Becker's Clinical Quality & Infection Control

10 INFECTION CONTROL & PATIENT SAFETY 'Eyeballing' patients may find sickest ones more effectively than formal assessment By Megan Knowles W hen assessing patients, simply eyeballing them may prove more effective than using a formal structured algorithm to prioritize those who need urgent medical care most, a study published in Emergency Medicine Journal found. e study found a basic clinical assessment may better predict patients most at risk of dying, even when healthcare professionals with relatively little emergency care experi- ence are assessing them, such as phleboto- mists and medical students. e researchers compared triage decisions nurses, phlebotomists and medical students made when prioritizing more than 6,000 patients at one emergency department over a three-month period. e nurses used an established algorithm to decide which patients were the sickest, while the phlebotomists and medical students made their decisions by only looking at each patient. e two approaches, which categorized need from minor injuries and conditions to most urgent, were compared for their ability to assess the likelihood of death within 30 days. e researchers also analyzed any links between triage method and death within 48 hours, and how oen both methods reached the same decisions for the same patients. Overall, 6,290 patients were assessed using both methods. It was uncommon for both methods to come to the same decisions for the same patients. When the researchers compared the ability to assess the likelihood of death within 48 hours and 30 days, simply eyeballing the patient was more accurate than structured triage. In an accompanying editorial, Ellen Weber, MD, professor emeritus of emergency medicine at the University of California, San Francisco, cautions that the study was carried out in only one emergency care department, and with a triage system that is not widely used across the globe. "[T]he study should make us rethink our current process and the evidence behind it," Dr. Weber said. n 'Patient safety room of horrors' helps med students prepare for hospital mishaps By Megan Knowles A t the University of Chicago Pritzker School of Medicine, a "patient safety room of horrors" is helping medical students and residents identify hospital room mistakes before they occur, according to a blog post on the AMA Wire. The tool is used by preclinical medical students during their second year and reintroduced to them after their third-year clerk- ships. The initiative is also part of the university's resident boot camp to prepare residents before they start practicing medicine. Before entering the room of horrors, students receive a mock door chart that describes a fake patient's condition, including allergies and complications. They have 15 minutes to identify all safety haz- ards around the patient. The room helps residents check to ensure patients are getting the right medications, their allergies are accounted for and safety railings are in use on hospital beds. They also check for cost haz- ards, such as catheters or hand restraints that are unneeded. "When you walk into a patient's room, it's not just the medica- tions, but many things that can put your patient at risk for some reason or other, resulting in either a near-miss or adverse event," said Jeanne Farnan, MD, associate professor of medicine and associate dean of evaluation and continuous quality improve- ment at the University of Chicago. "We try to make our residents and students very vigilant about recognizing that by stressing the importance of situational awareness." n 3 hospitals honored for eliminating patient deaths By Megan Knowles T he Patient Safety Movement Foundation teamed up with the Carter Foundation for the fourth con- secutive year on an initiative to eliminate patient deaths. The organizations recognized three hospitals for their commitment to save the most lives. The prize is a private fishing trip with former President Jimmy Carter and former first lady Rosalynn Carter. This year's top three hospitals were: 1. MedStar Health (Columbia, Md.). Saved 225 lives. MedStar Health is using processes to elimi- nate healthcare-associated infections, made com- mitments to identify and treat sepsis and helped launch a culture of safety. 2. Parrish Medical Center (Titusville, Fla.). Saved 110 lives. Parrish Medical Center implemented processes to eliminate pediatric adverse drug events and reduce falls, as well as an antimicrobial stewardship program. 3. Intermountain Healthcare (Salt Lake City.). Saved 75 lives. Intermountain implemented processes to eliminate venous thromboembolism, which is linked to increased mortality and poor patient outcomes. Intermountain also put processes in place to eliminate central line-associated bloodstream infections and catheter-associated urinary tract infections. n

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