Large-scale deployment of the Global Trigger Tool across a large hospital system: refinements for the characterisation of adverse events to support patient safety learning opportunities.

BACKGROUND: The Institute for Healthcare Improvement encourages use of the Global Trigger Tool to objectively determine and monitor adverse events (AEs). SETTING: Baylor Health Care System (BHCS) is an integrated healthcare delivery system in North Texas. The Global Trigger Tool was applied to BHCS's eight general acute care hospitals, two inpatient cardiovascular hospitals and two rehabilitation/long-term acute care hospitals. STRATEGY: Data were collected from a monthly random sample of charts for each facility for patients discharged between 1 July 2006 and 30 June 2007 by external professional nurse auditors using an MS Access Tool developed for this initiative. In addition to the data elements recommended by Institute for Healthcare Improvement, BHCS developed fields to permit further characterisation of AEs to identify learning opportunities. A structured narrative description of each identified AE facilitated text mining to further characterise AEs. INITIAL FINDINGS: Based on this sample, AE rates were found to be 68.1 per 1000 patient days, or 50.8 per 100 encounters, and 39.8% of admissions were found to have ≥1 AE. Of all AEs identified, 61.2% were hospital-acquired, 10.1% of which were associated with a National Coordinating Council - Medical Error Reporting and Prevention harm score of "H or I" (near death or death). FUTURE DIRECTION: To enhance learning opportunities and guide quality improvement, BHCS collected data-such as preventability and AE source-to characterise the nature of AEs. Data are provided regularly to hospital teams to direct quality initiatives, moving from a general focus on reducing AEs to more specific programmes based on patterns of harm and preventability.

Community mental health service use by older adults in California.

The objective of this research was to examine older Californians who used county mental health services between 1999 and 2002. We estimated treated prevalence rates, identified repeat service users, depicted service mix patterns and tested for differences among these service process outcomes. We observed 36,230 older Californians who used at least one service between 1999 and 2002. Logistic regressions estimated the effects of time, geographic region, age, diagnosis and insurance status on service process outcomes across 49 county mental health departments. The number of older adults who used services increased significantly during the observation period. Odds of accessing care were higher in the state's northern region, for those diagnosed with mood disorders and Medi-Cal beneficiaries. Repeat service use increased over time, and odds were higher for mood disorders and Medi-Cal beneficiaries. Odds of one-time service use were higher for persons with dementia and other psychiatric diagnoses; mood disorders and Medi-Cal beneficiaries had higher odds of consistent and continuous service use. The counties entered a period of diversification between 1999 and 2002, and varied significantly across treated prevalence rates, service continuity and service mix patterns. We considered how these differences may relate to administrative polices, service management practices, local market conditions and individual characteristics, and called for future research to determine how the public mental health system can assume a more critical role in providing care to older adults.

Enhancing perioperative nursing effectiveness through informatics.

The science of nursing informatics is becoming increasingly important to delivering quality nursing care to all patient populations. Perioperative nursing informatics skills are practiced within the context of powerful and complex information systems that enhance nurses' ability to view and report clinical data in a manner that has never before been possible. This article explores how the analysis of several examples of two typical system indicators (i.e., the unplanned returns to surgery rate within the same admission event, surgical site infection rate) can result in improved patient outcomes. Nursing informatics is an invaluable tool for identifying trends and communicating them to perioperative nurses in a way that can positively influence the delivery of perioperative care and patient outcomes.

Fundamentals of video production and script writing.

Designing and producing videos for medical teaching has nothing in common with television production for broadcasting. The educational video producer has a well defined audience of known intellectual level, the audience is small and the justifiable budget commensurate. The producer must capitalize on the presentational characteristics of the television medium and ensure that the video fits the learning context. The production process is explained with the different roles and responsibilities emphasized.

Group therapy with parents of children with leukemia.

This paper deals with a six-year experience of group therapy for parents of leukemic children. The group, which includes the hospital staff, strengthens the role of parents, doctors, and nurses. Group therapy is seen as a preventive measure in the sense of working with and partially resolving family stresses. Mourning reactions are dealt with but within limits. The group is built into the total treatment program and, while funding lasts, is not considered to be ancillary or temporary.