Operational Communications: Adapting a Hospital Daily Check-In (DCI) for Expanded Use During Emergency Events.

Low-frequency, high-acuity emergency events can and do occur within health care settings. Having a strong sense of daily situational and operational awareness is the first step in responding to any emergency event. To maintain high reliability, hospital leaders and staff must understand the full impact to the organization as the emergency event evolves.

Achieving High Reliability Through Cultural Mindfulness.

Healthcare has enthusiastically embraced quality and safety improvement. Yet, more radical transformation is clearly needed to make a more significant impact on error reduction and to ensure consistent quality. This need for transformation is leading healthcare to examine how other industries, such as nuclear power and aviation, improve safety to achieve a high degree of reliability and avoid potential catastrophes.

Evolution and Initial Experience of a Statewide Care Transitions Quality Improvement Collaborative: Preventing Avoidable Readmissions Together.

Increasing scrutiny of hospital readmission rates has spurred a wide variety of quality improvement initiatives. The Preventing Avoidable Readmissions Together (PART) initiative is a statewide quality improvement learning collaborative organized by stakeholder organizations in South Carolina. This descriptive report focused on initial interventions with hospitals.

The key principles and characteristics of an effective hospital medicine group: an assessment guide for hospitals and hospitalists.

Background: Despite the growth of hospital medicine, few guidelines exist to guide effective management of hospital medicine groups (HMGs).

Methods: The Society of Hospital Medicine Board of Directors appointed a workgroup consisting of individuals who have experience with a wide array of HMG models. The workgroup developed an initial draft of characteristics, which then went through a multistep process of review and redrafting.

Excess health care service utilization and costs associated with underrecognition of psychiatric comorbidity in a medical/surgical inpatient setting.

Psychiatric comorbidity is common among chronically medically ill populations and the presence of psychiatric conditions tends to be associated with increased costs and excess utilization of general medical services. The purpose of this pilot investigation was to determine whether differences in nonpsychiatric inpatient hospitalization frequency, duration, and costs existed between patients receiving outpatient psychiatric treatment and patients without identified psychiatric problems. Length of stay and cost information for patients that had at least 1 inpatient medical/surgical hospitalization during a 6-month period was extracted from the hospital's inpatient billing database (n = 10,865).

Impact of improvement efforts on glycemic control and hypoglycemia at a university medical center.

Background: Great emphasis is placed on optimizing treatment of hospitalized patients with diabetes and hyperglycemia.

Objective: This study was conducted to determine if the application of hospital-wide insulin order sets improved inpatient safety by reducing the number of actual hypoglycemic and hyperglycemic events and increasing at-target blood glucose.

Design: A retrospective chart review was conducted of hypoglycemic and hyperglycemic events and at-target blood glucose occurring before and after institution of the insulin order sets and blood glucose protocols.

Continuous infusion of a local anesthetic versus interscalene block for postoperative pain control after arthroscopic shoulder surgery.

Purpose: The purpose of this investigation was to evaluate the efficacy, complication rate, and cost of a 1-time interscalene block compared with a continuous infusion of a local anesthetic for postoperative pain relief in patients having arthroscopic shoulder surgery.

Methods: After prospective power analysis and institutional review board approval, 56 consecutive patients having arthroscopic shoulder surgery under general anesthesia performed by a single surgeon were randomly assigned to 1 of 2 groups to evaluate postoperative pain control. Group 1 patients received a preoperative interscalene block, and group 2 patients received a subacromial continuous infusion of a local anesthetic (0.

Postoperative pain management for arthroscopic shoulder surgery: interscalene block versus patient-controlled infusion of 0.25% bupivicaine.

We compared an interscalene block with a patient-controlled regional anesthesia device (Pain Care 2000; Breg, Inc, Vista, Calif) for pain management after outpatient arthroscopic shoulder surgery (subacromial decompression as principal procedure). The 41 patients in this prospective study were randomized to receive either the block or the device. During the postoperative period, all patients in both groups received standardized oral medications and continuous cold therapy and used continuous passive motion machines.

Overcoming barriers to pneumococcal vaccination in patients with pneumonia.

Inpatient pneumococcal vaccination remains underutilized, and little data exist to guide hospital personnel in improving their performance. The authors report their experience with a stepwise program to improve vaccination assessment rates for hospitalized patients with community-acquired pneumonia. They assessed barriers to vaccination and applied a stepwise educational and intranet-based decision support implementation program for hospitalized patients with community-acquired pneumonia.

Hospitalists and improved cost savings in patients with bacterial pneumonia at a state level.

Objectives: In the hospitalist literature, most studies have focused on outcomes related to cost savings for individual hospital systems. This study sought to determine if hospitalists could improve cost savings at a state level.

Methods: This is a retrospective analysis of a statewide database for inpatients in 2002 with bacterial pneumonia.

Custom-fit versus premanufactured braces.

Custom-made and off-the-shelf functional knee orthoses from four manufacturers were evaluated. Anterior tibial translation testing was performed using a pneumatic mechanical surrogated knee. The mechanical surrogate was interfaced with a servohydraulic materials testing system, which applied all anterior/posterior displacements to an ultimate anterior load of 400 N.

Physiologic axial load, frictional resistance, and the football shoe-surface interface.

The purpose of this investigation was to report on the interaction between different types of athletic shoes and playing surfaces using physiologic loads of 40 and 220 lbs. This is a continuation of our previous report using a load of 25 lbs. Nine shoes by three manufacturers were characterized as turf, court, molded cleat, or traditional cleat and tested on both natural grass and synthetic turf.

The effect of continuous cryotherapy on glenohumeral joint and subacromial space temperatures in the postoperative shoulder.

Purpose: The objective of this investigation was to determine the effect of continuous cryotherapy on glenohumeral joint and subacromial space temperatures in the postoperative shoulder.

Type Of Study: Prospective, randomized, and controlled clinical trial.

Methods: Twenty patients (10 cryotherapy, 10 controls) with a full-thickness rotator cuff repair were monitored with temperature sensors in the glenohumeral joint and subacromial space of the shoulder for 23 postoperative hours.

Effect of CounterForce brace on symptomatic relief in a group of patients with symptomatic unicompartmental osteoarthritis: a prospective 2-year investigation.

We investigated the effect of the CounterForce brace (Breg, Inc, Vista, Calif) on symptomatic relief in a group of 30 patients who had symptomatic unicompartmental osteoarthritis and who had undergone at least 6 months of conservative treatment without resolution of symptoms. After 8 weeks of brace use, the majority of patients reported statistically significant improvements-substantial reduction in pain, increase in ability to work and to engage in activities of daily living, and substantial reduction in use of oral pain medication. At long-term follow-up (mean, 2.

Conservative Treatment of Inflamed Knee Bursae.

In brief Knee bursitis often mimics other brief Pathologies, making correct diagnosis necessary to initiate appropriate treatment. Most commonly affected are the prepatellar, pes anserine, tibial collateral ligament, and two infrapatellar bursae. Other common bursitic conditions include Baker's cysts and posttraumatic adventitious hemorrhagic bursitis.