Format

Send to

Choose Destination
J Gen Intern Med. 2010 Oct;25(10):1078-82. doi: 10.1007/s11606-010-1427-5. Epub 2010 Jun 17.

Improved clinical outcomes combining house staff self-assessment with an audit-based quality improvement program.

Author information

1
Saint Vincents Hospital, New York Medical College, Lenox Hill Hospital, New York, NY 10075, USA. lkirschenbaum@Lenoxhill.net

Abstract

BACKGROUND:

There is a focus on integrating quality improvement with medical education and advancement of the American College of Graduate Medical Education (ACGME) core competencies.

OBJECTIVE:

To determine if audits of patients with unexpected admission to the medical intensive care unit using a self-assessment tool and a focused Morbidity and Mortality (M&M) conference improves patient care.

DESIGN:

Charts from patients transferred from the general medical floor (GMF) to the medical intensive care unit (ICU) were reviewed by a multidisciplinary team. Physician and nursing self-assessment tools and a targeted monthly M&M conference were part of the educational component.

PARTICIPANTS:

Physicians and nurses participated in root cause analysis.

MEASURES:

Records of all patients transferred from a general medical floor (GMF) to the ICU were audited. One hundred ninety-four cases were reviewed over a 10-month period.

RESULTS:

New policies regarding vital signs and house staff escalation of care were initiated. The percentage of calls for patients who met medical emergency response team/critical care consult criteria increased from 53% to 73%, nurse notification of a change in a patient's condition increased from 65% to 100%, nursing documentation of the change in the patients condition and follow-up actions increased from 65% percent to a high of 90%, the number of cardiac arrests on a GMF decreased from 3.1/1,000 discharges to 0.6/1,000 discharges (p = 0.002), and deaths on the Medicine Service decreased from 34/1,000 discharges to 24/1,000 discharges (p = 0.024).

CONCLUSION:

We describe an audit-based program that involves nurses, house staff, a self-assessment tool and a focused M&M conference. The program resulted in significant policy changes, more rapid assessment of unstable patients and improved hospital outcomes.

PMID:
20556534
PMCID:
PMC2955460
DOI:
10.1007/s11606-010-1427-5
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center