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When the University of Michigan Health System, Ann Arbor, instituted a "rolling forecast" approach to budgeting, its administrators established a target to improve labor productivity by 2% in fiscal 2010.
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Every summer The Joint Commission issues a list of those standards hospitals find most difficult to comply with. Among those challenging standards are three that experts say most directly impact the ED:
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There are any number of reasons why an ED and its hospital would have difficulty complying with The Joint Commission standard regarding egress, says Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles.
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As The Grateful Dead might say if asked to describe the various iterations of the National Patient Safety Goal (NPSG) for medication reconciliation, "what a long, strange trip it's been."
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What should ED managers be doing while they wait for The Joint Commission to publish a new standard for medication reconciliation? Take a team approach, recommends Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles.
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This web-based survey assessed 1976 critical care practitioners' perceptions of the risks for unplanned extubation. Members of the American Association for Respiratory Care, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine reported a number of factors associated with unplanned extubation, including outward migration of the endotracheal tube (ETT; reported by 73% of respondents), the patient tugging on the ETT (87%), removing a nasogastric tube (71%), absence of physical restraints (72%), a nurse/patient ratio of 1:3 (60%), trips out of the ICU for tests (59%), and light sedation (42%).
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Project IMPACT, a proprietary database originally created by the Society for Critical Care Medicine and now maintained by Cerner Corp., collects data from a voluntary consortium of ICUs across America.
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Paralytic agents such as vecuronium and cis-atracurium have been used as "rescue therapies" in patients with ARDS for many years, but, as with other rescue strategies including prone mechanical ventilation or inhaled vasodilators, evidence of a mortality benefit from this intervention has been lacking.
