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Quality Improvement and Patient Safety Section Newsletter - September 2014

The Drive Home

Beach2014Diagnostic error is a recent common buzzword in healthcare, catching the attention of healthcare providers, media and laypersons alike.  We’ve all seen articles with conclusions or commentary such as:

“…we estimate 15,000-165,000 misdiagnosed cerebrovascular events annually in US ED’s…”1

“…diagnostic error is the leading cause of medical malpractice claims in the US, and is estimated to cause 40,000 – 80,000 deaths annually.”2

“…Americans' health is even worse than we thought, ranking below 16 other developed nations.”3

So it’s nice to see the recent press release from the U.S. Department of Health and Human Services (HHS) that revealed improvements in safety of care based predominantly on reductions in pharmaceutical errors, falls and infections.  Since most patients begin their inpatient hospital visit in the ED we should be proud that we are a part of a reduction in hospital acquired conditions such as ventilator associated pneumonia, falls, pressure ulcers and venous thromboembolic complications, amongst others.

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Good Standards Gone Wrong

Jaben 2014Today at your department meeting, a new program is announced.  Called 'pull to full,' it is described as a best-practice proven to decrease door-to-doctor times and increase patient satisfaction scores. Your director made the point that this was not an optional program, but rather something administration expected to be implemented. No longer will you be sitting around all caught up while patients are sitting around in the waiting room. It will be better for the patients and better for you. It will be to the docs to 'encourage' the nurses to follow through. 

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QIPS TIPS Danger : Night Shift at Work

Shari WelchAt the State University of New York in Albany, recent research demonstrated that rats that were forced to be sleep deprived at night (analogous to night shift workers), aged more quickly, had a shorter lifespan and demonstrated more tumorigenesis than rats that were not sleep deprived.  It has been suggested that humans working the night shift may have an increased risk of developing breast cancer and other cancers, though the research is contradictory and inconclusive.  On the other hand, we do know that night shift does take a toll on its workers.  A recent article in Chronobiology International showed that night shift workers had an increased odds ratio of being obese, having central obesity (suggesting endocrine dysfunction) and hypertension. 

A third article published in 2010 in Euro J Epidem showed an increased risk for cardiovascular disease in night shift workers. Numerous studies over the years have shown a shortened life expectancy, an increased risk of diabetes, increased risk of anxiety and depression, eating disorders and sleep.  Night shift workers eat fewer calories but consume more fat and sugar and often resort to fast food, caffeinated drinks and energy drinks. The long term consequences of this diet are only beginning to be studied.  Suffice it to say that night shift work is hazardous to your health.

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Editor’s Notes

Jeff PothofA handful of events and announcements have been made since the last edition of this newsletter.  First off, we’d like to announce the QIPS Section’s partnership with the Emergency Medicine Patient Safety Foundation (EMPSF).  EMPSF is a non-profit organization that has been promoting the practice of quality healthcare as it relates to Emergency Medicine since 2003.  EMPSF has created a special page for QIPS members featuring complimentary access to its educational webinar series, CMS & EMTALA updates and speaker presentations from its Patient Safety Summits. Please click here to access EMPSF patient safety resources.

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A Just Culture: Relevance, and Challenges of Implementation

The importance of developing “A Just Culture” within a healthcare setting is one of the critical components of helping to improve the overall culture of safety at a given institution. A just culture is simply trying to win the hearts and minds of health care providers and have them believe that they are part of a system that recognizes several important tenets of the work environment related to patient safety. One being that humans are fallible, systems are fallible, errors and near misses occur, and when they do, the humans in the system are treated fairly or just. They also have to believe that organization wants to learn from the events.

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The Future of Emergency Medicine Part II

The last newsletter contained a synopsis of the presenters prior to the break at the December 4th, 2013 “The Future of Emergency Medicine” conference sponsored by the journal Health Affairs.  Please see the May issue of the QIPS newsletter to get up to speed with “The Future of Emergency Medicine Part I” where leaders in emergency medicine such as Art Kellerman MD, FACEP and Jeremiah Schuur MD, MHS, FACEP gave their predictions on the future of emergency medicine.

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