American journal of medical quality : the official journal of the American College of Medical Quality
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Review Meta Analysis
Outcome of adverse events and medical errors in the intensive care unit: a systematic review and meta-analysis.
Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects of MEs/AEs on mortality and hospital and ICU lengths of stay among ICU patients. ⋯ Of 902 studies screened, 12 met the inclusion criteria, 10 of which are included in the quantitative analysis. Patients with 1 or more MEs/AEs (vs no MEs/AEs) had a nonsignificant increase in mortality (odds ratio = 1.5; 95% confidence interval [CI] = 0.98-2.14) but significantly longer hospital and ICU stays; the mean difference (95% CI) was 8.9 (3.3-14.7) days for hospital stay and 6.8 (0.2-13.4) days for ICU. The ICU environment is associated with a substantial incidence of MEs/AEs, and patients with MEs/AEs have worse outcomes than those with no MEs/AEs.
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Critically ill patients commonly experience poor sleep quality in the intensive care unit (ICU) because of various modifiable factors. To address this issue, an ICU-wide, multifaceted quality improvement (QI) project was undertaken to promote sleep in the Johns Hopkins Hospital Medical ICU (MICU). ⋯ Measures of performance included daily completion rates of daytime and nighttime sleep improvement checklists and completion rates of individual interventions. Although long-term adherence and sustainability pose ongoing challenges, this model provides a foundation for future ICU sleep promotion initiatives.
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This process improvement project aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. Using failure modes and effects analysis, a protocol employing the Modified Early Warning Score and serum lactate level was implemented to identify deteriorating patients who required the attention of the rapid response team. ⋯ A retrospective analysis to control for age, sex, race, severity of illness, and do not resuscitate status was performed, yielding a codes odds ratio of 0.51 (95% confidence interval = 0.31-0.85) and a preventable codes odds ratio of 0.25 (95% confidence interval = 0.07-0.82). At the study team's institution, implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers.
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This study aimed to assess practices in emergency department (ED) handoffs as perceived by emergency medicine (EM) residency program directors and other senior-level faculty and to determine if there are deficits in resident handoff training. This cross-sectional survey study was guided by the Kern model for medical curriculum development. A 12-member Council of Emergency Medicine Residency Directors (CORD) Transitions in Care task force of EM physicians performed these steps and constructed a survey. ⋯ At least 41% of the 158 American College of Graduate Medical Education EM residency programs were represented. More than half (56.6%) of responding EM physicians reported that their ED did not use a standardized handoff. There also exists a dearth of formal handoff training and handoff proficiency assessments for EM residents.