Physician reporting of clinically significant events through a computerized patient sign-out system.

OBJECTIVES: : Although electronic reporting systems for near-misses and adverse events have been implemented nationwide, physician participation in such systems has typically been very limited. Previous efforts to improve such rates have met with some success but may be costly and time-consuming. To improve events reporting rates at our academic medical center, we incorporated a physician reporting module into the computer software that house officers already use for their daily sign-out routine. METHODS: : During the period between January 1 and June 30, 2009, house staff were asked to report a set of 13 predefined "clinically significant events" such as cardiopulmonary arrests and unexpected transfers to the intensive care unit. Entries were maintained in an administrative data collection module and were reviewed daily by the residency program director and chief residents. RESULTS: : House staff reported approximately 12 incidents per month. A survey of the intern class (the heaviest users of system) showed that the principal barriers to physician reporting at our facility were related to ease of use, time pressure, and fear of disciplinary actions. Information gleaned from the reports has been useful in modifying a number of patient care processes on the medicine service. CONCLUSIONS: : Our experience suggests that if a training program makes it easy for the house officer to report events during routine work duties, by integrating the reporting system into the tools of daily patient care, physicians will become willing participants in the process. A handheld version of such a reporting system holds promise for even greater physician participation in the future.

An overview of outpatient treatment of adolescent substance abuse.

This paper reviews the literature on ambulatory substance abuse treatment for adolescents, including brief intervention, Twelve-Step-based outpatient treatment, family-based treatment, cognitive behavioral therapy, and pharmacologic treatment. An overview of socially and culturally specific strategies is also included. The diversity of settings and approaches and combinations of approaches in the treatment of adolescents is emphasized as are adaptations of Twelve-Step and other group based interventions. Family-based and multisystem therapy, adapted for substance using adolescents, is highlighted as a promising future direction of effective treatment.

Recovery and spiritual transformation among peer leaders of a modified methadone anonymous group.

This analysis of five recovery narratives from leaders of a peer-led, 12-Step-based self- help group in a methadone treatment program highlights the importance of spiritually-mediated role transformation in the recovery process. For these men and women in their forties and fifties, their progression to a leadership role helping others with their recovery validated the spiritual transformation they regarded as underlying their own recovery process. Assumption of this new leadership/helper role marked a tangible sign that their deepened spirituality allowed them to assume a new, higher function in a struggle with the addiction that had plagued their lives. For these peer leaders, methadone was at the core of the group experience and an aid to spiritual transformation.

Network therapy: decreased secondary opioid use during buprenorphine maintenance.

Network therapy (NT) employs family members and/or friends to support compliance with an addiction treatment carried out in office practice. This study was designed to ascertain whether NT is a useful psychosocial adjunct, relative to a control treatment, for achieving diminished illicit heroin use for patients on buprenorphine maintenance. Patients agreeing to randomization to either NT (N = 33) or medication management (MM, N = 33) were inducted onto short-term buprenorphine maintenance and then tapered to zero dose. NT resulted in significantly more urine toxicologies negative for opioids than MM (65% vs. 45%) and more NT than MM patients (50% vs. 23%) experienced a positive outcome relative to secondary heroin use by the end of treatment. The use of NT in office practice may therefore improve the effectiveness of eliminating secondary heroin use during buprenorphine maintenance. It may also be useful in enhancing compliance with an addiction treatment regimen in other contexts.