Publications by authors named "Laura L Morlock"

Objective: To evaluate whether implementation of the Michigan Keystone ICU project, a comprehensive statewide quality improvement initiative focused on reduction of infections, was associated with reductions in hospital mortality and length of stay for adults aged 65 or more admitted to intensive care units.

Design: Retrospective comparative study, using data from Medicare claims.

Setting: Michigan and Midwest region, United States.

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Objective: To describe inpatient and outpatient pediatric antidepressant medication errors.

Methods: We analyzed all error reports from the United States Pharmacopeia MEDMARX database, from 2003 to 2006, involving antidepressant medications and patients younger than 18 years.

Results: Of the 451 error reports identified, 95% reached the patient, 6.

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Objective: To determine whether high patient inflow volumes to an intensive care unit are associated with unplanned readmissions to the unit.

Design: Retrospective comparative analysis.

Setting: The setting is a large urban tertiary care academic medical center.

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Little is known about vaccination errors. We analyzed 607 outpatient pediatric vaccination error reports from MEDMARX, a nationwide, voluntary medication error reporting system, occurring from 2003 to 2006. We used the "5 Rights" framework (right vaccine, time, dose, route, and patient) to determine whether vaccination error types were predictable.

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The movement to improve quality of care and patient safety has grown, but examples of measurable and sustained progress are rare. The slow progress made in health care contrasts with the success of aviation safety. After a tragic 1995 plane crash, the aviation industry and government created the Commercial Aviation Safety Team to reduce fatal accidents.

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Background: Medication errors contribute to significant morbidity, mortality, and costs to the health system. Little is known about the characteristics of Emergency Department (ED) medication errors.

Study Objective: To examine the frequency, types, causes, and consequences of voluntarily reported ED medication errors in the United States.

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Of 361 reports of errors involving pediatric attention deficit hyperactivity disorder from 2003 to 2005, 82% reached the patient but were not harmful; more serious errors were rare.

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Health insurance systems in Central and Eastern Europe have evolved in different ways from the centralized health systems inherited from the Soviet era, but there remain common trends and challenges in the region. Health spending is low in comparison to the spending of pre-2004 European Union members, but population aging, medical technology, economic growth, and heightened expectations will generate major spending pressures. Social health insurance is the dominant model in the region, but coverage is uneven.

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Background: Errors may be more common and more likely to be harmful with opioids than with other medications, but little research has been conducted on these errors.

Methods: The authors retrospectively analyzed MEDMARX, an anonymous national medication error reporting database, and quantitatively described harmful opioid errors on inpatient units that did not involve devices such as patient-controlled analgesia. The authors compared patterns among opioids and qualitatively analyzed error descriptions to help explain the quantitative results.

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Purpose: The aim of this study is to determine if patient safety incidents and the system-related factors contributing to them systematically differ for medical versus surgical patients in intensive care units.

Materials And Methods: We conducted a multicenter prospective study of 646 incidents involving adult medical patients and 707 incidents involving adult surgical patients that were reported to an anonymous patient safety registry over a 2-year period. We compared incident characteristics, patient harm, and associated system factors for medical versus surgical patients.

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Objective: To describe the organization of physician services in intensivist-staffed intensive care units (ICU) reporting that they meet vs. do not meet the Leapfrog Physician Staffing standard, and to describe ICU directors' perceptions of the quality of care in their unit.

Design: Hospitals that were asked to participate in the 2001 and 2002 Leapfrog surveys regarding implementation of the ICU Physician Staffing standard were sampled.

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Purpose: The aim of this study was to describe hospital efforts to meet the Leapfrog Group's intensive care unit (ICU) physician staffing (IPS) standard; compare adopters and committers with resisters relative to perceived benefits, barriers and motivating factors; and examine implementation strategies.

Materials And Methods: Chief medical officers (CMO) and ICU directors at hospitals in 6 US regions were surveyed between August 2003 and January 2004. Hospital classifications were based on level of IPS implementation pioneer (met before IPS), adopter (met after IPS by 2002 Leapfrog survey), committer (not met but committed to December 2004 implementation), and resister (refused to adopt IPS).

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Purpose: To evaluate the frequency and type of factors involved in incidents reported to a patient safety reporting system and answer specific questions to enhance the value of PSRS data to improve patient safety.

Materials And Methods: Prospective cohort study of incidents reported from adult and pediatric intensive care units (ICUs) in the United States to the web-based, voluntary, and anonymous Intensive Care Unit Safety Reporting System. Results from July 1, 2002, to June 30, 2004.

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Objective: To analyze the system factors related to "line, tube, and drain" (LTD) incidents in the intensive care unit (ICU).

Design: Voluntary, anonymous Web-based patient safety reporting system.

Setting: Eighteen ICUs in the United States.

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Quality-based purchasing is a growing trend that seeks to improve healthcare quality through the purchaser-provider relationship. This article provides a unifying conceptual framework, presents examples of the purchaser-provider relationship in countries at different income levels, and identifies important supporting mechanisms for quality-based purchasing. As countries become wealthier, a higher proportion of healthcare spending is channeled through pooled arrangements, allowing for greater involvement of purchasers in promoting the quality of service provision.

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Objective: To evaluate the contributing and limiting factors for airway events reported in the Intensive Care Unit Safety Reporting System (ICUSRS) developed in partnership with the Society of Critical Care Medicine.

Design: Analysis of system factors in airway vs. nonairway events reported to a voluntary, anonymous, Web-based patient safety reporting system (the ICUSRS).

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Despite the growing demand for improved safety in health care, debate remains regarding the magnitude of the problem and the degree to which harm is preventable. To a great extent, this debate stems from variation in the definition and methods for measuring safety, its "shadow" error, and the degree of preventability. This article reviews the definition of safety and error, discusses approaches to measuring safety, and provides a framework for investigating incidents that unveils how the systems under which care is delivered may contribute to adverse incidents.

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In an effort to improve patient safety, researchers at the Johns Hopkins University designed and implemented a comprehensive Web-based Intensive Care Unit Safety Reporting System (ICUSRS). The ICUSRS collects data about adverse events and near misses from all staff in the ICU. This report reflects data on 854 reports from 18 diverse ICUs across the United States.

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