A case vignette study to refine the target group of an intermediate care model: the Acute Geriatric Community Hospital.

Purpose: To refine the admission criteria of the Acute Geriatric Community Hospital (AGCH) by defining its target group boundaries with (geriatric) hospital care and other bed-based intermediate care models in the Netherlands.

Methods: A qualitative study consisting of a three-phase refinement procedure with case vignettes. Physicians, medical specialists, nurse practitioners, and physician assistants in hospitals (n = 10) or intermediate care facilities (n = 10) in the Netherlands participated.

A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives.

Objective:: To characterize how rehabilitation goals of older patients change over time and to explore professionals' attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals.

Design:: Qualitative interview study.

Setting:: Three geriatric rehabilitation centers.

Outcomes Associated With the Nationwide Introduction of Rapid Response Systems in The Netherlands.

Objective: To describe the effect of implementation of a rapid response system on the composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death.

Design: Pragmatic prospective Dutch multicenter before-after trial, Cost and Outcomes analysis of Medical Emergency Teams trial.

Setting: Twelve hospitals participated, each including two surgical and two nonsurgical wards between April 2009 and November 2011.

Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured identification strategy.

Background: Older patients are at high risk for experiencing Adverse Drug Events (ADEs) during hospitalization. To be able to reduce ADEs in these vulnerable patients, hospitals first need to measure the occurrence of ADEs, especially those that are preventable. However, data on preventable ADEs (pADEs) occurring during hospitalization in older patients are scarce, and no 'gold standard' for the identification of ADEs exists.

How nurses and physicians judge their own quality of care for deteriorating patients on medical wards: self-assessment of quality of care is suboptimal*.

Objective: To describe how nurses and physicians judge their own quality of care for deteriorating patients on medical wards compared with the judgment of independent experts.

Design: Cross-sectional study using interviews of care-providers regarding their perceived quality of care for clinically deteriorating patients compared with retrospective judgment by independent experts.

Setting: Academic Medical Center of Amsterdam, the Netherlands.

Association between acute geriatric syndromes and medication-related hospital admissions.

Background: Elderly patients are at a 4-fold higher risk of adverse drug events (ADEs) and drug-related hospitalization. Hospitalization of an elderly patient is often preceded by geriatric syndromes, like falls or delirium.

Objectives: The primary aim of this study was to investigate whether geriatric syndromes were associated with ADEs in acutely admitted elderly patients.

Recognition of adverse drug events in older hospitalized medical patients.

Objective: To assess medical teams' ability to recognize adverse drug events (ADEs) in older inpatients.

Methods: The study cohort comprised 250 patients aged 65 years or older consecutively admitted to Internal Medicine wards of three hospitals in the Netherlands between April and November 2007. An independent expert team identified ADEs present upon admission or occurring during hospitalization by a structured retrospective patient chart review.

A checklist to improve patient safety in interventional radiology.

Purpose: To develop a specific RADiological Patient Safety System (RADPASS) checklist for interventional radiology and to assess the effect of this checklist on health care processes of radiological interventions.

Materials And Methods: On the basis of available literature and expert opinion, a prototype checklist was developed. The checklist was adapted on the basis of observation of daily practice in a tertiary referral centre and evaluation by users.

Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients.

Introduction: More than half of in-hospital adverse events can be attributed to a surgical discipline. Checklists can effectively decrease errors and adverse events. However, the mechanisms by which checklists lead to increased safety are unclear.

Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score.

Background And Purpose: Clear and detectable signs of deterioration have been shown to be present in many patients multiple hours before undergoing a serious life-threatening event. To date, few studies are available describing normal practice and the possible effectiveness of structured tools regarding recognition of deteriorating patients. The aim of this study was to describe the current practice in measurement and documentation of vital signs and the possible usefulness of the Modified Early Warning Score (MEWS) to identify deteriorating patients on hospital wards.

The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors).

Background: The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs) during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical pharmacists in medical teams. Within the current Hospital Pharmacy organisation in the Netherlands, such on-ward service is less feasible and therefore not yet established.

Quality indicators for in-hospital pharmaceutical care of Dutch elderly patients: development and validation of an ACOVE-based quality indicator set.

Background: In 2001, the ACOVE (Assessing Care Of Vulnerable Elders) quality indicators (QIs) were developed in the US to measure the quality of care of vulnerable elderly patients. However, the ACOVE QI set was developed mainly to assess the overall quality of care of community-dwelling vulnerable elders (as opposed to hospitalized elderly). Therefore, they need to be adapted when used in a non-US hospital setting.

Prevention of surgical malpractice claims by use of a surgical safety checklist.

Objective: To assess what proportion of surgical malpractice claims might be prevented by the use of a surgical safety checklist.

Background: Surgical disciplines are overrepresented in the distribution of adverse events. The recently described multidisciplinary SURgical PAtient Safety System (SURPASS) checklist covers the entire surgical pathway from admission to discharge and is being validated in various ways.

Effect of a comprehensive surgical safety system on patient outcomes.

Background: Adverse events in patients who have undergone surgery constitute a large proportion of iatrogenic illnesses. Most surgical safety interventions have focused on the operating room. Since more than half of all surgical errors occur outside the operating room, it is likely that a more substantial improvement in outcomes can be achieved by targeting the entire surgical pathway.

The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis.

Background: Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS) checklist was developed and implemented. This multidisciplinary checklist covers the entire surgical pathway and includes, among other items, administration of antibiotic prophylaxis before induction of anaesthesia.

Application of the Bow-Tie model in medication safety risk analysis: consecutive experience in two hospitals in the Netherlands.

Background: To improve medication safety effectively, one should systematically analyse and assess the risks for medication errors and determine the possible causes. So far, no risk-analysis instrument exists in healthcare that can be used to analyse and visualize risks, causes and consequences of potential adverse events in a prospective manner. In high-risk industries such as petrochemistry and aviation, the Bow-Tie model is frequently used.

The effect of low molecular weight heparin on survival in patients with advanced malignancy.

Purpose: Studies in cancer patients with venous thromboembolism suggested that low molecular weight heparin may prolong survival. In a double-blind study, we evaluated the effect of low molecular weight heparin on survival in patients with advanced malignancy without venous thromboembolism.

Methods: Patients with metastasized or locally advanced solid tumors were randomly assigned to receive a 6-week course of subcutaneous nadroparin or placebo.

Thrombosis prophylaxis in patient populations with a central venous catheter: a systematic review.

Background: Central venous catheters (CVCs) are used in a wide variety of patients. Associated complications are thrombosis and infection. It is a matter of debate whether thromboprophylaxis is beneficial.