Guiding principles for physician reentry programs.

Physician reentry is defined by the American Medical Association (AMA) as: "A return to clinical practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment." Physician reentry programs are creating an avenue for physicians who have left medicine in good standing to return to clinical practice. To date, however, programs have developed independently, with little coordination among them.

Reporting trends in a regional medication error data-sharing system.

Inter-organizational systems for sharing data about medication errors have emerged as an important strategy for improving patient safety and are expected to encourage not only voluntary error reporting but also learning from errors. Yet, few studies have examined the hypothesized benefits of inter-organizational data sharing. The current study examined the developmental trends in information reported by hospitals participating in a regional reporting system for medication errors.

An advanced pharmacy practice experience in inpatient medication education.

Objective: To describe a unique advanced pharmacy practice experience (APPE) in which pharmacy students provided medication education to hospitalized patients.

Design: Students were trained to independently assess patients' needs for education and identify drug-related problems. Students then provided medication education and performed medication therapy management under the supervision of clinical staff pharmacists.

Medication errors resulting from computer entry by nonprescribers.

Purpose: The characteristics of medication errors associated with the use of computer order-entry systems by nonprescribers are discussed.

Methods: A retrospective analysis of records submitted to MEDMARX was conducted for the period from July 1, 2001, to December 31, 2005, to identify all computer-related medication errors made by nonprescribers. Quantitative analysis of the records included the severity of each error, the origin within the medication-use process, the type of error, principal causes, the location within the facility where the error was made, and the therapeutic drug classes frequently involved.

Clinical triggers or rapid response teams: does the emperor need "new" clothes?

Essential to any rapid response system is certainty regarding its ability to provide an immediate and appropriate response to calls for help.

The need for organizational change in patient safety initiatives.

Objectives: This study describes a computer simulation model that has been developed to explore organizational changes required to improve patient safety based on a medication error reporting system.

Methods: Model parameters for the simulation model were estimated from data submitted to the MEDMARX medication error reporting system from 570 healthcare facilities in the U.S.

Paramedic intubation errors: isolated events or symptoms of larger problems?

Paramedics provide life-saving emergency medical care to patients in the out-of-hospital setting, but only selected emergency interventions have proved to be safe or effective. Endotracheal intubation (the insertion of an emergency breathing tube into the trachea) is an important and high-profile procedure performed by paramedics. In our study population, we found that errors occurred in 22 percent of intubation attempts, with a frequency of up to 40 percent in selected ambulance systems.

Pennsylvania partners in pursuit of good health: building a shared-responsibility model for state health improvement.

Over the last decade, much attention has focused on the reorganization of the roles and functions of public health to improve the health of communities. The Pennsylvania State Health Improvement Plan (SHIP) offers one example of how national, state, and local components of the public health system can effectively integrate their strategies and resources to improve responsiveness to local public health needs. This article reviews the policy action and planning process used to develop a community partnership, shared-responsibility model and the strategies and implementation plans that have been adopted to achieve substantial, measurable improvement in community health status.

Long-term mortality and quality of life after prolonged mechanical ventilation.

Objective: To describe and identify factors associated with mortality rate and quality of life 1 yr after prolonged mechanical ventilation.

Design: Prospective, observational cohort study with patient recruitment over 26 months and follow-up for 1 yr.

Setting: Intensive care units at a tertiary care university hospital.

Pittsburgh Regional Healthcare Initiative: a systems approach for achieving perfect patient care.

The Pittsburgh Regional Healthcare Initiative (PRHI) is an innovative model for health system change based on regionwide shared learning. By linking patient outcomes data with processes of care and sharing that information widely, PRHI supports measurable improvements in regionwide clinical practice and patient safety. In addition, through the redesign of problem solving at the front lines of care, PRHI helps health care organizations to evolve toward becoming sustainable systems of perfect patient care.

Hospital costs in patients receiving prolonged mechanical ventilation: does age have an impact?

Background: The aging of the population is one of the causes of the increase in healthcare costs in the past few decades. It is controversial whether chronological age alone should be used in making healthcare decisions.

Objective: To determine the association between age and hospital costs in patients receiving mechanical ventilation (MV).

Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes.

Background: Acute renal failure (ARF) is associated with a persistent high mortality in critically ill patients in intensive care units (ICUs). Most studies to date have focused on patients with established, intrinsic ARF or relatively severe ARF due to multiple factors. None have examined outcomes of dialysis-dependent chronic renal failure [end-stage renal disease (ESRD)] patients in the ICU.

Identifying potentially ineffective care in a community hospital.

Objectives: To develop a formula to predict mortality for intensive care unit patients between day 5 in an intensive care unit and 100 days after hospital discharge from a community hospital.

Design: Retrospective 1-yr derivation study with validation on a subsequent year's intensive care unit population.

Setting: An 850-bed, not-for-profit community hospital with three adult intensive care units, including medical-surgical, cardiac-medical, and cardiac-surgical units.

Age and the risk of in-hospital death: insights from a multihospital study of intensive care patients.

Objectives: To determine independent relationships between age and the risk of in-hospital death.

Design: Retrospective cohort study.

Setting: Thirty-eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region.

A new conceptual framework for ICU performance appraisal and improvement.

Purpose: This study examined the use of outcomes for the purposes of ICU evaluation and improvement. We reviewed the strengths and weaknesses of an outcomes-centered approach to intensive care unit (ICU) evaluation and present a more comprehensive conceptual framework for ICU evaluation and improvement.

Materials And Methods: Data was collected from 2 sources: (1) a structured review of the literature, with relevant articles identified using Medline, and (2) 85 semistructured interviews of health care professionals (eg, physicians) and health care administrators (eg, chief executive officer).

Day of the week of intensive care admission and patient outcomes: a multisite regional evaluation.

Background: Relationships between day of the week of admission to hospitals and hospital outcomes have been poorly studied. Intensive care units (ICUs) appear to be uniquely suited to examine such a question given the unpredictability of ICU admissions and the clinical instability of their patient populations.

Methods: This retrospective cohort study included 156,136 patients admitted to 38 ICUs in 28 hospitals in a large Midwestern metropolitan area during 1991 to 1997.