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Chapter 58. Practices Rated by Research Priority

Further research on a number of practices would clarify a range of questions (e.g., whether the practice is effective, what aspects of a multi-faceted intervention matter the most, how best to implement the practice). The conceptual framework for this categorization is described in Chapter 56. In Table 58.1 and 58.2, the practices are grouped in zones: "research likely to be highly beneficial," and "research likely to be beneficial." We also list, in the far-right column, the practices' categorization for "Strength of the Evidence" (as detailed above in Tables 57.1-57.5). For presentation in this table, this category is simplified into a 1 ("highest strength of evidence") to 5 ("lowest strength of evidence") which corresponds exactly to the groupings in Tables 57.1-5. We list these here to allow the reader to compare and contrast the research priority rankings with the evidence rankings. Practices that are not listed in either Table 58.1 or 58.2 may benefit from more research, but were not scored as highly as those included in these 2 lists.

Table 58.1 Further Research Likely to be Highly Beneficial

ChapterPatient Safety TargetPatient Safety PracticeStrength of the Evidence
(1-5 Scale; 1 is highest)
20.4Surgical site infectionsPerioperative glucose control3
18Mortality associated with surgical proceduresLocalizing specific surgeries and procedures to high volume centers2
20.3Surgical site infectionsUse of supplemental perioperative oxygen2
39Morbidity and mortalityChanges in nursing staffing2
15.1Hospital-acquired urinary tract infectionUse of silver alloy-coated catheters2
6Medication errors and adverse drug events (ADEs) primarily related to ordering processComputerized physician order entry (CPOE) with clinical decision support (CDSS)3
14Hospital-acquired infections due to antibiotic-resistant organismsLimitations placed on antibiotic use3
20.1Surgical site infectionsAppropriate use of antibiotic prophylaxis1
31Venous thromboembolism (VTE)Appropriate VTE prophylaxis1
33Morbidity and mortality in post-surgical and critically ill patientsVarious nutritional strategies (especially early enteral nutrition in critically ill and post-surgical patients)1
37.1Inadequate pain relief in patients with abdominal pain in hospital patientsUse of analgesics in the patient with acute abdomen without compromising diagnostic accuracy4
12Hospital-acquired infectionsImprove handwashing compliance (via education/behavior change; sink technology and placement; washing substance)4
9Adverse events related to chronic anticoagulation with warfarinPatient self-management using home monitoring devices1
21Morbidity due to central venous catheter insertionUse of real-time ultrasound guidance during central line insertion1
38Morbidity and mortality in ICU patientsChange in ICU structure—active management by intensivist2
32Contrast-induced renal failureHydration protocols with acetylcysteine3
43.1Adverse events due to patient misidentificationUse of bar coding4
27Pressure ulcersUse of pressure relieving bedding materials1
20.2Surgical site infectionsMaintenance of perioperative normothermia3
25Perioperative cardiac events in patients undergoing noncardiac surgeryUse of perioperative beta-blockers1
48Missed or incomplete or not fully comprehended informed consentUse of video or audio stimuli2
28Hospital-related deliriumMulti-component delirium prevention program2
7Medication errors and adverse drug events (ADEs) related to ordering and monitoringClinical pharmacist consultation services3
13Serious nosocomial infections (e.g., vancomycin-resistant enterococcus, C. difficile)Barrier precautions (via gowns & gloves; dedicated equipment; dedicated personnel)3
9Adverse events related to anticoagulationAnticoagulation services and clinics for coumadin3
48Missed, incomplete or not fully comprehended informed consentProvision of written informed consent information3
49Failure to honor patient preferences for end-of-life careComputer-generated reminders to discuss advanced directives3
9Adverse events related to anticoagulationProtocols for high-risk drugs: nomograms for heparin3
26.3FallsUse of bed alarms3
11Adverse drug events (ADEs) in drug dispensing and/or administrationUse of automated medication dispensing devices4
Table 58.2 Further Research Likely to be Beneficial
ChapterPatient Safety TargetPatient Safety PracticeImpact/ Evidence Category
17.2Ventilator-associated pneumoniaContinuous aspiration of subglottic secretions (CASS)1
17.1Ventilator-associated pneumoniaSemi-recumbent positioning2
26.5Falls and fall injuriesUse of hip protectors2
30Hospital-acquired complications (functional decline, mortality)Geriatric evaluation and management unit2
47Adverse events due to transportation of critically ill patients between healthcare facilitiesSpecialized teams for interhospital transport3
34Stress-related gastrointestinal bleedingH2-antagonists3
37.2Inadequate pain reliefAcute pain service3
15.2Hospital-acquired urinary tract infectionUse of suprapubic catheters3
26.2Restraint-related injury; FallsInterventions to reduce the use of physical restraints safely3
45Adverse events due to provider inexperience or unfamiliarity with certain procedures and situationsSimulator-based training4
49Failure to honor patient preferences for end-of-life careUse of physician order form for life-sustaining treatment (POLST)4
42.2Adverse events during cross-coverageStandardized, structured sign-outs for physicians4
44Adverse events related to team performance issuesApplications of aviation-style crew resource management (e.g., Anesthesia Crisis Management; MedTeams)4
16.2Central venous catheter-related bloodstream infectionsAntibiotic-impregnated catheters1
17.3Ventilator-associated pneumoniaSelective decontamination of digestive tract2
42.4Failures to communicate significant abnormal results (e.g., pap smears)Protocols for notification of test results to patients3
36Pneumococcal pneumoniaMethods to increase pneumococcal vaccination rate3
16.3Central venous catheter-related bloodstream infectionsCleaning site (povidone-iodine to chlorhexidine)4
16.4Central venous catheter-related bloodstream infectionsUse of heparin4
16.4Central venous catheter-related bloodstream infectionsTunneling short-term central venous catheters4
29Hospital-acquired complications (e.g., falls, delirium, functional decline, mortality)Geriatric consultation services4
46Adverse events related to fatigue in healthcare workersLimiting individual provider's hours of service4
26.4Falls and fall-related injuriesUse of special flooring material in patient care areas5
43.2Performance of invasive diagnostic or therapeutic procedure on wrong body part"Sign your site" protocols5
42.1Adverse events related to discontinuities in careInformation transfer between inpatient and outpatient pharmacy2
48Missed, incomplete or not fully comprehended informed consentAsking that patients recall and restate what they have been told during informed consent1
8Adverse drug events (ADEs) related to targeted classes (analgesics, KCl, antibiotics, heparin) (focus on detection)Use of computer monitoring for potential ADEs2
24Critical events in anesthesiaIntraoperative monitoring of vital signs and oxygenation4
42.3Adverse events related to information loss at dischargeUse of structured discharge summaries5

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Current as of July 2001
Internet Citation: Chapter 58. Practices Rated by Research Priority. July 2001. Agency for Healthcare Research and Quality, Rockville, MD.