ACR Appropriateness Criteria® Epigastric Pain.

Epigastric pain can have multiple etiologies including myocardial infarction, pancreatitis, acute aortic syndromes, gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia. This document focuses on the scenarios in which epigastric pain is accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis, which raise suspicion for gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, or hiatal hernia. Although endoscopy may be the test of choice for diagnosing these entities, patients may present with nonspecific or overlapping symptoms, necessitating the use of imaging prior to or instead of endoscopy.

Implementation of unit-based interventions to improve teamwork and patient safety on a medical service.

In a prior study involving 2 medical units, Structured Interdisciplinary Rounds (SIDRs) improved teamwork and reduced adverse events (AEs). SIDR was implemented on 5 additional units, and a pre- versus postintervention comparison was performed. SIDR combined a structured format for communication with daily interprofessional meetings.

Comparison of traditional trigger tool to data warehouse based screening for identifying hospital adverse events.

Background: Research supports medical record review using screening triggers as the optimal method to detect hospital adverse events (AE), yet the method is labour-intensive.

Method: This study compared a traditional trigger tool with an enterprise data warehouse (EDW) based screening method to detect AEs. We created 51 automated queries based on 33 traditional triggers from prior research, and then applied them to 250 randomly selected medical patients hospitalised between 1 September 2009 and 31 August 2010.

Structured interdisciplinary rounds in a medical teaching unit: improving patient safety.

Background: Effective collaboration and teamwork is essential to providing safe hospital care. The objective of this study was to assess the effect of an intervention designed to improve interdisciplinary collaboration and lower the rate of adverse events (AEs).

Methods: The study was a controlled trial of an intervention, Structured Inter-Disciplinary Rounds, implemented in 1 of 2 similar medical teaching units in a tertiary care academic hospital.

Hospitalized patients' understanding of their plan of care.

Objective: To evaluate hospitalized patients' understanding of their plan of care.

Patients And Methods: Interviews of a cross-sectional sample of hospitalized patients and their physicians were conducted from June 6 through June 26, 2008. Patients were asked whether they knew the name of the physician and nurse responsible for their care and specific questions about 6 aspects of the plan of care for the day (primary diagnosis, planned tests, planned procedures, medication changes, physician services consulted, and the expected length of stay).

Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care.

Background: A significant barrier to communication among patient care providers in hospitals is the geographic dispersion of team members.

Objective: To determine whether localizing physicians to specific patient care units improves nurse-physician communication and agreement on patients' plans of care.

Methods: We conducted structured interviews of a cross-sectional sample of nurses and physicians before and after an intervention to localize physicians to specific patient care units.

Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary.

Background: Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous.

Objective: To evaluate the effect of a newly-created electronic discharge summary.

Design And Participants: Pre-post evaluation of discharge summaries using a survey of outpatient physicians and a medical records review.