Reducing pediatric liver transplant complications: a potential roadmap for transplant quality improvement initiatives within North America.

Though robust clinical data are available within transplantation, these data are not used for broad-based, multicentered quality improvement initiates. This article describes a targeted quality improvement initiative within the Studies of Pediatric Liver Transplantation (SPLIT) Registry. Using standard statistical techniques and clinical expertise to adjust for data and statistical reliability, we identified the pediatric liver transplant centers in North America with the lowest hepatic artery thrombosis rate and biliary complication rates. A survey was completed to establish current practices within the entire SPLIT group. Surgeons from the highest performing centers presented a detailed, technically oriented overview of their current practices. The presentations and discussion that followed were recorded and form the basis of the best practices described herein. We frame this work as a unique six-step approach roadmap that may serve as an efficient and cost effective model for novel broad-based quality improvement initiatives within transplantation.

The impact of unlicensed assistive personnel on nursing care delivery.

Besieged with fiscal and political constraints in acute care, the addition or substitution of less expensive nursing personnel is quickly gaining popularity. The evolution of nursing care delivery systems in the acute care setting, the factors associated with the increased use of unlicensed assistive personnel, examination and evaluation of the current literature surrounding unlicensed assistive personnel, and recommendations for a future strategy are described.

Visiting hours in the adult intensive care unit: using research to develop a system that works.

A decade of research has generated controversy and speculation over the ideal visiting practices in the adult intensive care unit (ICU). Analysis of the growing body of research can now be applied to review and revise existing visiting policies. This article provides an analysis of both classic and current research surrounding visiting hours in the ICU and suggests recommendations to guide the nurse in incorporating research-based strategies into practice.