An innovative programme to track and address burnout in physician trainees.

Background: There is a call to action for health care systems to assess and address burnout among physician trainees. To address this need for programmatic change, we developed a novel initiative to (1) proactively assess trainee burnout and identify drivers and (2) provide resources and recommendations for preventing and reducing burnout.

Approach: This pilot burnout tracking initiative began in 2020.

Interprofessional Care and Teamwork in the ICU.

Objectives: We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success.

Data Sources: Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives.

Preventing Harm in the ICU-Building a Culture of Safety and Engaging Patients and Families.

Objective: Preventing harm remains a persistent challenge in the ICU despite evidence-based practices known to reduce the prevalence of adverse events. This review seeks to describe the critical role of safety culture and patient and family engagement in successful quality improvement initiatives in the ICU. We review the evidence supporting the impact of safety culture and provide practical guidance for those wishing to implement initiatives aimed at improving safety culture and more effectively integrate patients and families in such efforts.

Predicting mortality in the intensive care unit: a comparison of the University Health Consortium expected probability of mortality and the Mortality Prediction Model III.

Background: Quality benchmarks are increasingly being used to compare the delivery of healthcare, and may affect reimbursement in the future. The University Health Consortium (UHC) expected probability of mortality (EPM) is one such quality benchmark. Although the UHC EPM is used to compare quality across UHC members, it has not been prospectively validated in the critically ill.

An analysis of near misses identified by anesthesia providers in the intensive care unit.

Background: Learning from adverse events and near misses may reduce the incidence of preventable errors. Current literature on adverse events and near misses in the ICU focuses on errors reported by nurses and intensivists. ICU near misses identified by anesthesia providers may reveal critical events, causal mechanisms and system weaknesses not identified by other providers, and may differ in character and causality from near misses in other anesthesia locations.

Acquired neuromuscular weakness and early mobilization in the intensive care unit.

Survival from critical illness has improved in recent years, leading to increased attention to the sequelae of such illness. Neuromuscular weakness in the intensive care unit (ICU) is common, persistent, and has significant public health implications. The differential diagnosis of weakness in the ICU is extensive and includes critical illness neuromyopathy.

Is antral follicle count a genetic trait?

Objective: The aim of this study was to determine the relationship between maternal age of menopause and antral follicle count.

Methods: This was a cross-sectional study of 124 women aged 25 to 48 years presenting with infertility. Women reported their mother's age of menopause and underwent transvaginal ultrasound to assess antral follicle count.

Perioperative glycemic control: an evidence-based review.

Hyperglycemia in perioperative patients has been identified as a risk factor for morbidity and mortality. Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality among the critically ill, decrease infection rates and improve survival after cardiac surgery, and improve outcomes in acute neurologic injury and acute myocardial infarction. However, recent evidence of severe hypoglycemia and adverse events associated with IIT brings its safety and efficacy into question.

Strategies for success: A PDSA analysis of three QI initiatives in critical care.

Background: Implementation of evidence-based quality improvement (QI) initiatives is not without its challenges. Recent experience in the design, implementation, and evaluation of three QI initiatives at the University of California, San Francisco Medical Center (UCSF) suggests lessons learned that may be generalizable to other QI initiatives. INITIATIVES: Between December 2002 and May 2006, a ventilator bundle of care and a tight glycemic control (TGC) protocol were implemented in the intensive care units (ICUs), and early goal-directed therapy (EGDT) for patients with severe sepsis or septic shock was implemented in the ICUs and emergency department.

Medication errors associated with code situations in U.S. hospitals: direct and collateral damage.

A retrospective analysis of 842 medication errors related to code situations revealed that "collateral damage" errors accounted for 74% of all code-related errors, whereas 21% involved patients directly experiencing codes.