ORIGINAL ARTICLES
Computed Tomography Angiography in Patients Evaluated for Acute Pulmonary Embolism with Low Serum D-dimer Levels: A Prospective Study.
In this prospective observational study of Emergency Department patients with possible pulmonary embolism (PE) who underwent pulmonary computed tomography angiography (CTA), the CTA findings positive for acute embolism should be viewed with caution, especially if the suspected PE is in a distal segmental or subsegmental artery in a patient with a serum D-dimer level of ≤ 1.0 μg/ml.
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Service Score Segmentation of Diverse Populations to Improve Patient and Physician Satisfaction—A Multicase Quality Improvement Study.
The changing demographic picture in California creates a complex challenge for physicians, facilities, and an organization. In response, one strategy is a service improvement program, with demonstrated successful outcomes that combines patient satisfaction “service scores”; data segmentation by ethnicity, sex and age; and data analysis, which recognizes the demographic subsets at which physicians excel and are weak. Five case examples are described, including clinicians interacting with Chinese patients, African-American patients, and young females, and two department level interventions in urology and internal medicine.
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Reducing Collusion Between Family Members and Clinicians of Patients Referred to the Palliative Care Team.
The deeply entrenched Asian cultural practice of collusion—a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from a patient—was studied by the Palliative Care Team. Between December 2004 and June 2008, 655 patients with advanced-stage cancers were referred to the team. Beginning in February 2005, with the implementation of awareness measures, the team was able to maintain an average awareness rate of 80% of patients.
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Decreasing Adverse Events through Night Talks: An Interdisciplinary, Hospital-Based Quality
Improvement Project.
The majority of medical adverse events are secondary to errors in communication. Review of nonoperative adverse events at Cincinnati Children’s Hospital Medical Center in 2007 found that 57% were related to failure to recognize abnormal vital signs and to communicate or to address parents’ or nurses’ concerns. The initiation of Night Talks—a late-evening review of patients’ status by physicians and nurses—reduced near misses in neurosurgical patients to zero in 201 days, a 5360% change.
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Staff Solutions for Noise Reduction
in the Workplace.
A comprehensive noise-reduction project was initiated in response to low patient-satisfaction scores on an inpatient neuroscience unit. Before project initiation, decibel readings (dB) were as high as 78.1 dB (standard recommended levels are 40 dB). Postproject satisfaction scores rose to the 95th percentile by July 2008.
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Developing a Unit-Based Family Advocacy Board on a Pediatric Intensive Care Unit.
A pediatric intensive care unit developed a family advocacy board to assist staff in providing patient- and family-centered care. Questions asked pediatric critical care staff related to patients and families as advisors showed a statistically significant improvement postimplementation. Staff perception of the level of family involvement during and after anesthesia induction increased from 42% to 78%, and during resuscitation increased from 28% to 90%.
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