ABSTRACT
Surgical site infection (SSI) is recognized as a focus area by the Centers for Medicare and Medicaid Services, the Joint Commission, the Institute for Healthcare Improvement, and the Institute of Medicine. An estimated 47% to 84% of SSIs present after discharge from the hospital or ambulatory care facility and, as a result, go undetected by standard SSI surveillance programs. Evidence-based processes and practices that are known to reduce the incidence of SSIs tend to be underused in routine practice. This article describes a multistakeholder process used to develop an educational initiative to raise awareness of best practices to reduce SSIs. The goal was to create a patient-centric educational initiative that involved an active partnership among all stakeholders-medical professional organizations, hospitals/health systems, health insurers, employers and other purchasers, and consumers/patients-to provide the climate necessary to create and sustain a culture of safety.
Subject(s)
Education, Medical, Continuing/methods , Practice Guidelines as Topic , Surgical Wound Infection/prevention & control , Cooperative Behavior , Education, Medical, Continuing/organization & administration , Humans , Patient Care Team/organization & administration , Patient Education as Topic/methods , Patient Safety , Patient-Centered Care/methodsABSTRACT
A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.
Subject(s)
Patient Safety , Perinatal Care/standards , Personnel, Hospital/education , Pregnancy Outcome/epidemiology , Safety Management/standards , Evidence-Based Practice/education , Evidence-Based Practice/standards , Female , Fetal Monitoring/methods , Fetal Monitoring/standards , Heart Rate, Fetal/physiology , Humans , Infant, Newborn , Logistic Models , Organizational Case Studies , Patient Satisfaction , Perinatal Care/methods , Pregnancy , Prospective Studies , Quality Indicators, Health Care , Safety Management/methods , Safety Management/organization & administrationABSTRACT
PURPOSE OF REVIEW: The purpose of this review is to examine recent evidence on the role and significance of anesthesiologists in caring for elderly patients suffering from severe trauma. RECENT FINDINGS: Recent findings suggest that early aggressive resuscitation and medical management interventions may lead to improved outcomes in elderly trauma patients. SUMMARY: Data suggest that anesthesiologists should actively participate in the resuscitation and critical care management of patients soon after they have suffered significant trauma. Further research is needed to delineate specific areas of focus and intervention to allow for optimal care and outcomes.
ABSTRACT
The New York State Society of Anesthesiologists' Committee on Continuing Medical Education and Remediation has been charged by the Office of Professional Medical Conduct of the New York State Department of Health to develop a remediation program for individuals ordered into retraining. We describe the development of an anesthesiology-specific evaluation to identify areas of deficiency to both determine a candidate's suitability, as well as to facilitate the creation of an appropriate prescription for retraining. A human patient simulator was used to aid in the gathering of information during the evaluation process. Specifically, the use of simulation allowed the exploration of a candidate's preparation, approach to clinical situations, technical abilities, response to clinical problems, ability to problem solve, and accuracy of medical record keeping. Human patient simulation should be considered a valuable tool in the process of evaluating physicians with lapsed medical skills.
