Increasing Patient Safety in Hemodialysis Units by Improving Handoff Communication.

This quality improvement project aimed to increase patient safety by preventing errors through improving staff handoff communication in an outpatient hemodialysis unit. Lewin's theory of planned change was applied. Staff familiarity with the situation-background-assessment-recommendation (SBAR) communication format was assessed. Education regarding SBAR format and supporting tools was provided to staff prior to implementing the SBAR handoff format. Safety incidences were compared pre- and post-implementation. Data analysis supported a statistically significant improvement in reported error rates post implementation (p = 0.000). Implementing a standardized handoff communication form provided a mechanism for improving patient safety.

The Impact of a Flexible Care Area on Throughput Measures in an Academic Emergency Department.

INTRODUCTION: Crowding in emergency departments is a multifaceted problem. We hypothesized that implementing an on-call "Flexible Care Area" (FCA), utilizing multiple front-end throughput solutions, would reduce ED length of stay (LOS). METHODS: This retrospective study evaluates the impact of an FCA on ED throughput at one hospital over a 2-year period (2011-2012). The average arrival-to-room time, arrival-to-physician time, LOS, number of inpatient admissions, and number of discharges during FCA hours were collected, and days with and without FCA functionality were compared. RESULTS: The FCA was open 165 days in 2011 and 252 days in 2012. The mean daily ED census, as well as the number of ED visits and inpatient admissions during FCA hours, were higher on days with FCA functionality than on days without FCA functionality. Total ED LOS was shorter for Emergency Severity Index (ESI) level 3 patients on days with FCA than on days without it in 2011, but this finding was not repeated in 2012. ESI level 4 patients had shorter LOS on FCA days in both years. The arrival-to-room and arrival-to-physician times showed variable improvement for ESI level 3 and 4 patients over the study period. No statistically significant difference for these measures was found when evaluating ESI levels 2 and 5. DISCUSSION: Implementing upfront throughput solutions through use of the FCA correlated with reduced ED LOS for all ESI level 3 and 4 patients, not just those who were seen in the FCA.

Look before you leap: lessons learned when introducing clinical simulation.

Before investing in a human patient simulator, we designed a preliminary study that examined student responses to a laboratory exercise that used lower-fidelity simulation. Our purpose was to compare beginning-level, baccalaureate nursing students' self-reported assessment in the domains of confidence, ability, stress, and critical thinking before and after they participated in the simulation. Results showed statistically significant improvement in all domains for skills in urinary catheterization, intravenous and nasogastric medication administration, and sterile dressing change.