Crew resource management improved perception of patient safety in the operating room.

To improve safety in the operating theater, a company of aviation pilots was employed to guide implementation of preprocedural briefings. A 5-point Likert scale survey that assessed the attitudes of operating room personnel toward patient safety was distributed before and 6 months following implementation of the briefings. Using Mann-Whitney analysis, the survey showed a significant (P < .05) improvement in 2 questions (of 13) involving reporting error and 2 questions (of 11) involving patient safety climate. When analyzed by occupation, there were no significant changes for faculty physicians; for resident physicians, there was a significant improvement in 1 question (of 13) regarding error reporting. For nurses, there were significant improvements in 3 questions (of 4) involving teamwork, 1 question (of 13) involving reporting error, and 3 questions (of 11) regarding patient safety climate. These results suggest that aviation-based crew resource management initiatives lead to an improved perception of patient safety, which was largely demonstrated by nursing personnel.

Lessons from Hurricane Rita: the University of Texas Medical Branch Hospital's evacuation.

In September 2005, the University of Texas Medical Branch at Galveston (UTMB) was threatened by Hurricane Rita, a category five storm. Abandoning its historic practice of clearing the hospital of all but the sickest patients, UTMB rapidly organized and conducted the first total evacuation in its 114-year history. The authors report how this was accomplished and lessons learned. Specific factors were crucial for success, including identifying an incident commander with sole authority to make decisions, developing and communicating a set of guiding principles, setting patient safety as our top priority, establishing an incident command center that consolidated vital institutional functions, avoiding delays in deciding to evacuate, identifying strategic partners, selecting essential personnel who would not be distracted by personal concerns during the emergency, and conducting periodic trial runs of emergency preparedness. Complex demands for communication were not met as well as was hoped. Technical problems were encountered with some communication devices that proved inoperable; trial runs would have probably revealed these problems in advance. Also, in-transit communication could be improved-not always knowing which patients were where, what vehicles were mired in stalled traffic, and what relocations occurred impeded optimal communication with patients' family members. Finally, a system ensuring that the recipients of UTMB's electronic records had the proper software to receive them would have facilitated communication and helped record keeping. The authors encourage physicians, as essential members of the health care team, to become better prepared to respond to disasters.

Improving perceptions of patient care--a nursing education and nursing practice initiative.

In January 2005, the University of Texas Medical Branch (UTMB) School of Nursing and the UTMB Hospitals and Clinics launched the first phase of a project to improve perceptions of patient care on the part of nursing faculty and nursing clinicians. A finding on the UTMB annual employee satisfaction survey that nursing faculty and clinicians tended to rate quality of UTMB patient care lower than other UTMB employees provided the impetus for the initiative. When UTMB colleagues noticed the findings, various entities including human resources and the Faculty Senate called for explanations from the dean of the School of Nursing, the chief nursing officer, and the CEO for the hospitals and clinics. In the process of attempting to give reasons for the findings, each of us determined we would take definitive action to address the situation. This article describes our accomplishments for Phase 1 of the initiative. Beginning with a vision for a productive professional community characterized by a pedagogical partnership between nursing education and practice, we share the processes we followed to (1) achieve mutual understanding among task force members, (2) obtain input on perceptions from nursing colleagues, (3) identify the clinical and nursing education aspects of the perceptions, (4) reach consensus on target perceptions for Phase 2 of the project, and (5) outline the next steps for the project.