Assessment of the Knowledge, Perception and Practice of Voluntary Blood Donation among Physicians in a Tertiary Health Facility, Uyo, South-South Nigeria.

Background: Provision of safe, affordable and adequate supply of blood and blood products is a daunting public health issue in developing countries. In Nigeria, there is an inadmissibly high dependence on family surrogate and remunerated blood donors which carries an attendant increased risk of transfusion transmissible infections. Physicians represent a potential, stable and sustainable safe donor pool. Assessment of the blood donation practices of these health professionals is essential in engendering effective strategy for sustaining adequate and safe blood supply in the hospitals. To assess the knowledge, attitude and practice of voluntary blood donation among physicians, to identify, recruit and retain potential voluntary blood donors among them and to determine the associations between blood donation and gender, marital status, duration of practice and professional cadre of the physicians. Methodology: This was a descriptive cross-sectional study carried out at the University of Uyo Teaching Hospital, Uyo. Pre-tested questionnaire were administered to 110 physicians in the tertiary hospital. Results: Majority of the respondents (95.1%) had a good knowledge of the risk of transmission of infections by blood transfusion. The risk of transmission of HIV, HBV, HCV and Syphilis was affirmed by 99.8%, 95.6%, 80.1% and 48.2% respectively. Forty-five(40.9%) physicians had donated blood in the past, with 32 (71.1%) donating less than once a year, 10(22.2%) between 1-3 times a year and 3(6.7%) more than thrice a year. Most (56.9%) donated voluntarily, 34.3% donated for friends and relatives, 5.7% donated in order to know their HIV, HBV and HCV status and 3.1% for financial gratification. There was significant association between blood donation practice and gender but not with marital status, duration of practice and professional cadre of the physicians as P values were 0.002, 0.767, 0.135 and 0.625 respectively. Conclusion: Physicians in the study expressed good knowledge of voluntary blood donation and had a positive attitude towards donation but there were inconsistencies in their practice of blood donation. Thus, regular and rigorous motivational and educational campaign should be intensified among physicians to improve their overall blood donation practice.

Unit-based interprofessional leadership models in six US hospitals.

The landscape of hospital-based care has shifted to place greater emphasis on improving quality and delivering value. In response, hospitals and healthcare organizations must reassess their strategies to improve care delivery in their facilities and beyond. Although these institutional goals may be defined at the executive level, implementation takes place at local sites of care. To lead these efforts, hospitals need to appoint effective leaders at the frontlines. Hospitalists are well poised to take on the role of the local clinical care improvement leader based on their experiences as direct frontline caregivers and their integral roles in hospital-wide quality and safety initiatives. A unit-based leadership model consisting of a medical director paired with a nurse manager has been implemented in several hospitals to function as an effector arm in response to the changing landscape of inpatient care. We provide an overview of this new model of leadership and describe the experiences of 6 hospitals that have implemented it.

Getting doctors to report medical errors: project DISCLOSE.

BACKGROUND: Despite the number of patient safety incidents that occur in hospitals, physicians currently may not have the ideal incident reporting tools for easy disclosure. A study was undertaken to assess the effectiveness of a simplified paper incident reporting process for internal medicine physicians on uncovering patient safety incidents. DESIGN: Thirty-nine internal medicine attending physicians were instructed to incorporate the use of a simplified paper incident reporting tool (DISCLOSE) into daily patient rounds during a three-month period. All physicians were surveyed at the conclusion of the three months. RESULTS: Compared with physician reporting via the hospital's traditional incident reports from the same time period, a higher number (98 incidents versus 37; a 2.6-fold increase) of incidents were uncovered using the DISCLOSE reporting tool in a larger number of error categories (58 versus 14, a 4.1-fold increase). When reviewed and classified with a five-point harm scale, 41% of events were judged to have reached patients but not caused harm, 33% to have resulted in temporary harm, and 9% of reports, though not considered events, were to indicate a "risky situation." Surveyed physicians were more satisfied with the process of submitting incident reports using the new DISCLOSE tool. DISCUSSION: A simplified incident reporting process at the point of care generated a larger number and breadth of physician disclosed error categories, and increased physician satisfaction with the process.

Establishing a rapid response team (RRT) in an academic hospital: one year's experience.

BACKGROUND: Rapid response teams and medical emergency teams have been utilized to rapidly manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions but have not been extensively described in the American medical literature. OBJECTIVES: To describe a full year's experience of implementing a rapid response team (RRT) in an academic medical center. DESIGN: Retrospective analysis of our hospital's RRT database and description of the implementation process from July 2004 to July 2005. SETTING: Urban, academic medical center. RESULTS: The RRT system was activated for 307 potentially unstable patients. The most common reasons for an RRT activation were cardiac, respiratory, and neurological conditions. At least 37% of RRT calls were for off-unit inpatients and to outpatient/common areas frequented by outpatients and visitors, whereas at least 42% occurred in inpatient units. Most RRT calls, 82.9%, occurred during daytime hours. In the opinion of RRT leaders 98% of the evaluated calls were appropriate and 85% of the RRT responses resulted in the prevention of further clinical deterioration. CONCLUSIONS: An RRT was introduced into an academic medical center, and the results suggested it is capable of preventing clinical deterioration in unstable patients and may have the potential to decrease the frequency of cardiac arrests. The RRT also may fill a gap in patient safety by enabling rapid triage and expedited treatment of off-unit inpatients, outpatients, and visitors. The keys to the early success of our implementation of an RRT were multidisciplinary input and improvements made in real time.