety culture on study units improved after the 1-year intervention, significantly for nurses (p < 0.001), but not for residents (p = 0.06). Scores significantly improved in nine of twelve survey dimensions for nurses, compared to in four dimensions for residents. CONCLUSION A multifaceted patient safety program suggested an association with improved hospital-acquired complications and weighted, risk-adjusted mortality, and improved nurses' perceptions of safety culture on inpatient study units.
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Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35 Suppl 2:S133-54. [PMID: 25376073 DOI: 10.1017/s0899823x00193894] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates “Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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18
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Barnhorst AB, Martinez M, Gershengorn HB. Quality improvement strategies for critical care nursing. Am J Crit Care 2015; 24:87-92. [PMID: 25554558 DOI: 10.4037/ajcc2015104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Amanda B. Barnhorst
- Amanda B. Barnhorst is chief critical care fellow, Mirian Martinez is a research nurse and quality assurance nurse, and Hayley B. Gershengorn is an assistant professor at the Jay B. Langner Critical Care System, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Mirian Martinez
- Amanda B. Barnhorst is chief critical care fellow, Mirian Martinez is a research nurse and quality assurance nurse, and Hayley B. Gershengorn is an assistant professor at the Jay B. Langner Critical Care System, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Hayley B. Gershengorn
- Amanda B. Barnhorst is chief critical care fellow, Mirian Martinez is a research nurse and quality assurance nurse, and Hayley B. Gershengorn is an assistant professor at the Jay B. Langner Critical Care System, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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Management strategies to effect change in intensive care units: lessons from the world of business. Part III. Effectively effecting and sustaining change. Ann Am Thorac Soc 2014; 11:454-7. [PMID: 24601653 DOI: 10.1513/annalsats.201311-393as] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.
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Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies. Ann Am Thorac Soc 2014; 11:444-53. [PMID: 24601668 DOI: 10.1513/annalsats.201311-392as] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.
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Langhan ML, Riera A, Kurtz JC, Schaeffer P, Asnes AG. Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff. J Med Eng Technol 2014; 39:44-53. [PMID: 25367721 DOI: 10.3109/03091902.2014.973618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Technologies are not always successfully implemented into practice. This study elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within 10 emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Five major categories emerged: decision-making factors, the impact on practice, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use and access difficulties. A positive outlook, sufficient training, support staff and user friendliness were facilitators. This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology.
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Affiliation(s)
- Melissa L Langhan
- Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine , New Haven, CT , USA and
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Goutier JM, Holzmueller CG, Edwards KC, Klompas M, Speck K, Berenholtz SM. Strategies to enhance adoption of ventilator-associated pneumonia prevention interventions: a systematic literature review. Infect Control Hosp Epidemiol 2014; 35:998-1005. [PMID: 25026616 DOI: 10.1086/677152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is among the most lethal of all healthcare-associated infections. Guidelines summarize interventions to prevent VAP, but translating recommendations into practice is an art unto itself. OBJECTIVE Summarize strategies to enhance adoption of VAP prevention interventions. METHODS We conducted a systematic literature review of articles in the MEDLINE database published between 2002 and 2012. We selected articles on the basis of specific inclusion criteria. We used structured forms to abstract implementation strategies and inserted them into the "engage, educate, execute, and evaluate" framework. RESULTS Twenty-seven articles met our inclusion criteria. Engagement strategies included multidisciplinary teamwork, involvement of local champions, and networking among peers. Educational strategies included training sessions and developing succinct summaries of the evidence. Execution strategies included standardization of care processes and building redundancies into routine care. Evaluation strategies included measuring performance and providing feedback to staff. CONCLUSION We summarized and organized practical implementation strategies in a framework to enhance adoption of recommended evidence-based practices. We believe this work fills an important void in most clinical practice guidelines, and broad use of these strategies may expedite VAP reduction efforts.
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Affiliation(s)
- Jente M Goutier
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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St Pierre M. Safe patient care - safety culture and risk management in otorhinolaryngology. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc09. [PMID: 24403977 PMCID: PMC3884544 DOI: 10.3205/cto000101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Safety culture is positioned at the heart of an organization's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organization's maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organization's safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality. Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate stimulation based team trainings into their curriculum.
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Affiliation(s)
- Michael St Pierre
- Department of Anesthesiology, University Hospital of Erlangen, Germany
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Human factors in critical care: towards standardized integrated human-centred systems of work. Curr Opin Crit Care 2013; 16:618-22. [PMID: 20736826 DOI: 10.1097/mcc.0b013e32833e9b4b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Improvements in safety and quality benefit from a systems approach. Human factors is the study and practice of the relationship between humans and systems. This review examines recent advances in human factors in healthcare. RECENT FINDINGS Early studies focused on understanding incidents, and on the translation of principles from aviation to healthcare, which demonstrated a useful but limited application of the human factors approach. More recent studies have begun to address the complexity of the relationship between human behaviour and technology, tasks, environment and organization. Human factors frameworks have been usefully applied that aid in these complex considerations, providing a better understanding of the healthcare system, and a much broader range of solutions to problems than checklists, protocols or training. In particular, in improving equipment design and procurement; improving job design by understanding the demands and tasks of individual healthcare practitioners; in improving what and when training is delivered; and the integration of these complex system components into a coherent whole. SUMMARY The human factors approach is not yet mature in healthcare, but the importance is being increasingly recognized, and the breadth of application continually expanded.
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Kahn SR, Morrison DR, Cohen JM, Emed J, Tagalakis V, Roussin A, Geerts W. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev 2013:CD008201. [PMID: 23861035 DOI: 10.1002/14651858.cd008201.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized patients. Numerous randomized controlled trials (RCTs) show that using thromboprophylaxis in hospitalized patients at risk for VTE is safe, effective and cost-effective. Despite this, prophylactic therapies for VTE are underutilized. System-wide interventions may be more effective to improve the use of VTE prophylaxis than relying on individual providers' prescribing behaviors. OBJECTIVES To assess the effects of interventions designed to increase the implementation of thromboprophylaxis in hospitalized adult medical and surgical patients at risk for venous thromboembolism (VTE), assessed in terms of: 1. Increase in the proportion of patients who receive prophylaxis and appropriate prophylaxis 2. Reduction in risk of symptomatic VTE3. Reduction in risk of asymptomatic VTE4. Safety of the intervention. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Group's Specialised Register (last searched July 2010) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) 2010, Issue 3. We searched the PubMed, EMBASE, and SCOPUS databases (19 April 2010) as well as the reference lists of relevant review articles. SELECTION CRITERIA We included all studies whose interventions aimed to increase the use of prophylaxis and/or appropriate prophylaxis, decrease the proportion of symptomatic VTE, or decrease the proportion of asymptomatic VTE in hospitalized adult patients. We excluded studies that simply distributed published guidelines and studies whose interventions were not clearly described. DATA COLLECTION AND ANALYSIS We collected the following outcomes: the proportion of patients who received prophylaxis (RP), the proportion of patients who received appropriate prophylaxis (RAP) (primary outcomes), and the occurrence of symptomatic VTE, asymptomatic VTE, and safety outcomes such as bleeding. We categorized interventions into education, alerts, and multifaceted interventions. We meta-analyzed RCTs and non-randomized studies (NRS) separately by random effects meta-analysis, and assessed heterogeneity using the I(2)statistic and subgroup analyses. Before analysis, we decided that results would be pooled if three or more studies were available for a particular intervention. We assessed publication bias using funnel plots and cumulative meta-analysis. MAIN RESULTS We included a total of 55 studies. One of these reported data in patient-days and could not be quantitatively analyzed with the others. The 54 remaining studies (8 RCTs and 46 NRS) eligible for inclusion in our quantitative synthesis enrolled a total of 78,343 participants. Among RCTs, there were sufficient data to pool results for one primary outcome (received prophylaxis) for the 'alert' intervention. Alerts, such as computerized reminders or stickers on patients' charts, were associated with a risk difference (RD) of 13%, signifying an increase in the proportion of patients who received prophylaxis (95% confidence interval (CI) 1% to 25%). Among NRS, there were sufficient data to pool both primary outcomes for each intervention type. Pooled risk differences for received prophylaxis ranged from 8% to 17%, and for received appropriate prophylaxis ranged from 11% to 19%. Education and alerts were associated with statistically significant increases in prescription of appropriate prophylaxis, and multifaceted interventions were associated with statistically significant increases in prescription of any prophylaxis and appropriate prophylaxis. Multifaceted interventions had the largest pooled effects. I(2) results showed substantial statistical heterogeneity which was in part explained by patient types and type of hospital. A subgroup analysis showed that multifaceted interventions which included an alert may be more effective at improving rates of prophylaxis and appropriate prophylaxis than those without an alert. Results for VTE and safety outcomes did not show substantial benefits or harms, although most studies were underpowered to assess these outcomes. AUTHORS' CONCLUSIONS We reviewed a large number of studies which implemented a variety of system-wide strategies aimed to improve thromboprophylaxis rates in many settings and patient populations. We found statistically significant improvements in prescription of prophylaxis associated with alerts (RCTs) and multifaceted interventions (RCTs and NRS), and improvements in prescription of appropriate prophylaxis in NRS with the use of education, alerts and multifaceted interventions. Multifaceted interventions with an alert component may be the most effective. Demonstrated sources of heterogeneity included patient types and type of hospital. The results of our review will help physicians, nurses, pharmacists, hospital administrators and policy makers make practical decisions about local adoption of specific system-wide measures to improve prevention of VTE, an important public health issue. We did not find a significant benefit for VTE outcomes; however, earlier RCTs assessing the efficacy of thromboprophylaxis which were powered to address these outcomes have demonstrated the benefit of prophylactic therapies and a favourable balance of benefits versus the increased risk of bleeding events.
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Affiliation(s)
- Susan R Kahn
- Division of Internal Medicine and Department of Medicine, McGill University,Montreal, Canada.
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Abstract
The past 50 years have witnessed the emergence and evolution of the modern pediatric ICU and the specialty of pediatric critical care medicine. ICUs have become key in the delivery of health care services. The patient population within pediatric ICUs is diverse. An assortment of providers, including intensivists, trainees, physician assistants, nurse practitioners, and hospitalists, perform a variety of roles. The evolution of critical care medicine also has seen the rise of critical care nursing and other critical care staff collaborating in multidisciplinary teams. Delivery of optimal critical care requires standardized, reliable, and evidence-based processes, such as bundles, checklists, and formalized communication processes.
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Abstract
OBJECTIVE To review the current status of critical care education of medical students, focusing on how early, vigorous undergraduate training may address the needs of the learners and society. DATA SOURCES Literature review of focused PubMed searches, online databases, and reference lists of recent publications. RESULTS Although management of unstable and critically ill patients is required of most interns, undergraduate education in these skills remains largely elective, scattered, and highly variable. Critical care competencies for medical school graduates have not been established in the United States, and many students feel unprepared for these responsibilities that they assume as interns. Several successful approaches to medical student education in critical care have been demonstrated, and the availability of simulation technology provides new educational opportunities. Early exposure to other medical disciplines has influenced medical student career choice, although this has not been studied in regards to critical care fields. CONCLUSIONS Undergraduate medical education in critical care would be advanced by consolidation and organization into formal curricula. These would teach biomedical and humanistic skills essential to critical care but valuable in all medical settings. Early, well-planned exposure to critical care as a distinct discipline might increase student interest in careers in the field. The effects of educational interventions on the acquisition of knowledge, attitudes, and skills as well as long-term career choice should be subjected to rigorous study.
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Govoni L, Dellaca' RL, Peñuelas O, Bellani G, Artigas A, Ferrer M, Navajas D, Pedotti A, Farré R. Actual performance of mechanical ventilators in ICU: a multicentric quality control study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012; 5:111-9. [PMID: 23293543 PMCID: PMC3534536 DOI: 10.2147/mder.s35864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Even if the performance of a given ventilator has been evaluated in the laboratory under very well controlled conditions, inappropriate maintenance and lack of long-term stability and accuracy of the ventilator sensors may lead to ventilation errors in actual clinical practice. The aim of this study was to evaluate the actual performances of ventilators during clinical routines. A resistance (7.69 cmH2O/L/s) – elastance (100 mL/cmH2O) test lung equipped with pressure, flow, and oxygen concentration sensors was connected to the Y-piece of all the mechanical ventilators available for patients in four intensive care units (ICUs; n = 66). Ventilators were set to volume-controlled ventilation with tidal volume = 600 mL, respiratory rate = 20 breaths/minute, positive end-expiratory pressure (PEEP) = 8 cmH2O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average ± standard deviation and range (min–max) of the ventilatory parameters were the following: inspired tidal volume = 607 ± 36 (530–723) mL, expired tidal volume = 608 ± 36 (530–728) mL, peak pressure = 20.8 ± 2.3 (17.2–25.9) cmH2O, respiratory rate = 20.09 ± 0.35 (19.5–21.6) breaths/minute, PEEP = 8.43 ± 0.57 (7.26–10.8) cmH2O, oxygen fraction = 0.49 ± 0.014 (0.41–0.53). The more error-prone parameters were the ones related to the measure of flow. In several cases, the actual delivered mechanical ventilation was considerably different from the set one, suggesting the need for improving quality control procedures for these machines.
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Affiliation(s)
- Leonardo Govoni
- TBM-Lab, Dipartimento di Bioingegneria, Politecnico di Milano University, Milano, Italy
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Abstract
Improving the quality and safety of intensive care unit (ICU) care in the United States is a significant challenge for the future. Obtaining improvement in systems of care is difficult given the reactionary mode physicians tend to enter when dealing with moment-to-moment crises. It will be important to implement quality and safety measures that are already supported by evidence. Improvement of device safety will be critical to reducing the large number of device-related complications that occur in US ICUs. Prospective collection of adverse events with rigorous analysis will be important to allow systematic errors to be exposed and corrected.
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Affiliation(s)
- Peter J Rossi
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Breeding J, Welch S, Whittam S, Buscher H, Burrows F, Frost C, Jonkman M, Mathews N, Wong KS, Wong A. Medication Error Minimization Scheme (MEMS) in an adult tertiary intensive care unit (ICU) 2009-2011. Aust Crit Care 2012; 26:58-75. [PMID: 22898357 DOI: 10.1016/j.aucc.2012.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/12/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The Medication Error Minimisation Scheme (MEMS) is a locally based ongoing multidisciplinary, multifaceted quality improvement (QI) project within an Australian adult tertiary level Intensive Care Unit (ICU). The project commenced in 2009. Its primary aim is to enhance medication safety within this ICU by utilising existing resources. The aim of this paper is to provide a descriptive account of the various activities, interventions and results of this project within the first three years. METHODS The research design for this project was based upon Plan-Do-Study-Act (PDSA) cycles associated with QI projects. Medication error rates and audits of: intravenous infusions, incompatible intravenous medications and incorrect documentation of withheld medications were analyzed according to simple statistical techniques. Initial and follow up medication safety surveys were compared using basic statistical analysis. Focus groups exploring barriers and enablers of medication incident reporting were analyzed according to qualitative techniques associated with focus group discussions. Other interventions included: regular education sessions; discussions within other departmental meetings such as nursing staff meetings and Morbidity and Mortality meetings; and bedside discussions and demonstrations. Promotion of medication safety occurred within a number of forums; activities and findings were advertised and displayed; a recognizable Logo for MEMS was employed; and incentives were provided for staff. RESULTS Reported Medication Incidents (MIs) increased from 6.2 to 14.9 MIs per 1000 patient days. Audits and chart reviews confirmed that more MIs are uncovered by employing a variety of techniques in addition to incident reporting. Staff surveys provided a rich source of information regarding medication safety. Audits of intravenous infusions revealed a reduced error rate from 38/331 (11.5%) to 15/468 (3.2%). Chart review of incorrect documentation of omitted medications decreased from 105/347 (30.3%) to 104/486 (21.4%). Focus groups provided information that was able to be used in a number of hospital forums in order to explain the impact of existing systems upon ICU staff. CONCLUSION This ongoing QI project was able to achieve its targeted goals. The MI reporting rate was increased. This project demonstrated that measurable, "non-incident report" errors can be reduced by focusing upon and promoting medication safety in the ICU. These activities demonstrated a workplace that values medication safety, the discovery of shortfalls and the benefits of ongoing improvement.
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Affiliation(s)
- Jeff Breeding
- Intensive Care Unit, St Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW 2010, Australia.
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Harrell R, Caley M, Allwood D, Fowler T. Changes in recruitment to public health consultant posts and hospital consultant posts in England: potential impact on the sustainability of the Public Health system. J Public Health (Oxf) 2011; 33:624-9. [PMID: 21994435 DOI: 10.1093/pubmed/fdr079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The UK government has proposed major changes to the Public Health system in England. This study aims quantify increasing anecdotal concern that the number of Public Health consultant posts advertised has plummeted since the publication of these plans. METHODS The archives of BMJ careers were interrogated for hospital and Public Health consultant posts advertised October 2008 and May 2011. Statistical process control charts were used to compare differences in recruitment over time and the ratio of Public Health:hospital consultant posts. RESULTS We found a highly significant reduction in the mean number of advertisements for Public Health consultant posts from 27.9 posts per month in the period October 2008-Novermber 2009 to 6.3 posts per month between December 2009 and May 2010 (P< 0.005). The ratio of Public Health:hospital consultant posts fell from 3.3 to 0.9 Public Health consultant posts per 100 hospital consultant posts (P< 0.005). CONCLUSIONS This study confirms the anecdotal concern that there has been a significant reduction in the advertisement, and by extrapolation, recruitment to Public Health consultants posts in England around the time of the publication of the government's reform plans. Public Health consultant posts have been disproportionately affected by this reduction compared to hospital consultant posts.
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Carne B, Kennedy M, Gray T. Review article: Crisis resource management in emergency medicine. Emerg Med Australas 2011; 24:7-13. [PMID: 22313554 DOI: 10.1111/j.1742-6723.2011.01495.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Effective team management is a core element of expert practice in emergency medicine. Thus far, training in emergency medicine has focussed predominantly on proficiency in medical and technical skills, with emergency physicians acquiring these 'non-technical' skills in an ad hoc manner or by trial and error with varying levels of success. This paper describes a set of behaviours that, when practised in conjunction with medical and technical expertise, can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of an ED. Teaching and practice of these behaviours is now a core element of training and skills maintenance in other high-risk areas, such as aviation, and is becoming part of the routine training for anaesthetists. They address areas, such as communication, leadership, knowledge of environment, anticipation and planning, obtaining timely assistance, attention allocation and workload distribution. We outline the application of these behaviours in the speciality of emergency medicine, and suggest that the teaching and practice of crisis resource management principles should become part of the curriculum for training and credentialing of emergency medicine specialists.
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Affiliation(s)
- Belinda Carne
- Emergency Department, Geelong Hospital, Geelong, Victoria, Australia.
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Elorza Mateos J, Ania González N, Agreda Sádaba M, Del Barrio Linares M, Margall Coscojuela MA, Asiain Erro MC. [Nursing care in the prevention of ventilator-associated pneumonia]. ENFERMERIA INTENSIVA 2011; 22:22-30. [PMID: 21296017 DOI: 10.1016/j.enfi.2010.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/22/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Certain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP). OBJECTIVES a) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP. METHOD This descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period. RESULTS Good compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30° and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation. CONCLUSIONS : For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30° and 45°.
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Affiliation(s)
- J Elorza Mateos
- Diplomadas en Enfermería, Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarre, Spain.
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Mahan CE, Spyropoulos AC. Venous thromboembolism prevention: a systematic review of methods to improve prophylaxis and decrease events in the hospitalized patient. Hosp Pract (1995) 2010; 38:97-108. [PMID: 20469630 DOI: 10.3810/hp.2010.02.284] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prevention of venous thromboembolism (VTE) is currently a key initiative internationally and in US hospitals, where there has been a recent focus on national quality initiatives to prevent hospital-acquired VTE. Multiple strategies exist to prevent VTE by increasing prophylaxis rates in the hospitalized setting. Active, multifaceted interventions, including provider education, an active reminder to the provider, and regular audit and feedback to medical and hospital staff, appear to be the most effective current interventions. Active intervention programs have been validated both as electronic alerts, with or without computerized clinical decision support software and, more recently, human alerts, many of which utilize in-hospital pharmacists. A passive strategy, such as guideline dissemination, should not be used as a lone method. Although inappropriate duration remains a key reason as to why at-risk patients do not receive appropriate thromboprophylaxis within the hospital (defined by type, dose, and duration of prophylaxis), few studies address duration compared with hospital length of stay. Preventable VTE is a new quality outcome measure for hospitals but is measured in few studies. Future studies should focus on comparing various multifaceted interventions to assess their effect over time, including endpoints of bleeding for safety, appropriate type, dose, and duration of prophylaxis, overall and preventable VTE, and the impact on unnecessary prophylaxis for patients not at risk.
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Affiliation(s)
- Charles E Mahan
- Cardinal Health Pharmacy Solutions, Lovelace Medical Center, Albuquerque, NM 87102, USA.
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Hart D, Lichte T, Jonitz G, Schrappe M. Sicherheitskultur – das magic bullet der Patientensicherheit? ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2009; 103:491-2. [DOI: 10.1016/j.zefq.2009.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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