Developing the Next Generation in Electronic Clinical Auditing: CoBRA Tool.

BACKGROUND: Although auditing is embedded into clinical culture, data collection tends to be retrospective, requires expertise, and is time consuming. LOCAL PROBLEM: Clinical audit data are needed in real time to manage patient safety issues. METHODS: An iterative approach was undertaken to develop the electronic audit tool with a cross-sectional survey used for evaluation. INTERVENTIONS: The Combined Bedside and Risk Assessment (CoBRA) audit tool captures patient safety risk and compliance such as falls, pressure injuries, and infections. RESULTS: More than 17 956 safety audits were collected on randomly selected inpatients. Monthly audits completion average is 96% (n = 614). Patient safety risk mitigation is available in real time. Stakeholders stated that the CoBRA tool was useful in educating patients on risks (n = 141; 78.3%), improved patient care (n = 120; 67.4%), and prompted staff to modify patient care based on CoBRA findings (n = 98; 54%). CONCLUSIONS: The electronic CoBRA process facilitates patient safety risk mitigation and data transparency.

Evaluation of a falls prevention programme in an acute tertiary care hospital.

AIMS AND OBJECTIVES: To evaluate a systematic, coordinated approach to limit the severity and minimize the number of falls in an acute care hospital. BACKGROUND: Patient falls are a significant cause of preventable injury and death, particularly in older patients. Best practice principles mandate that hospitals identify those patients at risk of falling and implement interventions to prevent or minimize them. METHODS: A before and after design was used for the study. All patients admitted to three medical wards and a geriatric evaluation management unit were enrolled over a six-month period. Patients' risk of falling was assessed using a falls risk assessment tool and appropriate interventions implemented using a falls care plan. Data related to the number and severity of falls were obtained from the Australian Incident Monitoring System database used at the study site. RESULTS: In this study, 1357 patient admissions were included. According to their risk category, 37% of patients (n = 496) were grouped as low risk (score = 1-10), 58% (n = 774) medium risk (score = 11-20) and 5% (n = 63) high risk (score = 21-33) for falls. The incidence of falls (per average occupied bed day) was eight per 1000 bed days for the study period. Compared with the same months in 2002/2003, there was a significant reduction in falls from 0.95 to 0.80 (95% CI for the difference -0.14 to -0.16, P < 0.001). CONCLUSION: We evaluated a systematic, coordinated approach to falls management that included a falls risk assessment tool and falls care plan in the acute care setting. Although a significant reduction in falls was found in this study, it could not be attributed to any specific interventions. RELEVANCE TO CLINICAL PRACTICE: Preventing falls where possible is essential. Assessment of risk and use of appropriate interventions can reduce the incidence of falls.

Comparison of short-term clinical postoperative outcomes in patients who underwent carotid endarterectomy: intensive care unit versus the ward high-dependency unit.

The objective of this research was to examine the routine postoperative management of patients who have undergone carotid endarterectomy and compare the intensive care unit (ICU) with the ward high-dependency unit (HDU) in terms of the number, type, severity, or management of postoperative clinical events within a 48-hour time frame. Two of the vascular surgeons routinely admitted patients to the ICU, and 1 vascular surgeon routinely admitted patients to the ward HDU. This research determines whether there was a difference in outcomes between the 2 groups with the intention of changing the practice of the 2 vascular surgeons who routinely admitted their patients to the ICU. This was a nonexperimental, descriptive, prospective study of all patients who underwent carotid endarterectomy during an 18-month period between August 1999 and January 2000. A total of 104 patients were recruited to the study. There were 84 patients in the ICU cohort; 59 were male and 25 were female, with a mean age of 72 years. There were 20 patients in the ward HDU cohort; 12 were male and 8 were female, with a mean age of 66 years. Major complications occurred in 3 patients. One patient from the ICU group was returned to the operating room for evacuation of a hematoma, and 2 patients from the ward HDU group were transferred to the ICU for an inotropic infusion. During the first 24 hours, hypertension developed in 37 patients in the ICU cohort, 12 of whom did not require intervention. Hypertension requiring intervention developed in 3 patients in the ward group. Chi-square cross-tabulation revealed a chi 2 value of 1.4 and a P value of.01, which is a significant difference in the number of hypertensive events in the ICU versus the ward HDU. Hypotension occurred in 41 patients in the ICU group and in 9 patients in the ward cohort. The same chi 2 test was used to reveal a chi 2 value of 0.026 and a P value of.87, which are nonsignificant results. There was no difference in the number of hypotensive events in the ICU versus the ward HDU. There were no reported incidents of tachycardia. Bradycardia was reported in 64 patients in the ICU group and in 12 patients in the HDU group. There was no significant difference in the number of patients with bradycardia in either group of patients. Chi-square analysis revealed a chi 2 value of 1.4 and a P value of.23 during the first 24 hours postoperatively. We believe that careful selection of patients to the ward HDU is safe and cost-effective.