Patient flow variability and unplanned readmissions to an intensive care unit.

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.

National study of patient, visit, and hospital characteristics associated with leaving an emergency department without being seen: predicting LWBS.

Objectives: The objective was to estimate the national left-without-being-seen (LWBS) rate and to identify patient, visit, and institutional characteristics that predict LWBS.

Methods: This was a retrospective cross-sectional analysis using the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1998 to 2006. Bivariate and multivariate analyses were performed to identify predictors of LWBS.

Mortality in sepsis versus non-sepsis induced acute lung injury.

Introduction: Sepsis-induced acute lung injury (ALI) has been reported to have a higher case fatality rate than other causes of ALI. However, differences in the severity of illness in septic vs. non-septic ALI patients might explain this finding.

Effect of epsilon aminocaproic acid on red-cell transfusion requirements in major spinal surgery.

Study Design: : Randomized, placebo-controlled trial.

Objective: : To evaluate the efficacy of epsilon aminocaproic acid (EACA) to reduce the number of red-cell (RBC) transfusions in adult patients undergoing major spinal surgery.

Summary Of Background Data: : Reconstructive spinal surgery is associated with significant blood loss.

Implementing standardized operating room briefings and debriefings at a large regional medical center.

Background: Effective communication and teamwork are critical in many health care settings, particularly the operating room (OR). Several studies have implicated failures of communication and teamwork as the root cause in a high proportion of sentinel events in the OR.

Methods: In a prospective cohort study at a high-volume teaching, research, and tertiary care referral hospital, a standardized one-page briefing and debriefing tool was developed and implemented in October 2006 to improve interdisciplinary communication and teamwork in the OR.

Implementing a team-based daily goals sheet in a non-ICU setting.

A tool was developed to improve communication in non-intensive care unit inpatient units. This tool clarifies patient-centered goals, provides an accurate information source for each patient, and helps nurses communicate more effectively with one another and the surgical team.

Use of beta-blockers during aortic aneurysm repair: bridging the gap between evidence and effective practice.

The Leapfrog Group aims to improve patient safety and outcomes in hospitals through promoting the routine use of evidence-based medicine (EBM) practices such as the perioperative use of beta-blocker medications during elective abdominal aortic aneurysm (AAA) repair. The emergence of recent evidence, however, has sparked debate about the benefits of this practice. We found that implementation of the Leapfrog Group's beta-blocker standard in California hospitals has led to an estimated 50 percent decrease in mortality following open AAA repair over time.

Disclosing medical errors to patients: it's not what you say, it's what they hear.

Background: There is consensus that patients should be told if they are injured by medical care. However, there is little information on how they react to different methods of disclosure.

Objective: To determine if volunteers' reactions to videos of physicians disclosing adverse events are related to the physician apologizing and accepting responsibility.

Beyond "see one, do one, teach one": toward a different training paradigm.

In the process of acquiring new skills, physicians-in-training may expose patients to harm because they lack the required experience, knowledge and technical skills. Yet, most teaching hospitals use inexperienced residents to care for high-acuity patients in complex and dynamic environments and provide limited supervision from experienced clinicians. Multiple efforts in the last few years have started to address the problem of patient safety.

Tele ICU: paradox or panacea?

Telemedicine has been studied in the intensive care unit for several decades, but many questions remain unanswered regarding the costs and the benefits of its application. Telemedicine ICU (Tele-ICU) is an electronic means to link physical ICUs to another location which assists in medical decision making. Given the shortage of intensive care physicians in the US, Tele-ICU systems could be an efficient mechanism for physicians to manage a larger number of critical care patients.

Family meetings made simpler: a toolkit for the intensive care unit.

Although a growing body of evidence has associated the intensive care unit (ICU) family meeting with important, favorable outcomes for critically ill patients, their families, and health care systems, these meetings often fail to occur in a timely, effective, and reliable way. In this article, we describe 3 specific tools that we have developed as prototypes to promote more successful implementation of family meetings in the ICU: (1) a family meeting planner, (2) a meeting guide for families, and (3) a family meeting documentation template. We describe the essential features of these tools and ways that they might be adapted to meet the local needs of individual ICUs and to maximize acceptability and use.

Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests.

Background: The quality of life support delivered during cardiopulmonary resuscitation affects outcomes. However, little data exist regarding the quality of resuscitation delivered to children and factors associated with adherence to American Heart Association (AHA) resuscitation guidelines.

Participants: Pediatric residents from an academic, tertiary care hospital.

Red blood cell transfusion practices in acute lung injury: what do patient factors contribute?

Objective: To describe red blood cell (RBC) transfusion practices and evaluate the association between patient-related factors and pretransfusion hemoglobin concentration in acute lung injury (ALI).

Design: Secondary analysis of prospectively collected data.

Setting: Nine intensive care units (ICUs) in three teaching hospitals in Baltimore, MD.

Predictors of posttraumatic deep vein thrombosis (DVT): hospital practice versus patient factors-an analysis of the National Trauma Data Bank (NTDB).

Objective: Trauma centers that perform more duplex ultrasounds report more deep vein thromboses (DVT). However, it is uncertain if this is due to variations in hospital practices or patient characteristics and case mix. We hypothesize that admission to trauma centers that use duplex ultrasound more frequently, independently predicts DVT reporting for individual patients, controlling for patient-level risk factors.

Rural hospital nursing: Better environments = shared vision and quality/safety engagement.

Objective: The aim of this study was to identify the independent effects among market forces, hospital factors, and the rural nursing work environment, controlling for hospital type, average daily census, and system or network membership.

Background: The hospital work environment affects both nurse and patient outcomes, yet little is known about the rural hospital setting.

Methods: A national sample of rural hospital nurse executives (n = 233) completed the Nursing Environment Survey and the Essentials of Magnetism (EOM) instrument.

Reducing health care hazards: lessons from the commercial aviation safety team.

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.

The intensive care unit family meeting: making it happen.

The intensive care unit (ICU) family meeting is an important forum for discussion about the patient's condition, prognosis, and care preferences; for listening to the family's concerns; and for decision making about appropriate goals of treatment. For patients, families, clinicians, and health care systems, the benefits of early and effective communication through these meetings have been clearly established. Yet, evidence suggests that family meetings still fail to occur in a timely way for most patients in ICUs.