Improving Resident Physician Participation in Reporting Patient Safety and Quality Concerns.

Background: Reporting medical errors, near misses, and adverse events is an important component of improving patient safety and resident learning. Studies have revealed that event reporting rates can be low for physicians, resident physicians, and fellows. The objective of this quality improvement project was to improve resident reporting of patient safety and quality events and engage residents in the analysis of events at a community-based teaching hospital in the United States. Methods: We developed a program to engage 122 residents from 6 Accreditation Council for Graduate Medical Education-accredited residency programs using a multifaceted approach that included instructing residents how to use the hospital's adverse event reporting system; requiring first-year residents to submit at least 1 report; reviewing all resident reports during a monthly multidisciplinary meeting; and ensuring that each resident who submitted a report received feedback on how the concern was being addressed. Results: The program resulted in a 41.8% (95% CI 31%-53%) absolute increase in the number of residents reporting a concern, and resident submissions led to several documented improvements in patient care. A survey was administered to the residents who submitted reports, and the majority (76.0% response rate) expressed satisfaction with both the reporting system and the feedback about how their submission was being addressed. The responding residents agreed that they were more likely to submit reports because of their experience with the program and that they felt the program would improve safety and the quality of care at the institution. Conclusion: This quality improvement project successfully increased resident event reporting and engaged residents in the review of submitted events. The program can serve as a model for other teaching hospitals.

Change in Methicillin-Resistant Staphylococcus aureus Testing in the Intensive Care Unit as an Antimicrobial Stewardship Initiative.

Background: Methicillin-resistant Staphylococcus aureus (MRSA)-associated infections are a cause of morbidity and mortality in the intensive care unit (ICU). Vancomycin is a treatment option but is not without risks. Methods: A MRSA testing change-the switch from culture to polymerase chain reaction-was implemented at 2 adult (tertiary and community) ICUs located in a Midwestern US health system. Data from 2016 to 2020 were included in the study, and the median change in time to test results was examined. Results: During the study period, 71% of 19,975 patients seen at the 2 ICUs received MRSA testing. In the preintervention period, 91% and 99% of patients at the tertiary and community hospitals received testing via culture, respectively. Culture testing was used 1% and ∼0% of the time at the tertiary and community hospitals, respectively, in the postintervention period. A counterfactual estimate showed 36 (95% credible interval [CrI], 35, 37) and 32 (95% CrI, 31, 33) fewer hours until results were available at the tertiary and community hospitals, respectively. Conclusion: After the testing change, MRSA results were available in less time. Obtaining results sooner can assist with antimicrobial stewardship through the potential delay in initiating therapies such as vancomycin and/or quicker de-escalation of such therapies.

Extreme material parameters accessible by active acoustic metamaterials with Willis coupling.

Active acoustic metamaterials incorporate electric circuit elements that input energy into an otherwise passive medium to aptly modulate the effective material properties. Here, we propose an active acoustic metamaterial with Willis coupling to drastically extend the tunability of the effective density and bulk modulus with the accessible parameter range enlarged by at least two orders of magnitude compared to that of a non-Willis metamaterial. Traditional active metamaterial designs are based on local resonances without considering the Willis coupling that limit their accessible effective material parameter range. Our design adopts a unit cell structure with two sensor-transducer pairs coupling the acoustic response on both sides of the metamaterial by detecting incident waves and driving active signals asymmetrically superimposed onto the passive response of the material. The Willis coupling results from feedback control circuits with unequal gains. These asymmetric feedback control circuits use Willis coupling to expand the accessible range of the effective density and bulk modulus of the metamaterial. The extreme effective material parameters realizable by the metamaterials will remarkably broaden their applications in biomedical imaging, noise control, and transformation acoustics-based cloaking.

Structured pharmaceutical representative interactions and counterdetailing sessions as components of medical resident education.

INTRODUCTION: Educational activities should be developed to teach residents how to constructively interact with pharmaceutical representatives and how to critically assess the provided information. METHODS: An educational study was implemented during the 2010-2011 academic year in an internal medicine residency program. The study included an initial educational session on physician-industry relations and then 4 interactive sessions with the pharmaceutical representatives, each followed by a counterdetailing session provided by a clinical pharmacist. Study surveys were conducted to evaluate resident attitudes concerning pharmaceutical representative presented information before and after the counterdetailing sessions. RESULTS: A total of 27 residents (n = 27) participated in the study. The study results revealed that residents learned new relevant product information from the representatives (P = .002) and strongly agreed that counterdetailing was beneficial (P = .009). Residents further agreed that they would recommend counterdetailing presentations to peers, suggested minimal changes to session formatting, and recommended its continued inclusion in their curriculum. CONCLUSIONS: This study demonstrated benefits of a comprehensive program to teach residents how to constructively interact with the pharmaceutical representatives and critically assess the information provided by the representatives. Best practices for incorporating interaction and counterdetailing sessions into medical resident curriculum should be further studied.

Evaluation of patient handoff methods on an inpatient teaching service.

BACKGROUND: The patient handoff process can be a highly variable and unstructured period at risk for communication errors. The morning sign-in process used by resident physicians at teaching hospitals typically involves less rigorous handoff protocols than the resident evening sign-out process. Little research has been conducted on best practices for handoffs during morning sign-in exchanges between resident physicians. Research must evaluate optimal protocols for the resident morning sign-in process. METHODS: Three morning handoff protocols consisting of written, electronic, and face-to-face methods were implemented over 3 study phases during an academic year. Study participants included all interns covering the internal medicine inpatient teaching service at a tertiary hospital. Study measures entailed intern survey-based interviews analyzed for failures in handoff protocols with or without missed pertinent information. Descriptive and comparative analyses examined study phase differences. RESULTS: A scheduled face-to-face handoff process had the fewest protocol deviations and demonstrated best communication of essential patient care information between cross-covering teams compared to written and electronic sign-in protocols. CONCLUSION: Intern patient handoffs were more reliable when the sign-in protocol included scheduled face-to-face meetings. This method provided the best communication of patient care information and allowed for open exchanges of information.

Results from a transitional-year program director survey: identifying crucial issues and concerns.

BACKGROUND: Transitional Year (TY) programs meet an important need by preparing residents for specialties that accept individuals after an initial preparatory year. To our knowledge, no surveys to date have been conducted to identify attributes of TY programs and concerns of TY program directors. PURPOSE: The purpose of this study was to review TY program characteristics and identify critical issues and concerns of TY program directors (TYPDs). METHODS: A web-based, 22-question survey was sent to all 114 TYPDs of programs accredited by the Accreditation Council for Graduate Medical Education between January and April 2011. The survey included open-formatted and closed-formatted questions addressing program and institution demographics, program director time, administrative support, satisfaction, and future plans. RESULTS: The survey response rate was 86%. The median age of TY programs was 28 years, with few new programs. More than 80% of TY programs were conducted at community hospitals and university-affiliated community hospitals. Of the responding TYPDs, 17% had served less than 2 years, and 32% had served 10 years or more. Common sponsoring TY programs included internal medicine (88%), general surgery (42%), family medicine (25%), emergency medicine (24%), and pediatrics (18%). Overall, TYPDs were satisfied with their positions. They expressed concerns about inadequate time to complete duties, salary support, and administrative duties assigned to program coordinators. Forty-nine percent of TYPDs reported they planned to leave the position within the next 5 years. CONCLUSIONS: Our survey provides useful information to assist institutions and the graduate medical education community in meeting the needs of TYPDs and strengthening TY programs.

Designing fish for improved human health status.

The time-course of accumulation of dietary organic and inorganic selenium (Se; 1.5 mg Se kg(-1) dry weight feed) was examined for muscle and hepatic tissues of hybrid striped bass (HSB) over 6 weeks. Animals, which had been fed a Se deficient diet for 2 months prior to study, were maintained in a recirculating life support system at 28 +/- 1 degrees C. PIT tagged fish were randomly assigned to one of 24 120 L aquaria (n = 5 per tank) and subsequently fed one of four diets: a fishmeal-based diet (control), soybean-casein-based feeds either supplemented with organic (SelPlex) or inorganic (sodium selenite) Se or as a basal diet, purposefully deficient in Se. Fish were fed twice daily on a 4% body weight basis. Samples taken at trial start (week 0), mid-way (3 weeks) and at trial end (6 weeks) included weight and length data, hepatosomatic (HSI) and visceral (VSI) indices, intraperitoneal fat (IPF) and muscle (MR) and feed conversion (FCR) ratios, serum protein (SP), hematocrit (PCV), and serum glutathione peroxidase (GP(x)) activity and muscle and heaptic Se concentrations. Survival was also monitored throughout the study. Muscle and hepatic Se levels increased in fishmeal and Se supplemented diets throughout the study. At trail end, greatest weight gain (P < 0.05) was observed in fish fed the control, fishmeal-based diet. Comparison of tissue Se levels indicated that the liver accumulated this mineral at greater concentrations than the muscle with highest levels being observed in the inorganic Se fed fish (P < 0.05). Se accumulation in control and inorganic Se fed fish was similar, whilst Se in the liver of fish fed the Se deficient diet was lowest among groups (P < 0.05). Muscle Se accumulation was found to be greatest in organic Se containing diets (P < 0.05), whereas the basal, Se deficient diet group, returned lowest levels (P < 0.05). Plasma GP(x) activity was similar in HSB fed the fishmeal and organic Se diets. The fishmeal fed group expressed higher (P < 0.05) GP(x) levels than that recorded for either the inorganic or basal diets. At trial end, no differences were recorded between groups for PCV or HSI, VSI or IPF. SP levels and MR were higher (P < 0.05) in fishmeal control fed fish. FCRs were lowest in fishmeal fed fish and highest for the Se deficient or basal diet. These studies demonstrate the feasibility of producing cultured fish with heightened levels of Se using simple dietary manipulations for 4-6 weeks or less before harvesting.