Evaluation of an infrared/radiofrequency equipment-tracking system in a tertiary care hospital

Optimal management of assets in large hospitals is important to both cost control and patient care. A prospective controlled evaluation was conducted to determine whether an asset-tracking system using combined radiofrequency and infrared signals could increase equipment utilization, increase appropriate charge capture, and decrease personnel time spent looking for equipment. Two wards at Duke University Medical Center were randomly assigned as intervention and control. Beds sequential compression devices (SCDs), and infusion pumps were monitored during a 6-week intervention period, preceded and followed by 6-week control periods. The system's accuracy for detecting equipment, relative to a trained surveyor, was greater than 80%. Accuracy for locating equipment to a specific room was 60-80%. With the system available, we observed increased utilization of infusion pumps but not of beds or SCDs. Nursing staff and system users had positive impressions of the system and its potential. Tracking systems can successfully locate hospital equipment and may improve utilization.

Microsystems in health care: Part 6. Designing patient safety into the microsystem

BACKGROUND

This article explores patient safety from a microsystems perspective and from an injury epidemiological perspective and shows how to embed safety into a microsystem's operations. MICROSYSTEMS PATIENT SAFETY SCENARIO: Allison, a 5-year-old preschooler with a history of "wheezy colds," and her mother interacted with several microsystems as they navigated the health care system. At various points, the system failed to address Allison's needs. The Haddon matrix provides a useful framework for analyzing medical failures in patient safety, setting the stage for developing countermeasures.

CASE STUDY

The case study shows the types of failures that can occur in complex medical care settings such as those associated with pediatric procedural sedation. Six patient safety principles, such as "design systems to identify, prevent, absorb, and mitigate errors," can be applied in a clinical setting. In response to this particular case, its subsequent analysis, and the application of microsystems thinking, the anesthesiology department of the Children's Hospital at Dartmouth developed the PainFree Program to provide optimal safety for sedated patients.

CONCLUSION

Safety is a property of a microsystem and it can be achieved only through thoughtful and systematic application of a broad array of process, equipment, organization, supervision, training, simulation, and team-work changes.

The Rotating Hospitalist: A Solution for an Academic Internal Medicine Practice

BACKGROUND

Concerns have been raised about the role that hospitalists may have in changing the educational process for medical students and residents, especially with regard to the primary care specialties.

METHODS

We implemented rotating hospital and office duties within our five-physician group.

RESULTS

Resident and student satisfaction increased, and additional faculty members could be added without expanding office space. Financial benefits then also ensued.

CONCLUSION

Rotating hospital with office duties among a small group of internists has resulted in most of the advantages with few of the drawbacks related to the hospitalist approach.

Developing a comprehensive diagnostic and interventional nephrology program at an academic center

Procedure-related delays in the treatment of patients with renal disease can be minimized and nephrology care can be delivered more efficiently by a nephrologist trained in nephrology-related procedures. Referrals to a radiologist for renal ultrasound and biopsy, to a surgeon for dialysis access placement, and to an interventional radiologist for dialysis catheter placement and vascular access procedures are time consuming and inconvenient to patients with renal disease. Moreover, such an approach may result in delays in the availability of critical diagnostic information and a break in the continuity of care. In an effort to optimize the care of nephrology patients, we developed a diagnostic and interventional nephrology (DIN) program that effectively deals with nephrology-related procedures in a timely manner. At present, some of the commonly performed nephrology-related procedures at our center include diagnostic ultrasonography, ultrasound-guided renal biopsy, peritoneal dialysis access procedures, permanent tunneled hemodialysis catheter placement, and endovascular procedures for arteriovenous dialysis access dysfunction. To date, we have performed 893 procedures during a period of 2 years. This article describes our approach and the tools required to develop a DIN program at an academic medical center.

Creating an integrated patient safety team

CREATING A PATIENT SAFETY TEAM: In May 2001 Brigham and Women's Hospital (Boston) created the Patient Safety Team, which was incorporated into the pre-existing safety and quality infrastructure. ESTABLISHING THE PATIENT SAFETY TEAM'S GOALS AND INITIATIVES: The goal was to create the safest possible environment for patients and staff by creating a culture of safety, increasing the capacity to measure and evaluate processes, committing to change unsafe processes, and adopting new technologies. To achieve this mission, the following initiatives were established: create a culture of safety, increase event identification, improve event analysis, close the feedback loop, assess risk proactively, improve medication safety, and involve the patient.

DISCUSSION

Integrating the Patient Safety Team into pre-existing committees and departments facilitated its work while helping to reinforce the multidisciplinary nature of safety efforts. It is critical that pre-existing groups feel that patient safety represents value added and is not a threat to their current roles.

SUMMARY AND CONCLUSIONS

If a patient safety strategy and team are to be effective, commitment from the organization's leaders is essential. This team should also work with individual departments and pre-existing quality structures to drive changes to the systems of care to enable health care to become as safe as possible.

A service-academic partnership in primary care research: one practice's experience

Further development of a strong research base for general practice is important if the profession is to respond appropriately to its central role in service provision. It can be difficult for general practitioners (GPs) who have not pursued an academic career path to make a significant contribution to research. The development of a service-academic partnership is described, together with an honest account of the difficulties encountered.

Managing technology in a physician-led organization

Mayo Clinic Scottsdale has extended the concept of an integrated, multispecialty clinical practice to the management of information technology. This adaptation of a traditional patient care model has been highly successful in a recent decade of extensive technology investment and deployment that has culminated in a paperless, filmless multicampus electronic medical record to support the mission of the clinic.

Reclassifying infusion therapy space at the University of Arizona: a case study

This case study focused on reclassifying infusion therapy space at the University of Arizona Medical Center to a physician-based treatment setting. The study followed the managerial decision-making process as it described how the space reclassification was recommended, adopted, and implemented. A successful reclassification required close attention to organizational structure, administrative policies and responsibilities, and related work-flow processes.

Promoting health and preventing disability in older adults: lessons from intervention studies carried out through an academic-community partnership

This article describes a partnership between an academic center and community-based organizations for the purpose of improving the health of older adults. Three sequential randomized trials of interventions that have been conducted by this partnership, along with an effectiveness study of one of the interventions, are presented as evidence of the partnership's success. Characteristics of an effective partnership are highlighted; these include: (1) a shared vision and a commitment to achieving similar goals; (2) complementary expertise and resources; (3) a willingness to contribute time and effort on projects that are jointly undertaken; (4) regularly scheduled meeting times to review progress and barriers to progress; and (5) time spent getting to know each other on a personal level. The iterative nature of research and programming that is carried out as part of this partnership is described.

Scholarly development of clinician faculty using evidence-based medicine as an organizing theme

While scholarship is a critical component of the mission of all academic departments, little is known about how to approach the scholarly development of clinician faculty. The authors developed a thematically based faculty development curriculum with two primary components: evidence-based clinical practice and critical appraisal of current clinical research. They took a task management approach to reducing anticipated barriers to program success by instituting a regularly scheduled seminar series, providing evidence-based reading materials, recruiting clinician faculty as speakers for the clinical presentations, and providing continuing medical education credits for seminar attendance. This case study illustrates a faculty development curriculum that stimulated scholarly discussion and research activities in the authors' clinician faculty.

Clinical operations in academic emergency medicine

The operations of an emergency department are increasingly being recognized as vital to the provision of safe, efficient, quality care. The numerous and highly variable processes that characterize our system must be closely examined and investigated to identify those which are effective and those which are not. Original research in this field should be promoted and embraced by our society for both our patients and our profession. Effective operational processes should ultimately be seen as those which preserve and enhance the patient-physician relationship.

Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models

The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.

The role of the academic medical center library in training public librarians

PURPOSE

This project enhanced access to and awareness of health information resources on the part of public libraries in western Pennsylvania.

SETTING/PARTICIPANTS/RESOURCES

The Health Sciences Library System (HSLS), University of Pittsburgh, conducted a needs assessment and offered a series of workshops to 298 public librarians.

BRIEF DESCRIPTION

The National Library of Medicine-funded project "Access to Electronic Health Information" at the HSLS, University of Pittsburgh, provided Internet health information training to public libraries and librarians in sixteen counties in western Pennsylvania. Through this project, this academic medical center library identified the challenges for public librarians in providing health-related reference service, developed a training program to address those challenges, and evaluated the impact of this training on public librarians' ability to provide health information.

RESULTS/OUTCOME

The HSLS experience indicates academic medical center libraries can have a positive impact on their communities by providing health information instruction to public librarians. The success of this project--demonstrated by the number of participants, positive course evaluations, increased comfort level with health-related reference questions, and increased use of MEDLINEplus and other quality information resources--has been a catalyst for continuation of this programming, not only for public librarians but also for the public in general.

EVALUATION METHOD

A training needs assessment, course evaluation, and impact training survey were used in developing the curriculum and evaluating the impact of this training on public librarians' professional activities.