Improving Communication in the Medical Intensive Care Unit Through Standardization of Handoff Format: A Quality Improvement Project.

Objective: To decrease interruptions in handoff, increase compliance with a structured verbal handoff format, and increase compliance with handoff template completion in electronic medical records without increasing the length of handoff time. Patients and Methods: The project timeline was from April 1, 2019, to February 1, 2020. Define phase data were obtained through a survey of stakeholders to identify the gap in needs. The baseline data included components from the illness severity, patient summary, action list, situational awareness and contingency plans, and synthesis by receiver (IPASS) handoff tool because this tool best aligned with information identified in the define phase. Observational data were collected in person and reviewed via audio recording for accuracy. Results were analyzed to determine adherence to the chosen intervention, the IPASS handoff tool, on which the stakeholders were educated and assessed prior to implementation. Five plan-do-study-act cycles were completed over 3 months to optimize the intervention. Final data were collected and analyzed using the same method as baseline data. Results: After implementation of the IPASS handoff tool, there were more care plan components mentioned in the provider handoffs across all unique IPASS components, there were fewer observed distracting events, and there was increased compliance with electronic medical record handoff completion. The time of handover increased by 3 minutes. Conclusion: A standardized handoff tool improved communication during provider handoffs by increasing the mention of pertinent details and reducing distracting events during handoff.

Government political structure and violent death rates: A longitudinal analysis of forty-three countries, 1960-2008.

OBJECTIVES: Currently, little is known regarding the effect of regime type on mortality on a global level. The purpose of this study is to examine the effect of regime type on the rates of violent deaths (homicide, suicide, and combined rates). METHODS: Three measures of democracy were used to quantify regime type, the independent variable. Homicide and suicide rates were obtained from the World Health Organization. Multivariate conditional fixed-effects models were run to examine associations between regime characteristics and logged rates of homicide, suicide, and violent deaths. Models were adjusted for unemployment and economic inequality. RESULTS: Nations that scored higher on democracy indices, especially emerging democracies, experienced increased mortality due to violence. Homicide and suicide were divergent, showing a different time course and decreasing statistical power as a combined variable. Unemployment and inequality were associated with higher violence-related mortality. CONCLUSIONS: Homicide and suicide appear to be more prevalent in democracies. Future analyses should examine which aspects of democracies lead to higher rates of violent death and should seek to use independently collected mortality data.