Reduction in hospital mortality over time in a hospital without a pediatric medical emergency team: limitations of before-and-after study designs.
Arch Pediatr Adolesc Med. 2011 May;165(5):419-23.
Source
Division of Pediatric Intensive Care, Department of Pediatrics, 8440 112th St., Edmonton, Alberta, Canada. ari.joffe@albertahealthservices.ca
Abstract
OBJECTIVE:
To determine whether hospital mortality has decreased over time in a hospital that has not introduced a pediatric medical emergency team (PMET).
DESIGN:
Retrospective observational study.
SETTING:
Quaternary children’s hospital.
PARTICIPANTS:
All pediatric inpatient separations (defined as any discharge, including death) during 10 fiscal years.
MAIN OUTCOME MEASURES:
We searched our hospital administrative database to determine the number of pediatric inpatient separations and deaths, and we searched the hospital switchboard and pediatric intensive care databases to determine ward code and cardiopulmonary arrest rates. Relative risks (RRs) with 95% confidence intervals (CIs) and logistic regression compared results over time.
RESULTS:
During the periods of the 2 PMET studies showing a reduction in hospital mortality, we found a decrease in hospital mortality: for 1999-2002 vs 2002-2006, 212 deaths among 14 161 patients (1.50%) vs 219 of 26 767 (0.82%), RR, 0.55 (95% CI, 0.44-0.69); for 2000-2005 vs 2005-2007, 300 deaths among 29 497 patients (1.02%) vs 98 of 14 005 (0.70%), RR, 0.69 (95% CI, 0.55-0.86). During the periods of the 3 PMET studies showing no change in or not examining hospital mortality, we found no significant change in hospital mortality. The annual odds ratio for survival was 1.13 (95% CI, 1.09-1.16). There were no changes in ward code and cardiopulmonary arrest rates over time.
CONCLUSIONS:
We found a reduction in hospital mortality over time in a children’s hospital without a PMET. This demonstrates the limitation of before-and-after study designs, and we hypothesize that multiple co-interventions account for the decrease in mortality. Whether a PMET could have reduced mortality further is unknown.
Comment in
- PMID:
- 21536956
- [PubMed - indexed for MEDLINE]
Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units.
Jt Comm J Qual Patient Saf. 2011 Aug;37(8):365-74.
Source
University of North Carolina Health Care, Chapel Hill, North Carolina, USA. cmayer@unch.unc.edu
Abstract
BACKGROUND:
An evidence-based teamwork system, Team-STEPPS, was implemented in an academic medical center’s pediatric and surgical ICUs.
METHODS:
A multidisciplinary change team of unit- and department-based leaders was formed to champion the initiative; develop a customized action plan for implementation; train frontline staff; and identify process, team outcome, and clinical outcome objectives for the intervention. The evaluation consisted of interviews with key staff, teamwork observations, staff surveys, and clinical outcome data.
RESULTS:
All PICU, SICU, and respiratory therapy staff received TeamSTEPPS training. Staff reported improved experience of teamwork posttraining and evaluated the implementation as effective. Observed team performance significantly improved for all core areas of competency at 1 month postimplementation and remained significantly improved for most of the core areas of competency at 6 and 12 months postimplementation. Survey data indicated improvements in staff perceptions of teamwork and communication openness in both units. From pre- to posttraining, the average time for placing patients on extracorporeal membrane oxygenation (ECMO) decreased significantly. The average duration of adult surgery rapid response team events was 33% longer at postimplementation versus pre-implementation. The rate of nosocomial infections at postimplementation was below the upper control limit for seven out of eight months in both the PICU and the SICU.
CONCLUSIONS:
The implementation of a customized 2.5-hour version of the TeamSTEPPS training program in two areas–the PICU and SICU–that had demonstrated successful ability to innovate suggests that the training was successful.
- PMID:
- 21874972
- [PubMed - indexed for MEDLINE]
Implementation of condition help: family teaching and evaluation of family understanding.
J Nurs Care Qual. 2012 Apr-Jun;27(2):176-81.
Source
Advanced Clinical Practice, Duke Children’s Hospital and Health Center, Duke University Hospital, Duke University, Durham, NC 27710, USA. remi.hueckel@duke.edu
Abstract
Partnering with families to deliver safe care includes teaching how to activate the rapid response team (RRT) if their hospitalized child’s condition worsens. Condition Help (Condition H) is how families call the RRT. Pediatric nurses used scripted Condition H teaching and follow-up surveys to evaluate family understanding about Condition H. Although there were only 2 Condition H calls during the study period, 53% to 90% of families received Condition H teaching, and family understanding was greater than 75%.
- PMID:
- 21989457
- [PubMed - in process]
Medication errors reported in a pediatric intensive care unit for oncologic patients.
Cancer Nurs. 2011 Sep-Oct;34(5):393-400.
Source
Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Brazil.
Abstract
BACKGROUND:
Considering all sources of errors that may occur during healthcare, medication errors are the most common and also the most frequent cause of adverse events.
OBJECTIVE:
The objective of the study was to describe the medication errors reported in a pediatric intensive care unit for oncologic patients.
METHODS:
This is a descriptive and exploratory study. The errors were reported by the professionals involved in the medication system in a medication error report form developed for the study.
RESULTS:
The sample consisted of 110 medication errors reported on 71 forms. The omission error was the most common error type reported (22.7%), followed by administration error (18.2%). No harm to patients was reported in 83.1% of the notifications.
CONCLUSION:
The analysis of the110 medication errors provides evidence of the context of their occurrence and the need to implement measures that can prevent or intercept these errors.
IMPLICATIONS FOR PRACTICE:
In an institution without adverse events report and a formal system to patient safety analysis, the implementation of a local nonpunitive approach to medication errors notification represented an important tool to patient safety promotion.
- PMID:
- 21860269
- [PubMed - indexed for MEDLINE]
Improving reporting of outpatient pediatric medical errors.
Pediatrics. 2011 Dec;128(6):e1608-13. Epub 2011 Nov 21.
Source
Department of Pediatrics, Levine Children’s Hospital, Charlotte, NC 28207, USA. daniel.neuspiel@carolinashealthcare.org
Abstract
OBJECTIVE:
Limited information exists about medical errors in ambulatory pediatrics and on effective strategies for improving their reporting. We aimed to implement nonpunitive error reporting, describe errors, and use a team-based approach to promote patient safety in an academic pediatric practice.
PATIENTS AND METHODS:
The setting was an academic general pediatric practice in Charlotte, North Carolina, that has ∼26 000 annual visits and primarily serves a diverse, low-income, Medicaid-insured population. We assembled a multidisciplinary patient safety team to detect and analyze ambulatory medical errors by using a reporter-anonymous nonpunitive process. The team used systems analysis and rapid redesign to evaluate each error report and recommend changes to prevent patient harm.
RESULTS:
In 30 months, 216 medical errors were reported, compared with 5 reports in the year before the project. Most reports originated from nurses, physicians, and midlevel providers. The most frequently reported errors were misfiled or erroneously entered patient information (n = 68), laboratory tests delayed or not performed (n = 27), errors in medication prescriptions or dispensing (n = 24), vaccine errors (n = 21), patient not given requested appointment or referral (n = 16), and delay in office care (n = 15), which together comprised 76% of the reports. Many recommended changes were implemented.
CONCLUSIONS:
A voluntary, nonpunitive, multidisciplinary team approach was effective in improving error reporting, analyzing reported errors, and implementing interventions with the aim of reducing patient harm in an outpatient pediatric practice.
- PMID:
- 22106082
- [PubMed - indexed for MEDLINE]
Identification by families of pediatric adverse events and near misses overlooked by health care providers.
CMAJ. 2012 Jan 10;184(1):29-34. Epub 2011 Nov 21.
Source
Department of Anesthesiology, Pharmacology, and Therapeutics, The University of British Columbia, Vancouver, BC. jeremy.patrick.daniels@gmail.com
Abstract
BACKGROUND:
Identifying adverse events and near misses is essential to improving safety in the health care system. Patients are capable of reliably identifying and reporting adverse events. The effect of a patient safety reporting system used by families of pediatric inpatients on reporting of adverse events by health care providers has not previously been investigated.
METHODS:
Between Nov. 1, 2008, and Nov. 30, 2009, families of children discharged from a single ward of British Columbia’s Children’s Hospital were asked to respond to a questionnaire about adverse events and near misses during the hospital stay. Rates of reporting by health care providers for this period were compared with rates for the previous year. Family reports for specific incidents were matched with reports by health care providers to determine overlap.
RESULTS:
A total of 544 familes responded to the questionnaire. The estimated absolute increase in reports by health care providers per 100 admissions was 0.5% (95% confidence interval -1.8% to 2.7%). A total of 321 events were identified in 201 of the 544 family reports. Of these, 153 (48%) were determined to represent legitimate patient safety concerns. Only 8 (2.5%) of the adverse events reported by families were also reported by health care providers.
INTERPRETATION:
The introduction of a family-based system for reporting adverse events involving pediatric inpatients, administered at the time of discharge, did not change rates of reporting of adverse events and near misses by health care providers. Most reports submitted by families were not duplicated in the reporting system for health care providers, which suggests that families and staff members view safety-related events differently. However, almost half of the family reports represented legitimate patient safety concerns. Families appeared capable of providing valuable information for improving the safety of pediatric inpatients.
Implementing medication reconciliation in outpatient pediatrics.
Pediatrics. 2011 Dec;128(6):e1600-7. Epub 2011 Nov 28.
Source
Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE 19803, USA. drappapo@nemours.org
Abstract
OBJECTIVE:
To describe the implementation of a system-wide, electronic medical record (EMR)-based quality improvement intervention targeting medication reconciliation (MedRec) in outpatient pediatrics and to test variables associated with the performance of MedRec.
METHODS:
This was a retrospective study using serial cross-sections of outpatient pediatric visits over a 5-year period set in a multispecialty children’s integrated health care network in Florida, Delaware, Pennsylvania, and New Jersey. We reviewed 2 745 523 outpatient pediatric visits between 2005 and 2010. In 2007, the performance of MedRec was identified as critical to improving patient safety at our organization. A comprehensive intervention involved changes in the EMR, automated generation of medication lists, educational modules, and provider compliance reports. In 2009, quality-based financial incentives to physicians to perform MedRec were added. The outcome measure was documentation of MedRec performance.
RESULTS:
MedRec improved consistently over time, from a nadir of 0% in 2005 to a maximum of 71% in 2010. Performance of MedRec varied according to practice location as the intervention was rolled out. Throughout the study period, documentation of MedRec was consistently less likely for sick visits (adjusted odds ratio [aOR] for each year ranged from 0.44 to 0.68) but more likely if the provider placed a medication order during the visit (aOR: 1.70-2.15). Beginning in 2009, visits with providers eligible for the quality-based financial incentive were more likely to have had MedRec performed (aOR: 2.02 [2009] and 2.31 [2010]).
CONCLUSIONS:
A system-wide, EMR-based, outpatient pediatric quality improvement intervention was successful in improving documentation of the performance of MedRec, a national patient safety goal.
- PMID:
- 22123872
- [PubMed - indexed for MEDLINE]
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