Effective communication for patient safety: transfer note and Modified Early Warning Score. / Comunicação efetiva para a segurança do paciente: nota de transferência e Modified Early Warning Score.

OBJECTIVE: To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD: A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS: NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION: NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.

Comunicação efetiva para a segurança do paciente: nota de transferência e Modified Early Warning Score / Comunicación efectiva para la seguridad del paciente: nota de transferencia y Modified Early Warning Score / Effective communication for patient safety: transfer note and Modified Early Warning Score

Resumo OBJETIVO Analisar o registro da Nota de Transferência (NT) e a emissão do Modified Early Warning Score (MEWS) realizados pelo enfermeiro em pacientes adultos transferidos do Serviço de Emergência como estratégia de comunicação efetiva para a segurança do paciente. MÉTODO Estudo transversal retrospectivo desenvolvido em um hospital de ensino no Sul do Brasil que avaliou 8028 prontuários eletrônicos no ano de 2017. Procedeu-se a análise descritiva. RESULTADOS A realização da NT atingiu a meta institucional de 95% nos meses de janeiro e fevereiro, ficando abaixo da meta nos demais meses. A mensuração do MEWS foi realizada em 85,6% (n=6.870) dos prontuários. Destes pacientes, 96,8% (n=6.652) possuíam MEWS não alterado. CONCLUSÃO A NT e o MEWS estão inseridos no trabalho do enfermeiro, no entanto, são necessárias ações com vistas a qualificar a segurança do paciente, melhorando a comunicação efetiva e, por conseguinte, diminuindo a possibilidade de ocorrências de eventos adversos.

Resumen OBJETIVO Analizar el registro, realizado por el enfermero, la Nota de Transferencia (NT) y la emisión del Modified Early Warning Score (MEWS) en pacientes adultos transferidos del Servicio de Emergencia como estrategia de comunicación efectiva para la seguridad del paciente. MÉTODO Estudio transversal retrospectivo desarrollado en un hospital de enseñanza en el sur de Brasil que evaluó 8028 históricos electrónicos en el año 2017. Se llevó a cabo el análisis descriptivo. RESULTADOS La realización de la NT alcanzó la meta institucional del 95% en los meses de enero y febrero, quedando por debajo de la meta en los demás meses. La medición del MEWS se realizó en el 85,6% (n = 6.870) de los históricos. De estos pacientes, el 96,8% (n = 6.652) poseía MEWS no alterado. CONCLUSIÓN La NT y el MEWS están insertos en el trabajo del enfermero, sin embargo es necesario acciones con miras a calificar la seguridad del paciente, para mejor la comunicación efectiva y, por consiguiente, disminuir la posibilidad de ocurrencia de eventos adversos.

Abstract OBJECTIVE To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.

In-hospital communication experiences of Aboriginal and Torres Strait Islander people: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify and synthesize available qualitative evidence to understand the in-hospital communication experiences of Aboriginal and Torres Strait Islander adults, their family members and hospital staff, and the factors that impact on these experiences.Specifically, the review questions are as follows.

Designing Technology for Assessments of CALD Patients.

Interpreters are required to aid communication between clinicians and culturally and linguistically diverse (CALD) patients to ensure appropriate and timely care. Demand for interpreting services however, often exceeds supply. A mobile app to translate clinical assessment questions in 10 common languages using pictorial, written and voice-over prompts to assist patient assessments when interpreters are unavailable has been developed. This paper reports on the User Needs Analysis that informed the app. The analysis consisted of focus groups with allied health clinicians to understand pertinent aspects of initial allied health assessments and the communication needs to be addressed in the design of an app-based patient assessment tool. Outcomes show that of primary importance to clinicians was the ability to not only ask the patients questions, but to communicate information to increase understanding of, and ensure compliance with, treatments and interventions to promote patient function and comfort.

Application of a smartphone nurse call system for nursing care.

BACKGROUND: Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. MATERIALS AND METHODS: A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. RESULTS: Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. CONCLUSIONS: After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients' satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses.

Cross hospital bed management system.

The lack of adequate numbers of hospital beds to accommodate the injured is a main problem in public hospitals. For control of occupancy of bed, we design a dynamic system that announces status of bed when it change with admission or discharge of a patient. This system provide a wide network in country for bed management, especially for ICU and CCU beds that help us to distribute injured patient in the hospitals.

A randomized trial of automated electronic alerts demonstrating improved reimbursable anesthesia time documentation.

STUDY OBJECTIVE: To investigate whether alerting providers to errors results in improved documentation of reimbursable anesthesia care. DESIGN: Prospective randomized controlled trial. SETTING: Operating room (OR) of a university hospital. INTERVENTIONS: Anesthesia cases were evaluated to determine whether they met the definition for appropriate anesthesia start time over 4 separate, 45-day calendar cycles: the pre-study period, study period, immediate post-study period, and 3-year follow-up period. During the study period, providers were randomly assigned to either a control or an alert group. Providers in the alert cohort received an automated alphanumeric page if the anesthesia start time occurred concurrently with the patient entering the OR, or more than 30 minutes before entering the OR. MEASUREMENTS: Three years after the intervention period, overall compliance was analyzed to assess learned behavior. MAIN RESULTS: Baseline compliance was 33% ± 5%. During the intervention period, providers in the alert group showed 87% ± 6% compliance compared with 41% ± 7% compliance in the control group (P < 0.001). Long-term follow-up after cessation of the alerts showed 85% ± 4% compliance. CONCLUSIONS: Automated electronic reminders for time-based billing charges are effective and result in improved ongoing reimbursement.

Use of communication technologies to cost-effectively increase the availability of interpretation services in healthcare settings.

Poor patient-provider communication due to limited English proficiency (LEP) costs healthcare providers and payers through lower patient use of preventive care, misdiagnosis, increased testing, poor patient compliance, and increased hospital and emergency room admissions. Scarcity of bilingual healthcare professionals and prohibitive interpretation costs hinder full implementation of language service despite federal and state laws requiring their provision. We review recent published literature and unpublished data documenting the use of telephonic and video interpretation methodologies to improve healthcare communication with LEP persons. For example, a cooperative of nine California public hospitals and their associated community clinics, psychiatric facilities, skilled nursing facilities, and public health departments have implemented shared video interpretation services with video/voice-over Internet Protocol call center technology that automatically routes requests for interpretation in 15 languages to a pool of 30 full-time interpreters and 4 trained bilingual staff. For organizations seeking to initiate or expand their language services, the Internet provides access to translated documents, promising practices, step-by-step guides, planning tools, and research briefs. Such recent technological advances make provision of language services-to respond to federal and state mandates and improve access and quality of care to LEP persons-more feasible than is widely believed. Increased government and foundation support, and collaboration among provider organizations themselves can catalyze these efforts.

Chapter 3. Coordination and collaboration with interface units. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PURPOSE: To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on enhancing coordination and collaboration between the ICU and other key stakeholders. METHODS: Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including coordination and collaboration. RESULTS: Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resource use and communications; (2) develop a system of communication, coordination and collaboration between the ICU and key interface departments within the hospital; (3) identify key functions or processes requiring coordination and collaboration, the most important of these being manpower and resources utilization (surge capacity) and re-allocation of personnel, equipment and physical space; (4) develop processes to allow smooth inter-departmental patient transfers; (5) creating systems and guidelines is not sufficient, it is important to: (a) identify the roles and responsibilities of key individuals necessary for the implementation of the guidelines; (b) ensure that these individuals are adequately trained and prepared to perform their roles; (c) ensure adequate equipment to allow key coordination and collaboration activities; (d) ensure an adequate physical environment to allow staff to properly implement guidelines; (6) trigger events for determining a crisis should be defined. CONCLUSIONS: Judicious planning and adoption of protocols for coordination and collaboration with interface units are necessary to optimize outcomes during a pandemic.

[Telemedicine: Improving the quality of care for critical patients from the pre-hospital phase to the intensive care unit]. / Telemedicina: mejora de la calidad en la atención de los pacientes críticos desde la fase prehospitalaria hasta el servicio de medicina intensiva.

The Health System is in crisis and critical care (from transport systems to the ICU) cannot escape from that. Lack of integration between ambulances and reference Hospitals, a deep shortage of critical care specialists and assigned economical resources that increase less than critical care demand are the cornerstones of the problem. Moreover, the analysis of the situation anticipated that the problem will be worse in the future. "Closed" ICUs in which critical care specialists direct patient care outperform "open" ones in which primary admitting physicians direct patient care in consultation with critical care specialists. However, the current paradigm in which a critical care specialist is close to the patient is in the edge of the trouble so, only a new paradigm could help to increase the number of patients under intensivist care. Current information technology and networking capabilities should be fully exploited to improve both the extent and quality of intensivist coverage. Far to be a replacement of the existing model Telemedicine might be a complimentary tool. In fact, to centralize medical data into servers has many additional advantages that could even improve the way in which critical care physicians take care of their patients under the traditional system.

A proclamation for change: transforming the hospital patient care environment.

Mounting evidence describes inefficiencies in the hospital work environment that threaten the safety and sustainability of care. In response to these concerns, diverse experts convened to create a set of evidence-based recommendations for the transformation of the hospital work environment. The resulting Proclamation for Change, now endorsed by multiple health systems and professional and consumer organizations, cites patient-centered design, systemwide integrated technology, seamless workplace environments, and vendor partnerships as the cornerstones of transformational change.

Lessons learned from Hurricane Ike.

After the poorly planned evacuation for Hurricane Rita in 2005, many health care systems in the Houston area updated the disaster plans they would implement in the event of a major disaster. In September 2008, Texas health care systems in the Houston-Galveston area had the opportunity to execute those plans when Hurricane Ike made landfall. Despite hours of hurricane preparation at the Texas Orthopedic Hospital in Houston, TX, before the storm, we found that there were still lessons to be learned from Hurricane Ike that can be used by other health care systems to prepare for disaster.

Changing from paper to paperless hospitals in busy academic centers.

To decide to change from paper to a paperless hospital, one decides to go on a journey. This chapter will outline the destination, the reasons to make the journey and describe the best route to the destination. Becoming paperless is the route taken to the destination.

Caring communications: how technology enhances interpersonal relations, part I.

It can help improve communication, collaboration, conflict resolution in healthcare by creating a foundation of caring capabilities.

Critical success factors for achieving superior m-health success.

Recent healthcare trends clearly show significant investment by healthcare institutions into various types of wired and wireless technologies to facilitate and support superior healthcare delivery. This trend has been spurred by the shift in the concept and growing importance of the role of health information and the influence of fields such as bio-informatics, biomedical and genetic engineering. The demand is currently for integrated healthcare information systems; however for such initiatives to be successful it is necessary to adopt a macro model and appropriate methodology with respect to wireless initiatives. The key contribution of this paper is the presentation of one such integrative model for mobile health (m-health) known as the Wi-INET Business Model, along with a detailed Adaptive Mapping to Realisation (AMR) methodology. The AMR methodology details how the Wi-INET Business Model can be implemented. Further validation on the concepts detailed in the Wi-INET Business Model and the AMR methodology is offered via a short vignette on a toolkit based on a leading UK-based healthcare information technology solution.

Effect of environmental changes on noise in the NICU.

PURPOSE: To evaluate the effect of changes in the NICU environment on sound levels. DESIGN: A prospective quasi-experimental design evaluated sound levels in a 43-bed NICU. Decibel levels were monitored utilizing a data-logging dosimeter for 24 hours weekly over 12 months. Sound levels were also measured inside four different incubator models. SAMPLE: Forty-four 24-hour decibel recordings were obtained in one of eight randomly selected four-bed pods. In addition, a single 1-hour recording was obtained in four different models of vacant incubators. MAIN OUTCOME VARIABLE: Ambient sound levels. RESULTS: Decibel levels were analyzed to identify changes in noise levels following alterations in the NICU environment. Installation of motion-sensing motorized paper towel holders significantly increased levels at beds closest to the towel dispensers, as did thetrial of a new communication system. Decibel levels in four different incubators revealed varying noise levels. This study suggests that all environmental changes must be monitored to ensure that they reduce rather than increase noise levels.

Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction.

BACKGROUND: Consensus guidelines and hospital quality-of-care programs recommend that ST-elevation myocardial infarction patients achieve a door-to-balloon time of < or = 90 minutes. However, there are limited prospective data on specific measures to significantly reduce door-to-balloon time. METHODS AND RESULTS: We prospectively determined the impact on median door-to-balloon time of a protocol mandating (1) emergency department physician activation of the catheterization laboratory and (2) immediate transfer of the patient to an immediately available catheterization laboratory by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected door-to-balloon time for 60 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention within 24 hours of presentation from October 1, 2004, through August 31, 2005, and compared this group with 86 consecutive ST-elevation myocardial infarction patients from September 1, 2005, through June 26, 2006, after protocol implementation. Median door-to-balloon time decreased overall (113.5 versus 75.5 minutes; P<0.0001), during regular hours (83.5 versus 64.5 minutes; P=0.005), during off-hours (123.5 versus 77.5 minutes; P<0.0001), and with transfer from an outside affiliated emergency department (147 versus 85 minutes; P=0.0006). Treatment within 90 minutes increased from 28% to 71% (P<0.0001). Mean infarct size decreased (peak creatinine kinase, 2623+/-3329 versus 1517+/-1556 IU/L; P=0.0089), as did hospital length of stay (5+/-7 versus 3+/-2 days; P=0.0097) and total hospital costs per admission ($26,826+/-29,497 versus $18,280+/-8943; P=0.0125). CONCLUSIONS: Emergency department physician activation of the catheterization laboratory and immediate transfer of the patient to an immediately available catheterization laboratory reduce door-to-balloon time, leading to a reduction in myocardial infarct size, hospital length of stay, and total hospital costs.