2011 December 06

Adoption of a wiki within a large internal medicine residency program: a 3-year experience.

J Am Med Inform Assoc Start a Discussion »

Dec 062011

Adoption of a wiki within a large internal medicine residency program: a 3-year experience.

J Am Med Inform Assoc. 2011 Dec 2;

Authors: Crotty BH, Mostaghimi A, Reynolds EE

Abstract
ObjectiveTo describe the creation and evaluate the use of a wiki by medical residents, and to determine if a wiki would be a useful tool for improving the experience, efficiency, and education of housestaff.Materials and methodsIn 2008, a team of medical residents built a wiki containing institutional knowledge and reference information using Microsoft SharePoint. We tracked visit data for 3 years, and performed an audit of page views and updates in the second year. We evaluated the attitudes of medical residents toward the wiki using a survey.ResultsUsers accessed the wiki 23?218, 35?094, and 40?545 times in each of three successive academic years from 2008 to 2011. In the year two audit, 85 users made a total of 1082 updates to 176 pages and of these, 91 were new page creations by 17 users. Forty-eight percent of residents edited a page. All housestaff felt the wiki improved their ability to complete tasks, and 90%, 89%, and 57% reported that the wiki improved their experience, efficiency, and education, respectively, when surveyed in academic year 2009-2010.DiscussionA wiki is a useful and popular tool for organizing administrative and educational content for residents. Housestaff felt strongly that the wiki improved their workflow, but a smaller educational impact was observed. Nearly half of the housestaff edited the wiki, suggesting broad buy-in among the residents.ConclusionA wiki is a feasible and useful tool for improving information retrieval for house officers.

PMID: 22140210 [PubMed - as supplied by publisher]

Link to Article at PubMed

Clinical characteristics and outcomes of diabetes sufferers hospitalized from 2009 pandemic influenza A H1N1 infections.

J Infect Start a Discussion »

Dec 062011

Clinical characteristics and outcomes of diabetes sufferers hospitalized from 2009 pandemic influenza A H1N1 infections.

J Infect. 2011 Nov 25;

Authors: Cortes Garcia M, Sierra Moros MJ, Santa-Olalla Peralta P, Hernandez-Barrera V, Jimenez-Garcia R, Pachon I

Abstract
OBJECTIVES: To describe demographic and clinical data and outcomes of severe cases of 2009 pandemic influenza A H1N1 (pH1N1) infections for persons with diabetes. METHODS: We selected all person with diabetes (N = 252) among severe laboratory confirmed cases reported to the Spanish Surveillance System for detection of pH1N1 from June through December, 2009. One patient without diabetes matched by age and sex was selected. Collected variables included demographic characteristics, underlying medical conditions, outcome, clinical course and treatment. RESULTS: Among those suffering diabetes only 15.9% did not report any other underlying condition. 38% of diabetic patients and 27.4% of non diabetic patients were admitted to ICU (p = 0.008). Thirty subjects suffering diabetes and fifteen without the disease died (11.9% vs. 6%[p = 0.019]). Multivariable analysis showed that the independent risk factors for ICU admission or death were suffering cardiovascular disease (OR = 2.28), morbid obesity (OR = 2.08) and antiviral treatment started after 48 h of onset of symptoms (OR = 1.89). Suffering diabetes was not independent risk factors for ICU admission or death after adjusting for covariates. CONCLUSIONS: The worse outcome among diabetes sufferers could be a consequence of the higher prevalence of comorbid underlying medical conditions but not diabetes itself. Further prospective studies are needed to verify these results.

PMID: 22138602 [PubMed - as supplied by publisher]

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Cardiothoracic ratio from postero-anterior chest radiographs: A simple, reproducible and independent marker of disease severity and outcome in adults with congenital heart disease.

Int J Cardiol Start a Discussion »

Dec 062011

Cardiothoracic ratio from postero-anterior chest radiographs: A simple, reproducible and independent marker of disease severity and outcome in adults with congenital heart disease.

Int J Cardiol. 2011 Nov 30;

Authors: Dimopoulos K, Giannakoulas G, Bendayan I, Liodakis E, Petracco R, Diller GP, Piepoli MF, Swan L, Mullen M, Best N, Poole-Wilson PA, Francis DP, Rubens MB, Gatzoulis MA

Abstract
OBJECTIVE: The wide spectrum of intracardiac anatomy and reparative surgery available for adults with congenital heart disease (ACHD) makes uniform measurement of cardiac size and disease severity challenging. The aim of this study was to assess the prognostic potential of cardiothoracic ratio, a simple marker of cardiomegaly, in a large cohort of ACHD. PATIENTS AND SETTING: Chest radiographs from 3033 ACHD patients attending our institution between 1998 and 2007 and 113 normal controls of similar age were analyzed blindly. DESIGN: Cardiothoracic ratio derived from plain postero-anterior chest radiographs, was compared between ACHD patients and controls, different diagnostic subgroups and different functional classes. Relationship between cardiothoracic ratio and survival was assessed using Cox regression. RESULTS: Average cardiothoracic ratio in ACHD was 52.0±7.6% (over 50% in 56.4%), significantly higher in all ACHD diagnostic subgroups compared to controls (42.3±4.0%, p<0.0001) and highest in the "complex" cardiac anatomy, Ebstein's anomaly and Eisenmenger subgroups. Cardiothoracic ratio related to functional class, but was high even in asymptomatic patients. During a median follow-up of 4.2years, 164 patients died. Patients with a cardiothoracic ratio >55% had an 8-fold increased risk of death compared to those in the lowest tertile (<48%). Even patients with mildly increased cardiothoracic ratio (48-55%) had an adjusted 3.6-fold increased mortality compared to the lowest tertile. CONCLUSIONS: Cardiothoracic ratio derived from postero-anterior chest radiographs is a simple, and reproducible marker, which relates to functional class and predicts independently mortality risk in ACHD patients.

PMID: 22137450 [PubMed - as supplied by publisher]

Link to Article at PubMed

Unit-based care teams and the frequency and quality of physician-nurse communications.

arch pediatr adolesc med Start a Discussion »

Dec 062011

Unit-based care teams and the frequency and quality of physician-nurse communications.

Arch Pediatr Adolesc Med. 2011 May;165(5):424-8

Authors: Gordon MB, Melvin P, Graham D, Fifer E, Chiang VW, Sectish TC, Landrigan CP

Abstract
OBJECTIVE: To determine whether reorganizing physicians into unit-based teams in general pediatric wards is associated with greater ability to identify other care team members, increased face-to-face communication between physicians and nurses, greater perception that their patient care concerns were met, and decreased number of pages to residents.
DESIGN: Prospective intervention study with data collected before and at 2 time points after implementation of unit-based teams.
SETTING: General pediatric wards at an urban, tertiary care, freestanding children's hospital from April 1, 2008, through June 30, 2009.
PARTICIPANTS: Pediatric residents rotating in the medical wards (n = 60) and ward-based pediatric nurses (n = 154).
INTERVENTION: We reorganized resident-physician care teams to be based on specific inpatient units, with residents admitting and caring only for patients on their assigned unit.
MAIN OUTCOME MEASURES: Anonymous physician and nurse self-reports of communication practices and number of pages residents received.
RESULTS: In the unit-based team system, physicians were more likely to be able to identify the nurse for their patients with the most complex conditions (62.3% vs 82.8% vs 82.5%, P = .05), to report contacting (27.3% vs 64.9% vs 56.9%, P = .01) and being contacted by (7.7% vs 48.2% vs 55.2%, P = .002) that nurse in person, and to believe their patient care concerns were met (44.2% vs 82.1% vs 81.8%, P = .009). Nurses reported parallel improvements in communication patterns. The mean number of pages per day to residents decreased by 42.1% (19 vs 10 vs 11, P < .001).
CONCLUSION: Unit-based teams improve the frequency and quality of multidisciplinary communication, which may create an improved climate for patient safety.

PMID: 21536957 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Implementing handoff communication.

j nurses staff dev Start a Discussion »

Dec 062011

Implementing handoff communication.

J Nurses Staff Dev. 2011 May-Jun;27(3):128-35

Authors: Ardoin KB, Broussard L

Abstract
Healthcare systems are seeking assistance from other well-known industries for a solution to issues related to handoff communication, the system for relaying patient information from one caregiver to another. Although the handoff should provide accurate information about a patient's care, treatment, services, and condition, inconsistencies in communication among practitioners exist. This lack of consistent messages prompted staff development nurses in a community hospital to introduce the SBAR process (situation, background, assessment, and recommendation) as the standard for handoff communication to reduce errors and improve patient safety.

PMID: 21602630 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Quality of care using a multidisciplinary team in the emergency room.

Dan Med Bull Start a Discussion »

Dec 062011

Quality of care using a multidisciplinary team in the emergency room.

Dan Med Bull. 2011 Jun;58(6):A4227

Authors: Christensen D, Maaløe R, Jensen NM, Rudolph SS, Perrild H

Abstract
INTRODUCTION: Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients.
MATERIAL AND METHODS: A retrospective evaluation was made of all ECs and TCs registered during a six-month period. Information on sex, age, interventions at the ED, time spent at the ED and outcome measures (admission, Intensive Care Unit (ICU) admission and death) were obtained. The quality of the acute medical treatment during the ED stay and the first 48 hours of admission were evaluated by senior consultants from the departments receiving the patients.
RESULTS: A total of 150 ECs and 47 TCs were included. The median time spent at the ED was 65 minutes for ECs and 95 minutes for TCs. In EC patients a median of eight interventions were performed at the ED, while a median of five interventions were performed in TC patients. A total of 137 EC patients were admitted to hospital including 32 patients admitted to the ICU. In all, 49 EC patients died during admission. Forty percent of TC patients were discharged to their homes. Only one trauma patient died and none were admitted to the ICU. The acute medical treatment was found to be satisfactory in 87% of EC patients and 96% of TC patients.
CONCLUSION: A multidisciplinary team reception ensures early initiation of diagnostic procedures and treatment, short ED stays and admission to relevant departments in critically ill and severely injured patients.

PMID: 21651874 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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