| Improved clinical outcomes combining house staff self-assessment with an audit-based quality improvement program. | |
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MedLine Citation:
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PMID: 20556534 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: There is a focus on integrating quality improvement with medical education and advancement of the American College of Graduate Medical Education (ACGME) core competencies. OBJECTIVE: To determine if audits of patients with unexpected admission to the medical intensive care unit using a self-assessment tool and a focused Morbidity and Mortality (M&M) conference improves patient care. DESIGN: Charts from patients transferred from the general medical floor (GMF) to the medical intensive care unit (ICU) were reviewed by a multidisciplinary team. Physician and nursing self-assessment tools and a targeted monthly M&M conference were part of the educational component. PARTICIPANTS: Physicians and nurses participated in root cause analysis. MEASURES: Records of all patients transferred from a general medical floor (GMF) to the ICU were audited. One hundred ninety-four cases were reviewed over a 10-month period. RESULTS: New policies regarding vital signs and house staff escalation of care were initiated. The percentage of calls for patients who met medical emergency response team/critical care consult criteria increased from 53% to 73%, nurse notification of a change in a patient's condition increased from 65% to 100%, nursing documentation of the change in the patients condition and follow-up actions increased from 65% percent to a high of 90%, the number of cardiac arrests on a GMF decreased from 3.1/1,000 discharges to 0.6/1,000 discharges (p = 0.002), and deaths on the Medicine Service decreased from 34/1,000 discharges to 24/1,000 discharges (p = 0.024). CONCLUSION: We describe an audit-based program that involves nurses, house staff, a self-assessment tool and a focused M&M conference. The program resulted in significant policy changes, more rapid assessment of unstable patients and improved hospital outcomes. |
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Authors:
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Linda Kirschenbaum; Susannah Kurtz; Mark Astiz |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2010-06-17 |
Journal Detail:
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Title: Journal of general internal medicine Volume: 25 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-21 Completed Date: 2011-08-16 Revised Date: 2012-05-07 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1078-82 Citation Subset: IM |
Affiliation:
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Saint Vincents Hospital, New York Medical College, Lenox Hill Hospital, New York, NY 10075, USA. lkirschenbaum@Lenoxhill.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Clinical Audit
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standards*,
trends Humans Intensive Care Units / standards, trends Internship and Residency / standards*, trends Quality Assurance, Health Care / standards, trends Quality Improvement / standards*, trends Self-Assessment* Treatment Outcome |
| Comments/Corrections | |
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