Standard Written Checklists Can Improve Patient Safety during Surgical Crises

Enewsletter, Issue 364

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

January 18, 2013

AHRQ Stats

Patients' survival following a heart attack in the hospital has improved since 2001, according to AHRQ projections. The in-hospital death rate is projected to fall to 5.4 percent by the end of 2012, compared with 9.9 percent in 2001. (Source: HCUP Projections: Cardiovascular/Cerebrovascular Conditions and Procedures 2011 to 2012).

Today's Headlines

  1. Standard Written Checklists Can Improve Patient Safety during Surgical Crises.
  2. Practice Facilitators and Case Managers Can Help Enhance the Primary Care Team.
  3. Access to Health Services Webinar: Securing Health Coverage for Children through Statewide Partnerships.
  4. Study Examines Use of Clinical Decision Support Systems to Promote Judicious Use of Antibiotics.
  5. AHRQ, CDC and HHS Assistant Secretary for Preparedness and Response Assess the 2009 Influenza Pandemic's Impact.
  6. New Study Highlights the Nurse's Role in Keeping Patients Safe.
  7. AHRQ Webinar: Using ACO Principles and Financial Incentives to Improve Health Outcomes.
  8. AHRQ's Health Care Innovations Exchange Focuses on Patient-Centered Hospital Design.
  9. AHRQ in the professional literature.
 

1. Standard Written Checklists Can Improve Patient Safety during Surgical Crises

Doctors, nurses and other hospital operating room staff who follow a written safety checklist to respond when a patient experiences cardiac arrest, severe allergic reaction, bleeding followed by an irregular heartbeat or other crisis during surgery, are nearly 75 percent less likely to miss a critical clinical step, according to a new AHRQ-funded study that appeared in the New England Journal of Medicine on January 16. Investigators simulated multiple operating room crises and assessed the ability of 17 operating room teams from three Boston-area hospitals—one teaching hospital and two community hospitals—to adhere to life-saving steps for each simulated crisis. In half of the crisis scenarios, operating room teams were provided with evidence-based, written checklists. In the other half of crisis scenarios, the teams worked from memory alone. While the use of checklists is rapidly becoming a standard of surgical care, the impact of their use during a surgical crisis has been largely untested. Select to read the AHRQ press release.

 

2. Practice Facilitators and Case Managers Can Help Enhance the Primary Care Team

Efforts to redesign primary care require multiple supports. Two potential members of the primary care team—the practice facilitator and care manager—play distinct roles in redesigning and improving care delivery, according to a new AHRQ study. Facilitators, also known as quality improvement coaches, help coordinate practices' quality improvement activities and build capacity for those activities. Care managers coordinate care and help patients navigate the system, improving access and overall communication. These complementary roles are examined in detail in "Enhancing the Primary Care Team to Provide Redesigned Care: The Roles of Practice Facilitators and Care Managers," which appears in the January/February online issue of Annals of Family Medicine. Select to access the article .

 

3. Access to Health Services Webinar: Securing Health Coverage for Children through Statewide Partnerships

In 2011, 5 million children had no health insurance coverage, yet providing health insurance to children is viewed by many as a critical step to improving public health. Registration is now open for a January 24 Web conference from 3:00 p.m.—3:45 p.m. EST that will be hosted by the HHS Office of the Assistant Secretary for Health. This Web conference highlights the success of one statewide partnership in securing coverage for more than 500,000 previously uninsured children through advocacy and community outreach. The 45-minute Web conference will be led by HHS Assistant Secretary for Health, Howard Koh, M.D., and will include a roundtable discussion on the impact of this critical topic.Select to register .

 

4. Study Examines Use of Clinical Decision Support Systems to Promote Judicious Use of Antibiotics

A recent AHRQ-funded study examined facilitators and barriers to the use of a clinical decision support system (CDSS) that targeted inappropriate antibiotic prescribing. Researchers determined adoption rates and explored providers' attitudes associated with the clinical decision support tool that was adopted at 9 primary care practices. Beliefs associated with successful adoption of the CDSS included the perception that the systems helped in the decision-making process and facilitated conversations with patients about appropriate antibiotic use. Other factors that influenced success included the engagement of non-physician staff and using an iterative, customizable CDSS. Barriers to adoption included providers' discomfort with CDSS recommendations, inability to use the CDSS at the point of care, and the perception that the CDSS had limited value for decisionmaking. The study, "Adoption of a Clinical Decision Support System to Promote Judicious Use of Antibiotics for Acute Respiratory Infections," appeared in the August 2012 issue of the International Journal of Medical Informatics. Select to access the abstract on PubMed®.

 

5. AHRQ, CDC and HHS Assistant Secretary for Preparedness and Response Assess the 2009 Influenza Pandemic's Impact

The 2009 H1N1 influenza pandemic resulted in an 18 percent surge in hospital emergency department encounters, but did not have a significant impact on overall admissions, a new study published online in Medical Care found. Ten percent of the hospitals in the study experienced a surge in admissions, and patients in those facilities had worse outcomes for heart attack and stroke during periods of the surge. These hospitals also had worse outcomes for acute cardiac illnesses before the pandemic, suggesting a link between daily hospital operations and disaster preparedness. The study, requested by HHS Secretary Kathleen Sebelius, was a collaborative effort involving AHRQ, CDC, NIH, the Office of the HHS Assistant Secretary for Preparedness and Response, and academic experts. Select to access the abstract on PubMed®.

A reprint copy is available by sending an Email to ahrqpubs@ahrq.hhs.gov. In addition to this study, AHRQ published a new statistical brief showing that hospital emergency department visits for influenza increased from 491,900 in 2008 to 1,281,700 in 2009 and that hospital admissions for influenza rose from 88,300 to 163,200. Select to access the statistical brief, "Emergency Department Visits and Hospital Inpatient Stays for Seasonal and 2009 H1N1 Influenza, 2008-2009" [Plugin Software Help].

 

6. New Study Highlights the Nurse's Role in Keeping Patients Safe

In this new AHRQ-funded study, nurses at a 274-bed Midwest academic medical center describe the challenges of keeping their patients safe amid constraints within their institution's patient safety culture. The findings helped develop a new framework to manage risk that recognizes the ongoing challenges for nursing staff to better manage patient safety. A more in-depth understanding of how nurses view and manage risk can help to improve their hospital's patient safety efforts, according to the authors. The study, "It's Always Something: Hospital Nurses Managing Risk," was published December 4, 2012, in Clinical Nursing Research. Select to access the abstract on PubMed®.

 

7. AHRQ Webinar: Using ACO Principles and Financial Incentives to Improve Health Outcomes

AHRQ's Health Care Innovations Exchange is sponsoring a Web conference on January 29 from 1:00 p.m.—2:30 p.m. EST that focuses on how to use Accountable Care Organization (ACO) principles and financial incentives to improve health outcomes. The following innovations will be featured during this event: The Montefiore Medical Center established an infrastructure based on ACO principles, improving the management of diabetes, asthma, and congestive heart failure and reducing hospital admissions, readmissions, and medical expenses among several key populations. Select to read the innovation profile.

Blue Cross Blue Shield of Michigan provides financial incentives and supports provider-led quality improvement collaboratives, significantly improving quality, reducing costs, and generating a positive return on investment. Select to read the innovation profile and select to register for the conference .

 

8. AHRQ's Health Care Innovations Exchange Focuses on Patient-Centered Hospital Design

The January 16 issue of AHRQ's Health Care Innovations Exchange showcases efforts to implement patient-centered hospital design. One hospital used playful room design and distraction techniques to help pediatric patients through radiology treatments without sedation; a second used natural light, soft colors, plants, art, and music to help patients feel comfortable and heal faster. An infusion center based its patient-centered redesign on the results of a patient survey, which highlighted the need for more comfortable furniture, better lighting, spacious waiting areas, and nature-inspired artwork.

View more innovation profiles and tools related to patient-centered hospital care and facility design on the Innovations Exchange Web site, which contains more than 750 searchable innovations and 1,500 Quality Tools.

 

9. AHRQ in the Professional Literature

Gibbons RD, Brown CH, Hur K, et al. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012 Jun; 69(6):580-587. Select to access the abstract on PubMed®.

Gawron AJ, Rothe J, Fought AJ, et al. Many patients continue using proton pump inhibitors after negative results from tests for reflux disease. Clin Gastroenterol Hepatol 2012 Jun; 10(6):620-625; quiz e57. Select to access the abstract on PubMed®.

Nemeth LS, Ornstein SM, Jenkins RG, et al. Implementing and evaluating electronic standing orders in primary care practice: a PPRNet study. J Am Board Fam Med 2012 Sep; 25(5):594-604. Select to access the abstract on PubMed®.

Zapka J, Klabunde CN, Taplin S, et al. Screening colonoscopy in the US: attitudes and practices of primary care physicians. J Gen Intern Med 2012 Sep; 27(9):1150-1158. Select to access the abstract on PubMed®.

Cox ED, Nackers KA, Young HN, et al. Influence of race and socioeconomic status on engagement in pediatric primary care. Patient Educ Couns 2012 Jun; 87(3):319-326. Select to access the abstract on PubMed®.

Wong ST, Pérez-Stable EJ, Kim SE, et al. Using visual displays to communicate risk of cancer to women from diverse race/ethnic backgrounds. Patient Educ Couns 2012 Jun; 87(3):327-335. Select to access the abstract on PubMed®.

Leeman J, Sommers J, Vu M, et al. An evaluation framework for obesity prevention policy interventions. Prev Chronic Dis 2012 Jun 28; 9:E120. Select to access the abstract on PubMed®.

D'Alessandro AM, Peltier JW, Dahl AJ. A large-scale qualitative study of the potential use of social media by university students to increase awareness and support for organ donation. Prog Transplant 2012 Jun; 22(2):183-191. Select to access the abstract on PubMed®.

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Page last reviewed January 2013
Internet Citation: Standard Written Checklists Can Improve Patient Safety during Surgical Crises: Enewsletter, Issue 364. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/364.html