Safety in training and learning in the intensive care unit.

Resident and subspecialty fellow trainees in the intensive care unit (ICU) present risks for patient safety because of their inexperience yet offer opportunities to promote safe patient care because of their around-the-clock presence and their involvement in frontline processes of care. Most trainees approach their ICU experiences without previous education in performance improvement or patient safety. This article reviews the barriers that are faced by residents in providing safe patient care and outlines the nature of a patient safety curriculum that could tap the opportunities that are presented by trainees to promote safer patient care.

Training resident physicians toward improved patient safety.

Residents in training represent both a problem and opportunity in promoting enhanced patients safety in acute care settings. Trainees do not bring the experience and knowledge of attending physicians to the bedside and have an increased risk for medical errors. Yet, the around-the-clock presence of residents in the hospital and their awareness of impediments to safer patient care present a potential for preventing error-related adverse events. Capturing this potential for improved patient safety requires a broadened training curriculum that focuses on patient safety.

Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

BACKGROUND: The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources. RESULTS: Work on COF began in March 2000 with transfer of 25 MUSC paper-based order set forms to an intranet site. Physician groups developed additional order sets, which number more than 200. Web traffic increased progressively during a 24-month period, peaking at more than 6,400 hits per month to COF. Decision support tools improved compliance with Centers for Medicare & Medicaid Services core indicators. DISCUSSION: Clinicians demonstrated a willingness to develop and use order sets and decision support tools posted on the COF site. COF provides a low-cost method for preparing caregivers and institutions to adopt CPOE and standardization of care. The educational resources, relevant links to external resources, and communication alerts will all link to CPOE, thereby providing a head start in CPOE implementation.

The guideline approach to chronic obstructive pulmonary disease: how effective?

Clinical practice guidelines are systematically developed to assist health care decisions in specific clinical circumstances. They first arose to improve quality of care by decreasing unexplained practice variation, controlling health care costs, fostering evidence-based decision-making, and accelerating the application of new advances in medical science to everyday practice. Unfortunately, multiple studies demonstrate incomplete and varied effectiveness of clinical practice guidelines in altering clinician behavior and improving patient outcomes. Efforts to enhance guideline effectiveness have focused on improving the methods for guideline development, diffusion, dissemination, and implementation. Despite evidence of limited effectiveness, more than 40 clinical practice guidelines pertaining to chronic obstructive pulmonary disease have been published since 1985. The present article reviews those guidelines, evidence for their effectiveness, and approaches to improve their implementation.