ABSTRACT
With increased oversight of residency work hours, there has been an increase in shift handoffs, which are prone to medical errors. To date, there are no evidence-based recommendations on essential elements of shift handoffs. We implemented a standardized shift-handoff rubric at an academic medicine residency program. Compliance, resident/faculty perceptions, and surrogate markers of patient safety were measured.Shift-handoff documents were collected January-February 2016 (control) April-June 2016 (intervention). Signouts were scored based on inclusion of seven elements: Daily events, Overnight events, Code status, Follow up tasks, If/then statements, 'sick or stable' and History present illness. The mnemonic 'DOCFISH' was taught in a grand-rounds forum then embedded into a shift-handoff tool within our electronic health record (EHR). Senior residents were assigned to supervise/provide feedback on shift handoffs from April-June 2016. Faculty and resident perceptions regarding quality of shift handoffs was measured by the annual ACGME (Accreditation Council Graduate Medical Education) program survey.Patient safety was measured by number of rapid-response teams (RRT) initiated for unstable vital signs. Handoffs were 74% complete in intervention group and 60% in control group (pâ<â.0001). Median DOCFISH features present in patients that required RRT was 3 of 7 whereas, total post-intervention group had 5 of 7 (pâ<â.001). 'Daily events' and 'follow -up tasks' were less frequent in patients that required RRT (20%, 67% respectively, pâ<â.001).Academic medical centers can implement standardized shift handoffs by embedding high-yield information in an EHR with peer-review. Information during shift changes that may have significant improvement on patient safety includes: 'daily events' and 'follow -up tasks.'
Subject(s)
Academic Medical Centers/organization & administration , Internal Medicine/education , Internship and Residency/organization & administration , Patient Handoff/organization & administration , Quality Improvement/organization & administration , Academic Medical Centers/standards , Attitude of Health Personnel , Hospital Rapid Response Team/statistics & numerical data , Humans , Internship and Residency/standards , Patient Handoff/standards , Patient Safety/standards , Perception , Pilot ProjectsSubject(s)
Bronchi , Foreign Bodies/complications , Levofloxacin/adverse effects , Respiratory Aspiration/complications , Respiratory Insufficiency/etiology , Bronchoscopes , Bronchoscopy/instrumentation , Bronchoscopy/methods , Computed Tomography Angiography , Female , Foreign Bodies/therapy , Humans , Middle Aged , Respiratory Aspiration/diagnostic imaging , Respiratory Aspiration/etiology , Respiratory Aspiration/therapy , Respiratory Insufficiency/diagnostic imaging , Tablets , Treatment OutcomeABSTRACT
Volume holographic gratings are recorded and retrieved in two commercially available glasses: Schott Foturan and Hoya PEG3. These materials are photoetchable, which describes their major application, but they also allow storage of volume holograms without any chemical etching. The samples are illuminated with ultraviolet light at a wavelength of 325 nm and thermally processed to achieve a maximum diffraction efficiency of approximately 9% for a 1-mm-thick sample. The two glasses show similar behavior; the diffraction efficiencies in Foturan tend to be slightly larger, whereas PEG3 tends to have weaker light scattering.
