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.

Examination of how a survey can spur culture changes using a quality improvement approach: a region-wide approach to determining a patient safety culture.

The objective of this study was to investigate safety climates within a cohort of regional hospitals to assess health care workers' perceptions of their hospitals' safety reporting, feedback, and problem-solving systems, and to examine how regional initiatives and health care organizations use safety climate information to improve patient safety outcomes. A purposive sample of staff at 25 western Pennsylvania hospitals was surveyed using Likert scale questions. The instrument studied provided foci on which regional efforts and hospitals could base interventions to improve patient safety culture.

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.

Using health information technology-related performance measures and tools to improve chronic care.

Background: The American Medical Association led a collaborative initiative to explore opportunities for improving the quality of outpatient chronic care through the use of nationally endorsed clinical performance measures and tools. The measures and tools focused on adult diabetes, major depressive disorder, chronic stable coronary artery disease, heart failure, hypertension, and asthma.

Methods: The RAND Corporation conducted an independent, formative assessment of the initiative's four pilot activities using the Context-Input-Process-Product evaluation model.

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.

Designing a strategy to promote safe, innovative off-label use of medications.

Innovative off-label medication use (defined as prescribing with reasonable rationale for use, but insufficient evidence to allay safety, efficacy, and cost-effectiveness concerns, yet is not clinical research) is common practice and provides challenges to ensuring high-quality health care and patient safety. This article describes a strategy to promote policy and standardization of innovative off-label medication use, ensure oversight of patient safety, and prospectively assess efficacy. A multidisciplinary group developed a policy and process to regulate innovative off-label medication use that standardizes formulary review, maximizes peer expertise input, and minimizes institution liability by evaluating the effectiveness of use, promoting evidence-based practices, and ensuring ethical obligations to patients and society.

United States medical practice summary: innovative off-label medication use.

Data are limited regarding how academic medical centers (AMCs) deal with medication use that represents a departure from product labeling; has reasonable rationale for use, but insufficient evidence to allay safety, efficacy, and cost-effectiveness concerns; yet is not clinical research (defined as innovative off-label medication use). This report describes national trends in management of innovative off-label medication use. A cross-sectional survey of US AMCs was conducted.

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.

A new model for accreditation of residency programs in internal medicine.

A renewed emphasis on clinical competence and its assessment has grown out of public concerns about the safety, efficacy, and accountability of health care in the United States. Medical schools and residency training programs are paying increased attention to teaching and evaluating basic clinical skills, stimulated in part by these concerns and the responding initiatives of accrediting, certifying, and licensing bodies. This paper, from the Residency Review Committee for Internal Medicine of the Accreditation Council for Graduate Medical Education, proposes a new outcomes-based accreditation strategy for residency training programs in internal medicine.

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).