Low Rate of Adverse Events Associated With Inpatient Parenteral Prostacyclins.

Parenteral prostacyclin is the most-effective therapy for patients with pulmonary arterial hypertension. Administration is complex, and administration errors are potentially life threatening. Hospital policies to minimize the risk to patients are necessary, but their effectiveness has not been well studied. We quantified the adverse event incident rate per at-risk patient day in a tertiary care hospital with an established parenteral prostacyclin policy. Patients on parenteral prostacyclin including new initiations from January 2003 to January 2013 were identified, encompassing 386 discrete admissions. Reports of adverse events were obtained from the inpatient risk feedback-reporting process and detailed chart review. Policy-divergent events were analyzed both categorically and by the degree of severity. Overall, 153 total policy-divergent events were identified. Data analysis indicated an incident rate of 45.9 per 1,000 patient days. In total, 21 of 153 potential errors reached the patient, translating to an incident rate of 6.3 per 1,000 patient days. Incident rate for "serious symptomatic" or "catastrophic" policy-divergent events was 3.3 per 1,000 patient days. Even with specific prostacyclin training and administration policy, there remains a small risk of adverse events in hospitalized pulmonary hypertension patients receiving parenteral prostacyclin.

Benefits of integrated behavioral health services: The physician perspective.

INTRODUCTION: There are benefits of integrating a behavioral health specialist in primary care; however, little is known about the physicians' perspectives. The purpose of this study was to explore primary care physicians' beliefs regarding the benefits of integrated care for both patients and themselves. METHOD: Fifteen senior staff physicians and 78 residents completed surveys regarding their opinions of referring to a psychologist in a patient-centered medical home. RESULTS: The top reasons that physicians believed their patients followed through with a visit with an integrated psychologist included that they recommended it (79.5%) and that patients can be seen in the same primary care clinic (76.9%). The overwhelming majority of physicians were satisfied with having access to an integrated psychologist (97.4%). Physicians believed that integrated care directly improves patient care (93.8%), is a needed service (90.3%), and helps provide better care to patients (80.9%). In addition, physicians reported that having an integrated psychologist reduces their personal stress level (90.1%). CONCLUSION: Primary care physicians may be motivated to integrate behavioral health services into their clinics knowing that other physicians believe that it directly and indirectly improves patient care and physician stress.