ABSTRACT
BACKGROUND: Multiple modalities are available to introduce patient safety training to healthcare professionals. In internal medicine, clinical rounds have always played an important role in education; however, the patient safety content taught at the point of care is not well studied. We studied, both quantitatively and qualitatively, the number and nature of patient safety messages delivered by attending physicians to determine what is taught at the point of care and how well this is recognised and recalled by attending physicians, residents and medical students. METHODS: This prospective mixed methods study was conducted on the medicine teaching service. Clinical rounds were audio-recorded. Immediately after rounds, attending physicians, residents and students completed a short survey card identifying the number and type of educational messages they immediately recalled teaching or hearing. Independent t-test was used to compare differences in the number of messages delivered by attendings and recalled by trainees. One-way analysis of variance was used to compare differences in messages delivered by attending physicians compared with trainees. Recordings were transcribed and analysed qualitatively for patient safety content. RESULTS: Trainees recalled more educational messages than attendings recalled teaching in all educational domains. Safety messages comprised 17.5% of educational messages. The average number of patient safety messages recalled per session was 1.08 per attending physicians, 1.84 per resident and 2.50 per student. Residents recalled 56.4% of safety messages delivered; students recalled 76.7% of safety messages. CONCLUSION: Patient safety is a focus of teaching during clinical rounds and provides meaningful opportunities to train students and residents to practice safe patient care.
Subject(s)
Patient Safety/standards , Teaching Rounds/methods , Attitude of Health Personnel , Clinical Competence/standards , Clinical Competence/statistics & numerical data , Cross-Sectional Studies , Humans , Patient Safety/statistics & numerical data , Prospective Studies , Qualitative Research , Students, Medical/psychology , Students, Medical/statistics & numerical data , Surveys and Questionnaires , Teaching Rounds/standards , Teaching Rounds/statistics & numerical dataSubject(s)
Hypertrophy, Right Ventricular/etiology , Lipomatosis/etiology , Obesity, Morbid/complications , Tachycardia, Ventricular/etiology , Ventricular Septum , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Electric Countershock/instrumentation , Electrocardiography , Female , Humans , Hypertrophy, Right Ventricular/diagnosis , Lipomatosis/diagnosis , Magnetic Resonance Imaging , Middle Aged , Multimodal Imaging/methods , Obesity, Morbid/diagnosis , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/therapy , Ventricular Septum/diagnostic imaging , Ventricular Septum/pathologyABSTRACT
A retrospective case-case control study was conducted, including 60 cases with daptomycin-nonsusceptible vancomycin-resistant enterococci (DNS-VRE) matched to cases with daptomycin-susceptible VRE and to uninfected controls (1â¶1â¶3 ratio). Immunosuppression, presence of comorbid conditions, and prior exposure to antimicrobials were independent predictors of DNS-VRE, although prior daptomycin exposure occurred rarely. In summary, a case-case control study identified independent risk factors for the isolation of DNS-VRE: immunosuppression, multiple comorbid conditions, and prior exposures to cephalosporines and metronidazole.
Subject(s)
Anti-Bacterial Agents/pharmacology , Daptomycin/pharmacology , Drug Resistance, Multiple, Bacterial , Enterococcus faecalis/drug effects , Enterococcus faecium/drug effects , Gram-Positive Bacterial Infections/epidemiology , Vancomycin/pharmacology , Adult , Aged , Case-Control Studies , Cephalosporins/therapeutic use , Comorbidity , Female , Gram-Positive Bacterial Infections/microbiology , Humans , Immunosuppression Therapy , Male , Metronidazole/therapeutic use , Middle Aged , Proportional Hazards Models , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Vancomycin ResistanceABSTRACT
In published studies, cohorts of patients with bacteremia due to vancomycin-resistant Enterococcus (VRE) have predominantly been infected with Enterococcus faecium. Little is known about the epidemiology and outcomes associated with bacteremia due to VR Enterococcus faecalis. A retrospective study of isolates obtained from January 2008 to October 2010 was conducted at Detroit Medical Center (DMC). Unique patients with blood cultures positive for VRE were reviewed. Outcomes were analyzed using logistic regression. During the study period, 105 cases of bacteremia due to VR E. faecalis and 197 cases of bacteremia due to VR E. faecium were identified. The mean age in the study cohort was 61.5 ± 15 years; 162 subjects (53.6%) were male. After controlling for a propensity score, bacteremia due to VR E. faecalis was associated with >2-fold-lower in-hospital mortality than bacteremia due to VR E. faecium. Interestingly, bacteremia due to VR E. faecalis was associated with longer hospital stay after VRE isolation, although total length of stay was similar for groups with VR E. faecalis and VR E. faecium. Bacteremia due to VR E. faecalis was associated with a >2-fold-lower risk for mortality than bacteremia due to VR E. faecium, possibly due to the availability of ß-lactam therapeutics for treatment of VR E. faecalis.
