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1.
Crit Care Med ; 52(7): e351-e364, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38535489

ABSTRACT

OBJECTIVES: Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU. DESIGN: Descriptive review of a patient safety initiative. SETTING: A newly built 24-bed neurocritical care unit at a tertiary care academic medical center. SUBJECTS: Care providers working in neurocritical care unit. INTERVENTIONS: We implemented a pragmatic three-stage in situ simulation program to learn a new patient care environment, transitioning patients from an open bay unit to a newly built private room-based ICU. The project tested the safety and efficiency of new workflows created by new patient- and family-centric features of the unit. We used standardized patients and high-fidelity mannequins to simulate patient scenarios, with "test" patients created through all electronic databases. Relevant personnel from clinical and nonclinical services participated in simulations and/or observed scenarios. We held a debriefing after each stage and scenario to identify safety threats and other concerns. Additional feedback was obtained via a written survey sent to all participants. We prospectively surveyed for missed latent safety threats for 2 years following the simulation and fixed issues as they arose. MEASUREMENTS AND MAIN RESULTS: We identified and addressed 70 latent safety threats, including issues concerning physical environment, infection prevention, patient workflow, and informatics before the move into the new unit. We also developed an orientation manual that highlighted new physical and functional features of the ICU and best practices gleaned from the simulations. All participants agreed or strongly agreed that simulations were beneficial. Two-year follow-up revealed only two missed latent safety threats. CONCLUSIONS: In situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units.


Subject(s)
Intensive Care Units , Patient Safety , Humans , Intensive Care Units/organization & administration , Quality Improvement/organization & administration , Simulation Training/methods , Academic Medical Centers/organization & administration , Hospital Design and Construction
2.
Am J Lifestyle Med ; 11(2): 153-166, 2017.
Article in English | MEDLINE | ID: mdl-30202328

ABSTRACT

We have developed, tested, and successfully implemented an affordable, evidence-based, technology-enabled, data-driven, outcomes-oriented, comprehensive lifestyle health coaching (LHC) program. The LHC program has been used primarily to provide services to employees of larger employers (ie, with at least 3000 employees) but has also been implemented in a variety of other settings, including hospitals, cardiac rehabilitation centers, physician practices, and as part of multicenter clinical trials. The program is delivered mainly using the telephone and Internet. Health coaches are guided by a Web-based participant management and tracking system. Lifestyle management interventions are based on several behavior change models and strategies, especially adult learning theory, social learning theory, the stages of change model, single concept learning theory, and motivational interviewing. The program is administered by nonphysician health professionals whose services are integrated with the care provided by participants' physicians. Outcomes data from published studies, including randomized clinical trials and independent third-party conducted research, have documented the clinical effectiveness of this evidence-based approach in terms of modification of multiple risk factors in healthy persons as well as those with certain common chronic diseases.

3.
J Cardiopulm Rehabil Prev ; 37(1): 11-21, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27798509

ABSTRACT

PURPOSE: Secondary prevention risk factor goals have been established by the American Heart Association/American College of Cardiology, and the American Heart Association has further delineated ideal cardiovascular health metrics. We evaluated risk factor goal achievement during early-outpatient cardiac rehabilitation (CR) and temporal trends in risk factor control. METHODS: Patients completed assessments on entry into and exit from CR at 35 centers between 2000 and 2009 and were categorized into 3 cohorts: entire (N = 12 984), 2000-2004 (n = 5468), and 2005-2009 (n = 7516) cohorts. RESULTS: Improvements occurred in multiple risk factors during CR. For the entire cohort, the percentages of patients at goal at CR completion ranged from 95.5% for smoking to 21.9% for body mass index (BMI) of <25.0 kg/m. Compared with 2000-2004, the percentage of the 2005-2009 cohort at goal was higher (P < .001) for blood pressure, low-density lipoprotein cholesterol, and physical activity, lower (P = .005) for BMI, and not significantly different (P > .05) for fasting glucose and smoking. At CR completion, of those in the entire, 2000-2004, and 2005-2009 cohorts, 4.4%, 3.9%, and 4.8% (P = .219 vs 2000-2004), respectively, had all biomarkers at the goal for ideal cardiovascular health and, of those with atherosclerotic cardiovascular disease, 70.8%, 71.5%, and 70.3% (P = .165 vs 2000-2004), respectively, were receiving statins. CONCLUSIONS: The percentage of patients at goal at CR completion increased for some, but not all, risk factors during 2005-2009 versus 2000-2004. Despite the benefits of CR, risk factor profiles are often suboptimal after CR. There remains room for improvement in risk factor management during CR and a need for continued intervention thereafter.


Subject(s)
Cardiac Rehabilitation/methods , Cardiovascular Diseases/blood , Cardiovascular Diseases/prevention & control , Goals , Plaque, Atherosclerotic/blood , Plaque, Atherosclerotic/prevention & control , Aged , Biomarkers/blood , Blood Glucose , Blood Pressure , Body Mass Index , Cholesterol/blood , Exercise , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Male , Middle Aged , Risk Factors , Smoking Prevention , Time
4.
Am J Cardiol ; 111(3): 346-51, 2013 Feb 01.
Article in English | MEDLINE | ID: mdl-23178050

ABSTRACT

Antidepressants might increase compliance with cardiovascular disease risk reduction interventions. However, antidepressants have been linked to deleterious metabolic effects. In the present multicenter study, we sought to determine whether patients who take antidepressants derive the expected benefits from cardiac rehabilitation in terms of improvements in multiple atherosclerotic risk factors. A cohort of 26,957 patients who had completed a baseline assessment before participating in an exercise-based cardiac rehabilitation program constituted the study population. The patients were stratified into 3 cohorts (i.e., nondepressed, depressed unmedicated, and depressed medicated) at baseline according to a self-reported history of depression and the current use of antidepressants. Risk factors were assessed at baseline and after ∼12 weeks of program participation. A self-reported history of depression was present at baseline in 5,172 patients (19.2%). Of these patients, 2,147 (41.5%) were taking antidepressants. Patients in the nondepressed cohort (49.4% completion) were more likely (p <0.001) to complete the exit assessment than patients in the depressed unmedicated (44.5% completion) or depressed medicated (43.5% completion) cohorts. Patients in all 3 cohorts who completed the exit assessment showed significant improvement in multiple risk factors. Moreover, the magnitude of improvement in blood pressure, serum lipids and lipoproteins, fasting glucose, weight, and body mass index was similar (p >0.05) in patients taking antidepressants and those who were not. In conclusion, our study is the first to show that antidepressants do not offset the average magnitude of improvement in multiple atherosclerotic risk factors that occurs with completion of a cardiac rehabilitation program.


Subject(s)
Antidepressive Agents/therapeutic use , Atherosclerosis/rehabilitation , Depression/drug therapy , Exercise Therapy/methods , Risk Assessment , Aged , Atherosclerosis/complications , Atherosclerosis/epidemiology , Depression/complications , Female , Humans , Male , Patient Compliance , Prevalence , Retrospective Studies , Risk Factors , Treatment Outcome
5.
Am J Cardiol ; 102(12): 1677-80, 2008 Dec 15.
Article in English | MEDLINE | ID: mdl-19064023

ABSTRACT

Although national clinical guidelines promulgate therapeutic lifestyle changes (TLC) as a cornerstone in the management of prehypertension, there is a perceived ineffectiveness of TLC in the real world. In this study of 2,478 ethnically diverse (African Americans n = 448, Caucasians n = 1,881) men (n = 666) and women (n = 1,812) with prehypertension and no known atherosclerotic cardiovascular disease, diabetes mellitus, or chronic kidney disease, we evaluated the clinical effectiveness of TLC in normalizing blood pressure (BP) without antihypertensive medications. Subjects were evaluated at baseline and after an average of 6 months of participation in a community-based program of TLC. TLC included exercise training, nutrition, weight management, stress management, and smoking cessation interventions. Baseline BP (125 +/- 8/79 +/- 3 mm Hg) decreased by 6 +/- 12/3 +/- 3 mm Hg (p or=30 kg/m(2). In conclusion, the present study adds to previous research by reporting on the effectiveness, rather than the efficacy, of TLC when administered in a real-world, community-based setting.


Subject(s)
Health Behavior , Hypertension/prevention & control , Life Style , Adult , Black or African American , Blood Pressure , Diet , Exercise , Female , Follow-Up Studies , Humans , Male , Middle Aged , Smoking Cessation , Stress, Psychological , White People
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