Staff perceptions of patient visibility systems in acute care settings.

Patient care visibility technology systems provide real-time information about patient admissions, discharges, transport, clinical activities and housekeeping services, in order to enhance patient care and flow. This article reports the results of a descriptive study that explored healthcare professionals' perceptions of and attitudes to a patient care visibility technology system in an acute care setting. The results indicate that staff find the system user friendly, and are positive about its staff- and patient-focused characteristics. Overall, positive staff perceptions and acceptance imply positive use of the system. This study forms the basis for further research on the effects on the patient-care outcomes of healthcare professionals' use of these systems.

Predictors of patient medication compliance on the day of surgery and the effects of providing patients with standardized yet simplified medication instructions.

BACKGROUND: Anesthesiologists are responsible for optimizing patients' preoperative medications, including maximizing their compliance with preoperative medication instructions. The authors hypothesized that a standardized, simplified instruction sheet presented and verbally reinforced during the preanesthesia clinic visit would improve patient medication compliance on the day of surgery. METHODS: An unmatched case-control design was applied, with nonrandomized, preintervention (controls) and postintervention (cases) data collected. In the preintervention group, patient education/instruction regarding taking medications on the day of surgery continued in the existing, unstandardized manner. In the postintervention group, patients were given a simplified, multicolored Preoperative Patient Medication Instruction Sheet, which was consistently verbally reviewed with patients. Group differences and independent variable associations were analyzed with conventional inferential biostatistics. RESULTS: A total of 521 and 531 patients were enrolled in the preintervention group and postintervention group, respectively. Of this, 309 patients (60%) of preintervention group versus 391 patients (74%) of postintervention group (P < 0.001) were compliant with their preoperative medication instructions on the day of surgery. Use of the Preoperative Medication Instruction Sheet (adjusted odds ratio [aOR] = 1.83; P < 0.001), Caucasian race (aOR = 1.74; P = 0.007), and recalling receiving both verbal/written preoperative medication instructions (aOR = 1.51; P = 0.006) were associated with greater patient medication compliance. Older age (aOR = 0.67; P = 0.014) and higher American Society of Anesthesiologists status (aOR = 0.60; P = 0.004) were associated with lesser patient medication compliance. CONCLUSIONS: A standardized, multicolored, pictorial Preoperative Patient Medication Instruction Sheet, with patient communication in both verbal/written forms, seems to improve patient medication compliance on the day of surgery. African-Americans, older patients, and those with greater comorbidities may require a more concerted effort to achieve an adequate preoperative medication compliance.

Inhibition of IRF5 cellular activity with cell-penetrating peptides that target homodimerization.

The transcription factor interferon regulatory factor 5 (IRF5) plays essential roles in pathogen-induced immunity downstream of Toll-, nucleotide-binding oligomerization domain-, and retinoic acid-inducible gene I-like receptors and is an autoimmune susceptibility gene. Normally, inactive in the cytoplasm, upon stimulation, IRF5 undergoes posttranslational modification(s), homodimerization, and nuclear translocation, where dimers mediate proinflammatory gene transcription. Here, we report the rational design of cell-penetrating peptides (CPPs) that disrupt IRF5 homodimerization. Biochemical and imaging analysis shows that IRF5-CPPs are cell permeable, noncytotoxic, and directly bind to endogenous IRF5. IRF5-CPPs were selective and afforded cell type- and species-specific inhibition. In plasmacytoid dendritic cells, inhibition of IRF5-mediated interferon-α production corresponded to a dose-dependent reduction in nuclear phosphorylated IRF5 [p(Ser462)IRF5], with no effect on pIRF5 levels. These data support that IRF5-CPPs function downstream of phosphorylation. Together, data support the utility of IRF5-CPPs as novel tools to probe IRF5 activation and function in disease.

Decreasing Time to Place and Teach Double-Lumen Endotracheal Intubation: Engaging Anesthesia in Lean.

BACKGROUND: This report documents our process to standardize and decrease the time to place and teach double-lumen endotracheal tube (DLETT) intubation. METHODS: A prospective database of patients who underwent lobectomy or segmentectomy by 1 surgeon was reviewed. A systematic approach was instituted starting in 2009. A monitor in the room displayed the bronchoscopic view as anesthesia residents were taught how to drive a bronchoscope. The bronchial side was placed above the carina, a bronchoscope went into the desired side, and the double-lumen tube slid over it. A head towel protected the ears, face, and hair, and the DLETT was anchored so that rebronching after turning was eliminated. All other nonvalued steps were eliminated. RESULTS: There were 2,940 patients. Pulmonary lobectomy was performed in 2,421 patients and segmentectomy in 566. Patients were divided into nine cohorts of 350 consecutive patients, except for the last cohort. Median time for DLETT placement decreased from 13 minutes from January 1997 to February 2001 to a median 45 seconds from June 2016 to May 2017 (p < 0.001). Anesthesia residents, present for 76% of the operations, were able to place the tube independently 80% of the time. There were no airway perforations. CONCLUSIONS: DLETT placement can be standardized and taught efficiently. Factors that may lead to this are eliminating nonvalued steps (process of lean), engaging anesthesiologists and surgeons to teach team standardization, improved tracheal-bronchial anatomy and bronchoscopy skills in residents, and displaying the intubation and bronchoscopy on a monitor.

Decreasing the Preincision Time for Pulmonary Lobectomy: The Process of Lean and Value Stream Mapping.

BACKGROUND: Our objective was to evaluate our results after the implementation of lean (the elimination of wasteful parts of a process). METHODS: After meetings with our anesthesiologists, we standardized our "in the operating room-to-skin incision protocols" before pulmonary lobectomy. Patients were divided into consecutive cohorts of 300 lobectomy patients. Several protocols were slowly adopted and outcomes were evaluated. RESULTS: One surgeon performed 2,206 pulmonary lobectomies, of which 84% were for cancer. Protocols for lateral decubitus positioning changed over time. We eliminated axillary rolls, arm boards, and beanbags. Monitoring devices were slowly eliminated. Central catheters decreased from 75% to 0% of patients, epidurals from 84% to 3%, arterial catheters from 93% to 4%, and finally, Foley catheters were reduced from 99% to 11% (p ≤ 0.001 for all). A protocol for the insertion of double-lumen endotracheal tubes was established and times decreased (mean, 14 minutes to 1 minute; p = 0.001). After all changes were made, the time between operating room entry and incision decreased from a mean of 64 minutes to 37 minutes (p < 0.001). Outcomes improved, mortality decreased from 3.2% to 0.26% (p = 0.015), and major morbidity decreased from 15.2% to 5.3% (p = 0.042). CONCLUSIONS: Lean and value stream mapping can be safely applied to the clinical algorithms of high-risk patient care. We demonstrate that elimination of non-value-added steps can safely decrease preincision time without increasing patient risk in patients who undergo pulmonary lobectomy. Selected centers may be able to adopt some of these lean-driven protocols.