Why are QI methods needed?

Size: px
Start display at page:

Download "Why are QI methods needed?"

Transcription

1 Quality Improvement for ICU Rehab, Sedation & Delirium Why are QI methods needed? Dale M. Needham, MD, PhD Professor, Pulmonary & Critical Care, and Physical Med network.org Quality Improvement Methods to Fill Gap in Translational Super Highway Quality Improvement Methods to Fill Gap in Translational Super Highway Pothole in translational superhighway 4 5 Where are we going CLINICALLY? Crit Care Med Apr 2014 Is there really a pot hole in the super highway for early ICU rehab? In 783 patients at 116 German ICUs: 1

2 Where are we going CLINICALLY? More info here Arch Phys Med Rehabil 2010;91: In 514 patients at 34 Aus/NZ ICU: 2. Identify local barriers to implementation: understand the process and context of work 2. Identify local barriers to implementation: understand the process and context of work J Crit Care Jun;25(2): Understanding barriers specific to the project is key to designing the correct KT intervention (Shojania Health Affairs 2005) Time requirements and adequate staffing Need for staff training Need for team work and coordination Over sedation of ICU patients Dislodgement of devices (CVC, ETT, feeding tubes) Worsening gas exchange Unstable hemodynamics Inadequate patient comfort, pain control 3. Measure performance Also Rehabilitation Specific Metrics Example performance measures : Staffing: Proportion of ICU patients with no therapy Safety: Safety events during PT Benefits: ICU and Hospital LOS Top Stroke Rehabil 2010;17(4):

3 interventions interventions: Engage Engage stakeholders to understand why interventions important Invited patients to return to MICU to share stories (e.g. weakness, physical impairment) Share data regarding MICU performance vs peer hospitals Invite guest speakers to discuss their approach interventions: Educate Educate stakeholders of evidence supporting interventions QI research made available to staff via: newsletter, posters, bulletin boards & invited speakers PT & OT educate RNs on rehab interventions RT orient PTs to vent settings for ambulating patients 2 large group training sessions held with RTs 16 small group discussions with RNs by MICU MD interventions: Execute Execute: design an intervention toolkit targeted at barriers Tips: standardization, checks/reminders, & convenience Dedicated PT and OT in the MICU Simple guidelines for PT & OT MICU consult Coordinator screens patients & prompts MD for PT referral Patients screened daily by PT/OT for mobilization activity MICU tech assists PT & OT with patient mobilization interventions: Evaluate Evaluate: regularly assess performance & unintended problems Review performance measures at weekly meetings Discuss any problems that arise Brainstorm ways to resolve unintended problems interventions: Evaluate Arch Phys Med Rehabil 2010;91: Results of Johns Hopkins MICU Rehab QI Project: Significant in sedative drug use & deep sedation Median Narc: 71 v. 24 mg/day (p=0.01), Benzo: 47 v. 15 mg/day (p=0.09) MICU days alert: 30 v. 67% (p<0.001) No difference in pain scale (0 10): 0.6 v. 0.6 (p=0.79) More ICU days without delirium No delirium: 21% vs 53% (p=0.003) PT consults: 59% vs. 93% of pts (p=0.04) ICU days with no PT/OT: 41% vs. 7% (p=0.004) MICU & hosp LOS by 30% and 18%, respec vely (p<0.03) 3

4 Follow up results. JHH MICU over 2.5 years (June 2009 Dec 2011) 1,110 admissions with >= 1 PT session 5,267 total PT tx (not individual activities) 66% of PT days: sitting at edge of bed or higher 37 JHH MICU over 2.5 years (June 2009 Dec 2011) 34 potential safety events in 25 admissions 0.6% of PT sessions (i.e., 6 per 1000 PT tx) 80% of events = transient physiological (HR, BP, Sp02) 4 events required any Tx (0.08% of all PT tx) 2 NG tube, 1 A line, 1 fall with laceration & suture A Quality Improvement Project Sustainably Decreased Time to Onset of Active PT Intervention in ALI Patients M. Zanni, PT, DScPT, Objectives to evaluate: Sustainability of MICU early rehab QI over 5yrs Other factors w/ timing of active PT Design: Pre post evaluation consecutive ARDS patients pre QI ( ) versus post QI ( ) 38 A Quality Improvement Project Sustainably Decreased Time to Onset of Active PT Intervention in ALI Patients Victor D. Dinglas, MPH, Ann M. Parker, MD, Dereddi Raja S. Reddy, MD, Elizabeth Colantuoni, PhD, Jennifer M. Zanni, PT, DScPT, Alison E. Turnbull, DVM, MPH, PhD, Archana Nelliot, BS, Nancy Ciesla, DPT, MS, Dale M. Needham, FCPA, MD, PhD Probability of 1 st PT in post vs. pre QI Annals of the American Thoracic Society, In press Post QI earlier PT (HR 8.38, p<0.01) significant each of 5 yr post QI Factors assoc d with delayed PT: opioid infusion (0.47, p=0.02) deep sedation (0.24, p<0.01) worse organ failure (0.93, p<0.01) increasing hypoxia (0.86, p=0.04) LOS Trends Early rehab QI assoc d with BIG decrease in time to onset of active PT and sustained for 5years 4

5 Crit Care Med 2013;41: Putting Evidence into Practice: QI Process: 4 E s Engage: Get clinicians interested in the problem! Day & night nurses: by nurse educator Interns & resident physicians: by QI physician champions Attending physicians: grand rounds & faculty meetings Educate: new sedation protocol, RASS/CAM, delirium prev n For RN: didactics, one on one teaching, case studies, quiz Physicians: Sedation and Delirium Survival Card Hager et al, 2013; Crit Care Med; 41: New Sedation Protocol Sedation Goal: see below Hager et al, 2013; Crit Care Med; 41: RASS goal: 0 Fentanyl & versed (A 1) Avoid infusions, use prn Initially q 5 min (if needed) Then q 1 2hr Daily stop of prn & infusion Avoid delirium drugs Anticipate agitation Do no use benzo Use IV haldol (check QTc) QI Process: 4 E s Model Execute: Sedation protocol replaced in EMR RN reported RASS score + CAM ICU at bedside rounds Super users available to answer questions Evaluate: Monthly review of barriers by QI team MICU pharmacist feedback at bedside rounds: sedation protocol adherence delirium screening and management Audit and feedback: RN regular review of RASS & CAM ICU documentation Overall RASS & CAM ICU results for MICU Hager et al, 2013; Crit Care Med; 41: Results of QI: Changes in Sedation of ARDS Patients Median (IQR), per patient analysis ARDS Severity & Day 1 Sedation (sickest) High severity of illness: median APACHE II = 29 Before QI 10/04 4/07 (n=120) After QI 7/09 4/11 (n=82) P value* Narcotic infusion (% days) 74 (50, 100) 33 (10, 65) <0.001 On Benzodiazepine infusion (% days) ) 70 (46, 94) 22 (0, 50) <0.001 Median RASS Score** 4( 5, 2) 1.5 ( 3, 0) <0.001 Awake &Not delirious 0(0, 18) 19 (0, 50) <0.001 No sig. dif btwn groups in ARDS severity Half severe ARDS Sig. decr in infusions; Only 25 31% in QI Hager et al. Critical Care Medicine 2013;41: e241 e243 5

6 New Target: Sleep Deprivation Without heavy sedation, pt not sleeping in ICU Sleep disruption risk factor for delirium ICU not conducive to sleep Need effort to reduce noise & promote sleep Crit Care Med 2013;41: Multi stage QI project (using SAME QI model): Baseline (2 mo.): daily sleep Richards Campbell Sleep Questionnaire 6 questions Phase I: Environmental change (1 mo.): Minimized intercom usage after 10 pm Bathing and Assessments completed by 10 pm Lights out in pt rooms by 10 pm Group RN assessments and tests (eg, morning x rays) Phase II: non drug tx (1 mo.): music, ear plug, eye mask Phase III: med guideline (2 mo.): non delirium med to sleep Questions? Some members of the OACIS Group at Hopkins 6

Ruchika D. Husa, MD, MS Assistant t Professor of Medicine in the Division of Cardiology The Ohio State University Wexner Medical Center

Ruchika D. Husa, MD, MS Assistant t Professor of Medicine in the Division of Cardiology The Ohio State University Wexner Medical Center Modified Early Warning Score (MEWS) Ruchika D. Husa, MD, MS Assistant t Professor of Medicine i in the Division of Cardiology The Ohio State University Wexner Medical Center MEWS Simple physiological scoring

More information

Overnight ICU Physician Coverage: Do We Need to Stay in Hospital 24-7?

Overnight ICU Physician Coverage: Do We Need to Stay in Hospital 24-7? Overnight ICU Physician Coverage: Do We Need to Stay in Hospital 24-7? Allan Garland, MD, MA Associate Professor of Medicine and Community Health Sciences University of Manitoba Introduction There are

More information

Chronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory.

Chronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory. Chronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory.edu Data free zone Disclosures A (Very) Old Case 65 year-old

More information

Pain Management in the Critically ill Patient

Pain Management in the Critically ill Patient Pain Management in the Critically ill Patient Jim Ducharme MD CM, FRCP President-Elect, IFEM Clinical Professor of Medicine, McMaster University Adjunct Professor of Family Medicine, Queens University

More information

Facilitators & Barriers to Acute Rehabilitation in the the Critically Ill

Facilitators & Barriers to Acute Rehabilitation in the the Critically Ill Facilitators & Barriers to Acute Rehabilitation in the the Critically Ill Karen K.Y. Koo MD, FRCPC, MSc Assistant Professor, Division Critical Care Medicine Department of Medicine, Western University Critical

More information

Rehabilitation within critical care. By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary

Rehabilitation within critical care. By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary Rehabilitation within critical care By David McWilliams Senior Specialist Physiotherapist Critical Care Manchester Royal Infirmary Contents Negative effects of Critical illness/ prolonged ventilation Evidence

More information

Goals of Presentations. The Rehab Team Do We Need a Recharge? Recharging the Rehab Team: Strategies to Improve Team Care and Patient Outcomes

Goals of Presentations. The Rehab Team Do We Need a Recharge? Recharging the Rehab Team: Strategies to Improve Team Care and Patient Outcomes Recharging the Rehab Team: Strategies to Improve Team Care and Patient Outcomes UDSMR Annual Conference - Thursday August 8, 2013 DALE STRASSER, MD ASSOC. PROFESSOR, REHABILITATION MEDICINE EMORY UNIVERSITY,

More information

Clinical Scenarios. 2013 MFMER slide-1

Clinical Scenarios. 2013 MFMER slide-1 Clinical Scenarios 2013 MFMER slide-1 Scenario 1 Mrs. P. is a 70 y.o. female with left above knee amputation, admitted with vascular insufficiency and right heel wound. Baseline functional status is independent

More information

EMR Tools as Agents of Change

EMR Tools as Agents of Change EMR Tools as Agents of Change Elizabeth Clark, MD Division of Geriatrics Albert Einstein College of Medicine Amy R. Ehrlich, MD Division of Geriatrics Albert Einstein College of Medicine Paul Douglas Ossman,

More information

Similar to the sequelae faced after a stroke,

Similar to the sequelae faced after a stroke, Rehabilitation Quality Improvement in an Intensive Care Unit Setting: Implementation of a Quality Improvement Model Dale M. Needham, MD, PhD, 1 3 and Radha Korupolu, MBBS, MS 1 1 OACIS Group, Division

More information

Rehabilitation Nurses: Champions for Optimizing Stroke Rehabilitation Across the Continuum of Care

Rehabilitation Nurses: Champions for Optimizing Stroke Rehabilitation Across the Continuum of Care Rehabilitation Nurses: Champions for Optimizing Stroke Rehabilitation Across the Continuum of Care Presenters Sandra Melchiorre RN, MN, ACNP, CNN (c) Regional Stroke Acute Care Advanced Practice Nurse,

More information

Sue Carol Verrillo, RN, MSN, CRRN The Johns Hopkins Hospital November 14, 2014

Sue Carol Verrillo, RN, MSN, CRRN The Johns Hopkins Hospital November 14, 2014 Early Detection of Patient Deterioration Using Remote Patient Monitoring with Wireless Nurse Notification Sue Carol Verrillo, RN, MSN, CRRN The Johns Hopkins Hospital November 14, 2014 1 Why Remote Patient

More information

4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal

4/18/14. Background. Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients. Background. Signs and Symptoms of Withdrawal Background 1 Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Alyssa Cavanaugh, PharmD PGY1 Pharmacy Resident Children s Hospital of Michigan **The speaker has no actual or

More information

UW MEDICINE PATIENT EDUCATION. Your Care Team. Helpful information

UW MEDICINE PATIENT EDUCATION. Your Care Team. Helpful information UW MEDICINE PATIENT EDUCATION Your Care Team Helpful information In this section: You: The Patient Medical Staff Nursing Staff Allied Health Professionals Support Staff Peer Mentors for People with Spinal

More information

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Jennifer Kuhns, Pharm.D. Pharmacy Practice Resident Children s Hospital of Michigan **The speaker has no actual or potential

More information

Knowledge Translation Issues: Clinical applications, pre-service curriculum development, and research applications

Knowledge Translation Issues: Clinical applications, pre-service curriculum development, and research applications Knowledge Translation Issues: Clinical applications, pre-service curriculum development, and research applications Kurt Johnson University of Washington Start at the beginning KT is thoroughly integrated

More information

Alarm management: The Abbott Northwestern Experience A quality improvement project

Alarm management: The Abbott Northwestern Experience A quality improvement project Alarm management: The Abbott Northwestern Experience A quality improvement project Stacy Jepsen, APRN, CNS, CCRN Sue Sendelbach, PhD, RN, CCNS, FAHA, FAAN September 3 rd, 2014 Abbott Northwestern Hospital

More information

Stroke Rehabilitation Triage Severe Strokes

Stroke Rehabilitation Triage Severe Strokes The London Stroke Rehab Data Base Project Robert Teasell MD FRCPC Professor and Chair-Chief Department of Phys Med Rehab London Ontario Retrospective Data Bases In stroke rehab limited funding for clinical

More information

Advancing Nursing Expertise in the Care of Older Patients with Cancer: A Multidisciplinary Educational Course for Oncology Nurses

Advancing Nursing Expertise in the Care of Older Patients with Cancer: A Multidisciplinary Educational Course for Oncology Nurses Advancing Nursing Expertise in the Care of Older Patients with Cancer: A Multidisciplinary Educational Course for Oncology Nurses Heidi Yulico RN, MSN, GNP-BC Lorraine McEvoy DNP, MSN, RN, OCN Beatriz

More information

Leadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015

Leadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015 Leveraging the Continuum to Avoid Unnecessary Utilization While Improving Quality Leadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015 Karim A. Habibi, FHFMA, MPH, MS Senior

More information

Why does delirium develop?

Why does delirium develop? What is delirium? Delirium is a name for acute confusion. The patient who is delirious is often experiencing a world that makes no sense to us but is very real to them. For instance they may: not know

More information

TITLE Code Comfort Pilot Policy DRAFT NUMBER To be assigned Last Revised/Reviewed TJC FUNCTIONS APPLIES TO

TITLE Code Comfort Pilot Policy DRAFT NUMBER To be assigned Last Revised/Reviewed TJC FUNCTIONS APPLIES TO CLINICAL TITLE Code Comfort Pilot Policy DRAFT NUMBER To be assigned Last Revised/Reviewed Effective Date: TJC FUNCTIONS APPLIES TO I. SCOPE / PURPOSE: Novant Health Code Comfort: Pain, Dyspnea, Anxiety

More information

Stacy McLaughlin, RN, MSN. Director of Quality & Performance Improvement

Stacy McLaughlin, RN, MSN. Director of Quality & Performance Improvement Stacy McLaughlin, RN, MSN Director of Quality & Performance Improvement 25-bed CAH 21 beds: acute / observation / swingbed 4 bed ICU ED volumes: 14,400 encounters/year 5 Clinics: Rural Health / Primary

More information

ABCDEF Improvement Collaborative: A project of ICU LIBERATION Campaign

ABCDEF Improvement Collaborative: A project of ICU LIBERATION Campaign ABCDEF Improvement Collaborative: A project of ICU LIBERATION Campaign Funded by Gordon and Betty Moore Foundation Collaborative Hospital Participation: Frequently Asked Questions (FAQs) What do I need

More information

Southern California Patient Safety First Collaborative Long Beach Memorial Medical Center Team Presentation. September 17, 2014

Southern California Patient Safety First Collaborative Long Beach Memorial Medical Center Team Presentation. September 17, 2014 Southern California Patient Safety First Collaborative Long Beach Memorial Medical Center Team Presentation September 17, 2014 1907 2014 Not-for-profit, community-based One of few campuses home to adult

More information

L A U R A C. D R I S C O L L P T, D P T, G C S ldriscol@bu.edu

L A U R A C. D R I S C O L L P T, D P T, G C S ldriscol@bu.edu L A U R A C. D R I S C O L L P T, D P T, G C S ldriscol@bu.edu Curriculum Vitae WORK EXPERIENCE Boston University Sargent College of Health and Rehabilitation Sciences Department of Physical Therapy and

More information

Fall Prevention in Acute Care Hospitals: A Randomized Trial

Fall Prevention in Acute Care Hospitals: A Randomized Trial Fall Prevention in Acute Care Hospitals: A Randomized Trial Patricia C. Dykes DNSc, RN, FAAN, FACMI Sr. Nurse Scientist Program Director Center for Patient Safety Research & Practice Center for Nursing

More information

Northwest EHR Usability and Safety Institute (NExUS): Scientifically Improving EHR Functionality and Safety. November 14, 2013 Jeff Gold, MD

Northwest EHR Usability and Safety Institute (NExUS): Scientifically Improving EHR Functionality and Safety. November 14, 2013 Jeff Gold, MD Northwest EHR Usability and Safety Institute (NExUS): Scientifically Improving EHR Functionality and Safety November 14, 2013 Jeff Gold, MD Background: Electronic Health Records Used by every member of

More information

Organization: MedStar Union Memorial Hospital. Solution Title: Call 911: Our Documentation Died! Program/Project Description, including Goal:

Organization: MedStar Union Memorial Hospital. Solution Title: Call 911: Our Documentation Died! Program/Project Description, including Goal: Organization: MedStar Union Memorial Hospital Solution Title: Call 911: Our Documentation Died! Program/Project Description, including Goal: Our Emergency Department (ED) converted to an electronic medical

More information

Sutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL

Sutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL Sutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL Delirium-(acute brain dysfunction) is defined as a disturbance of consciousness with inattention accompanied by a change in cognition or

More information

University of Michigan Alcohol Withdrawal Guidelines Overview

University of Michigan Alcohol Withdrawal Guidelines Overview University of Michigan Alcohol Withdrawal Guidelines Overview The following document contains the University of Michigan Alcohol Withdrawal Guidelines. These guidelines were developed through an intensive

More information

Translating Evidence to Safer Care Patient Safety Research Introductory Course Session 7 Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg

More information

Complex Care Planning in the Emergency Department: Demonstrating Rehabilitation Contributions

Complex Care Planning in the Emergency Department: Demonstrating Rehabilitation Contributions Complex Care Planning in the Emergency Department: Demonstrating Rehabilitation Contributions CAOT Conference 2016 Inspired for Higher Summits Banff, AB No conflict of interest Project Team all from Sunnybrook

More information

JOHNS HOPKINS CRITICAL CARE REHABILITATION CONFERENCE

JOHNS HOPKINS CRITICAL CARE REHABILITATION CONFERENCE CONTINUING MEDICAL EDUCATION DIVISION OF PULMONARY AND CRITICAL CARE MEDICINE AND DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION Present the Fourth Annual: JOHNS HOPKINS CRITICAL CARE REHABILITATION

More information

Plugging Behavioral Health. Health into Electronic Medical Records

Plugging Behavioral Health. Health into Electronic Medical Records Plugging Behavioral Health into Electronic Medical Records 2:15 3:15 pm Cheryl Odell, RN Fadi Nicolas, MD Mary Kay Shibley, RN Sharp Mesa Vista Plugging Behavioral Health into Electronic Medical Records

More information

Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design. Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer

Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design. Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer 0 Gap Between Knowledge and Delivery Translational Roadmap

More information

Mobile Rehabilitation Team St Vincent s Style. Dr Shari Parker Rehabilitation Physician

Mobile Rehabilitation Team St Vincent s Style. Dr Shari Parker Rehabilitation Physician Mobile Rehabilitation Team St Vincent s Style Dr Shari Parker Rehabilitation Physician Drivers for Change 1. Pressure on beds, bed blocks 2. Evidence for Early Rehabilitation 3. The problem of Deconditioning

More information

Targeting patients for use of dexmedetomidine

Targeting patients for use of dexmedetomidine Targeting patients for use of dexmedetomidine H a n n a h W u n s c h, M D M S c H e r b e r t I r v i n g A s s i s t a n t P r o f e s s o r o f A n e s t h e s i o l o g y & E p i d e m i o l o g y

More information

Patients Receive Recommended Care for Community-Acquired Pneumonia

Patients Receive Recommended Care for Community-Acquired Pneumonia Patients Receive Recommended Care for Community-Acquired Pneumonia For New Jersey to be a state in which all people live long, healthy lives. DSRIP LEARNING COLLABORATIVE PRESENTATION The Care you Trust!

More information

The Hospital Elder Life Program (HELP): Resources for Implementation

The Hospital Elder Life Program (HELP): Resources for Implementation The Hospital Elder Life Program (HELP): Resources for Implementation Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley

More information

What do these stories illustrate about ER/ALC issue?

What do these stories illustrate about ER/ALC issue? What do these stories illustrate about ER/ALC issue? Maximizing the Impact of Rehab on Provincial Priority Issues Mark Bayley, MD, FRCPC Medical Director, Neuro Rehabilitation Program, Toronto Rehab and

More information

Robot-Assisted Stroke Rehabilitation

Robot-Assisted Stroke Rehabilitation American Heart Association International Stroke Conference, 2012, New Orleans Robot-Assisted Stroke Rehabilitation Albert Lo, M.D., PhD Departments of Neurology and Epidemiology Associate Director, Center

More information

Fall Risk Identification and Intervention To Prevent Falls In The Outpatient Care Setting

Fall Risk Identification and Intervention To Prevent Falls In The Outpatient Care Setting Fall Risk Identification and Intervention To Prevent Falls In The Outpatient Care Setting Kathleen Burns RN, MSN OCN Margaret Hanbury RN,BSN, MPH Cheryl Larsen RN,BSN Christine Waszynski RN,MSN,GNP-BC

More information

Hospice Care in The Nursing Home. Perspectives of a Medical Director Carole Baraldi, M.D.

Hospice Care in The Nursing Home. Perspectives of a Medical Director Carole Baraldi, M.D. Hospice Care in The Nursing Home Perspectives of a Medical Director Carole Baraldi, M.D. Evolution of Nursing Facilities Alms houses began over 1000 years ago Historically serve older people who can no

More information

BEHAVIORAL HEALTH AND DETOXIFICATION - MEETING DEMAND FOR SERVICES UNIVERSITY OF PITTSBURGH MEDICAL CENTER MERCY HOSPITAL Publication Year: 2013

BEHAVIORAL HEALTH AND DETOXIFICATION - MEETING DEMAND FOR SERVICES UNIVERSITY OF PITTSBURGH MEDICAL CENTER MERCY HOSPITAL Publication Year: 2013 BEHAVIORAL HEALTH AND DETOXIFICATION - MEETING DEMAND FOR SERVICES UNIVERSITY OF PITTSBURGH MEDICAL CENTER MERCY HOSPITAL Publication Year: 2013 Summary: The development of separate intake area for behavioral

More information

Alternatives to Hospital: Models of Integrated Care

Alternatives to Hospital: Models of Integrated Care Alternatives to Hospital: Models of Integrated Care Tom Bowen The Balance of Care Group www.balanceofcare.com IMA Health 2007, London, UK 2 April 2007 Projects taking whole systems approach Sheffield Designed

More information

20 Years in Stroke Rehabilitation: Trials, Tribulations and Tomorrow

20 Years in Stroke Rehabilitation: Trials, Tribulations and Tomorrow 20 Years in Stroke Rehabilitation: Trials, Tribulations and Tomorrow Julie Bernhardt Assoc Prof, Director AVERT Very Early Rehabilitation Program, National Stroke Research Institute and School of Physiotherapy,

More information

Care Management Can We Do It Better?

Care Management Can We Do It Better? Care Management Can We Do It Better? Wilma Acosta, Associate Director Protiviti, Inc. Alex Robison, Managing Director Protiviti, Inc. Agenda I. Care Management Challenges II. Compliance Case Studies Intermittently

More information

Iatrogenesis. Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging

Iatrogenesis. Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging Iatrogenesis Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging Iatrogenesis Definition from the Greek word, iatros,, meaning healer, iatrogenesis means brought forth by a healer

More information

Retrospective review of the Modified Early Warning Score in critically ill surgical inpatients at a Canadian Hospital

Retrospective review of the Modified Early Warning Score in critically ill surgical inpatients at a Canadian Hospital Retrospective review of the Modified Early Warning Score in critically ill surgical inpatients at a Canadian Hospital Alisha Mills PGY 4 General Surgery Northern Ontario School of Medicine S Disclosures

More information

Lesson 2: Health Professions

Lesson 2: Health Professions Glossary 1. Bachelor s Degree: a 4-year degree from a college or university 2. Certification: some jobs require you to complete a training program or pass an exam to show that you have the knowledge to

More information

Improving Pediatric Emergency Department Patient Throughput and Operational Performance

Improving Pediatric Emergency Department Patient Throughput and Operational Performance PERFORMANCE 1 Improving Pediatric Emergency Department Patient Throughput and Operational Performance Rachel Weber, M.S. 2 Abbey Marquette, M.S. 2 LesleyAnn Carlson, R.N., M.S.N. 1 Paul Kurtin, M.D. 3

More information

MINISTRY OF HEALTH ELECTRONIC MEDICAL RECORDS

MINISTRY OF HEALTH ELECTRONIC MEDICAL RECORDS MINISTRY OF HEALTH ELECTRONIC MEDICAL RECORDS MEXICO CITY November 10, 2010 OVERVIEW Why Electronic Medical Records (EMR)? Planning, Implementation & Challenges Observed Outcomes Valuable Lessons 1 EMR

More information

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013)

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals: Timely access to geographically located acute stroke unit care with a dedicated interprofessional team

More information

How to Build a Case Management System that Leads to Success

How to Build a Case Management System that Leads to Success How to Build a Case Management System that Leads to Success PRESENTED BY SHARON M. LITWIN, RN, BS, MHA, HCS D SENIOR MANAGING PARTNER, 5 STAR CONSULTANTS AND SHERYL BELLINGER, MA, BSN, RN, CHCA, ADMINISTRATOR,

More information

Delirium, Patient Outcomes, and Nursing Practice. Objectives

Delirium, Patient Outcomes, and Nursing Practice. Objectives Delirium, Patient Outcomes, and Nursing Practice Sharon Gunn, MSN, MA, RN, ACNS-BC, CCRN Clinical Nurse Specialist Critical Care Baylor University Medical Center Dallas, TX Objectives Describe the three

More information

T. Franklin Williams

T. Franklin Williams Falls in Older Adults: Implementing Research in Practice University of Leuven February, 2012 Mary Tinetti MD T. Franklin Williams Symposium: Valpreventie bij ouderen 1 Phases in the research First phase:

More information

Outline. Advanced Practice Providers in the Intensive Care Unit. Why utilize APPs in the ICU? 5/30/2013

Outline. Advanced Practice Providers in the Intensive Care Unit. Why utilize APPs in the ICU? 5/30/2013 Outline Advanced Practice Providers in the Intensive Care Unit Thomas Farley MS, NP Assistant Clinical Professor UCSF School of Nursing Why utilize APPs in the ICU Recent publications General review of

More information

What do ACO s and Hospitals want from SNF s and CCRC s

What do ACO s and Hospitals want from SNF s and CCRC s What do ACO s and Hospitals want from SNF s and CCRC s Presented to the Institute of Senior Living, April 11, 2013 A Division of Kindred Healthcare 1 Assessing the match: What hospitals and ACO s currently

More information

Falls Prevention Strategy

Falls Prevention Strategy Falls Prevention Strategy Policy of the Fall Season October-November 2011 Revised for CCTC By: Krista Shea RN, BScN, CNCC(C) Did you know In Canada: Falls are the 6th leading cause of death among older

More information

Mary Ann Forciea MD Kathleen Walsh, DO Division of Geriatric Medicine November 2008

Mary Ann Forciea MD Kathleen Walsh, DO Division of Geriatric Medicine November 2008 Why aren t they called Doctor s Homes? or The Role of the Physician in the Nursing Home Mary Ann Forciea MD Kathleen Walsh, DO Division of Geriatric Medicine November 2008 Format of visit Opening seminar

More information

A. Sue Carlisle, PhD, MD Professor of Anesthesia and Medicine Associate Dean for UCSF at SFGH

A. Sue Carlisle, PhD, MD Professor of Anesthesia and Medicine Associate Dean for UCSF at SFGH A. Sue Carlisle, PhD, MD Professor of Anesthesia and Medicine Associate Dean for UCSF at SFGH VIEW FROM 23RD STREET 10 10 100,000 individuals seen/year 600,000 outpatient visits 16,500 admissions 6000

More information

Current Research IMPLEMENTING A PAIN RESOURCE NURSE PROGRAM. Relevance to Your Organization Collect the Data. Relevance to Your Organization

Current Research IMPLEMENTING A PAIN RESOURCE NURSE PROGRAM. Relevance to Your Organization Collect the Data. Relevance to Your Organization IMPLEMENTING A PAIN RESOURCE NURSE PROGRAM Dr. Fran Hoh PhD APN PCM CS Current Research Improves Nurse Retention Improves Nurse Physician Collaboration Improves Patient Satisfaction Improves Nursing Autonomy

More information

Peter Munk Cardiac Centre, University Health Network. Allied Health Personnel Symposium American Association of Thoracic Surgery April 26, 2014

Peter Munk Cardiac Centre, University Health Network. Allied Health Personnel Symposium American Association of Thoracic Surgery April 26, 2014 The Expanding Role of the Nurse Practitioner and Physician Assistant Across the Continuum of Care for the CTS Patient: Preoperative, Postoperative, and After Discharge Jane MacIver RN NP PhD Peter Munk

More information

Building an Emergency Response to Acute Stroke

Building an Emergency Response to Acute Stroke Great Lakes Stroke Network August 2006 Building an Emergency Response to Acute Stroke Wende N. Fedder RN, BSN, MBA Director, Stroke & Neurovascular Services Alexian Brothers Hospital Network Elk Grove

More information

Proposal for Consideration. Submitted by: The South Okanagan Similkameen Divisions of Family Practice and the Interior Health Authority

Proposal for Consideration. Submitted by: The South Okanagan Similkameen Divisions of Family Practice and the Interior Health Authority Service Delivery Model for Quality Medical Care in Residential Care for Interior Health Authority Contracted Residential Care Facilities in Penticton and Summerland Proposal for Consideration Submitted

More information

Introducing a NEW simulation based training program for KGH / HDH Emergency Room Nurses

Introducing a NEW simulation based training program for KGH / HDH Emergency Room Nurses Introducing a NEW simulation based training program for KGH / HDH Emergency Room Nurses Are you looking to improve your skills in ER nursing care? Have you heard about the benefits of simulation based

More information

Alison E. Turnbull, D.V.M., M.P.H., Ph.D. Curriculum Vitae

Alison E. Turnbull, D.V.M., M.P.H., Ph.D. Curriculum Vitae Alison E. Turnbull, D.V.M., M.P.H., Ph.D. Curriculum Vitae August 2, 2015 Alison Turnbull DEMOGRAPHIC INFORMATION Current Appointments 2015 present Assistant Professor, Pulmonary & Critical Care Medicine,

More information

Synapses: Continuity of Care Through the ARN Role. Lunder 6 Neuroscience ICU Lunder 7 Neurosciences Lunder 8 - Neurosciences

Synapses: Continuity of Care Through the ARN Role. Lunder 6 Neuroscience ICU Lunder 7 Neurosciences Lunder 8 - Neurosciences Synapses: Continuity of Care Through the ARN Role Lunder 6 Neuroscience ICU Lunder 7 Neurosciences Lunder 8 - Neurosciences MGH Neuroscience ARNs Lunder 8 Kristin Cina, Mikaela Arruda Lunder 7 Susan Sullivan,

More information

Creating a Checklist Culture Chris George, RN MS cgeorge@mha.org

Creating a Checklist Culture Chris George, RN MS cgeorge@mha.org Creating a Checklist Culture Chris George, RN MS cgeorge@mha.org Objectives Benefits of using checklists What makes a good checklist Creating a culture that supports checklists Why do we need checklists?

More information

Place hospital logo here

Place hospital logo here Place hospital logo here Device-Related Pressure Ulcers Reducing device-related pressure ulcers of the nose and mouth in adult critical care patients Device-Related Pressure Ulcers Jennifer Markowitz,

More information

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting

More information

LIMITED PERFECTIONISM, How I Learned to Stop Worrying and Love the Epic Fails

LIMITED PERFECTIONISM, How I Learned to Stop Worrying and Love the Epic Fails LIMITED PERFECTIONISM, OR How I Learned to Stop Worrying and Love the Epic Fails WHAT DO WE TALK ABOUT WHEN WE TALK ABOUT FAILURE? Concrete/Discrete Completion of Project Budget/Finance Timeline Quality

More information

Place hospital logo here

Place hospital logo here Place hospital logo here Nurse-Driven Protocol for the Management of Patients in Alcohol/Substance Withdrawal Maimonides Medical Center (MMC) Sharon Hawthorne, RN, BSN, CCRN, SSN II Ariadne Williams, RN,

More information

HIV Outpatient Clinical Care Pathway Version 11 [As per 10 updated for documentation review]

HIV Outpatient Clinical Care Pathway Version 11 [As per 10 updated for documentation review] HIV Outpatient Clinical Care Pathway Version 11 [As per 10 updated f documentation review] Categy 1: New Categy 2: Stable Categy 3: Complex - ACCESS HIV + Diagnosis Patient from: G.U. clinic A&E Medical

More information

Credentialing Critical Care Providers

Credentialing Critical Care Providers Credentialing Critical Care Providers Neal H. Cohen, MD, MPH, MS Professor and Vice Dean UCSF School of Medicine Chair, Risk Management Committee August 8, 2008 Credentials in Critical Care Medicine What

More information

Michael R. Pinsky, M.D., C.M., Dr.h.c., FCCP, MCCM Professor of Critical Care Medicine, Bioengineering, Anesthesiology, Cardiovascular Diseases, and

Michael R. Pinsky, M.D., C.M., Dr.h.c., FCCP, MCCM Professor of Critical Care Medicine, Bioengineering, Anesthesiology, Cardiovascular Diseases, and Michael R. Pinsky, M.D., C.M., Dr.h.c., FCCP, MCCM Professor of Critical Care Medicine, Bioengineering, Anesthesiology, Cardiovascular Diseases, and Clinical & Translational Sciences, Vice Chair for Academic

More information

Safety Implications of EHR/HIT

Safety Implications of EHR/HIT Safety Implications of EHR/HIT PSA Board Meeting July 24, 2012 Erin Sparnon, MEng. William M. Marella, MBA 7/19/2012 2012 Pennsylvania Patient Safety Authority 1 What does it take to have safe HIT? Availability

More information

Preventing Patient Falls

Preventing Patient Falls Preventing Patient Falls Patient Falls are the #1 cause of ALL sentinel events. All patients at Doctors Community Hospital are assessed for fall risk and, as appropriate, the Fall Risk Protocol is implemented.

More information

Discharge Planning. Barry K. Bennett, LCSW Adjunct Assistant Professor Department of Surgery

Discharge Planning. Barry K. Bennett, LCSW Adjunct Assistant Professor Department of Surgery Discharge Planning Barry K. Bennett, LCSW Adjunct Assistant Professor Department of Surgery WHO ARE SOCIAL WORKERS? Licensed professionals who help individuals, families, and communities understand the

More information

DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE

DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE REFERENCES: The Joint Commission Accreditation Manual for Hospitals American Society of Post Anesthesia Nurses: Standards of Post Anesthesia Nursing Practice (1991, 2002). RELATED DOCUMENTS: SHC Administrative

More information

PRESENCE OF A DEDICATED TRAUMA CENTER PHYSIATRIST IMPROVES FUNCTIONAL OUTCOMES FOLLOWING TRAUMATIC BRAIN INJURY CHRISTINE GREISS D.O.

PRESENCE OF A DEDICATED TRAUMA CENTER PHYSIATRIST IMPROVES FUNCTIONAL OUTCOMES FOLLOWING TRAUMATIC BRAIN INJURY CHRISTINE GREISS D.O. PRESENCE OF A DEDICATED TRAUMA CENTER PHYSIATRIST IMPROVES FUNCTIONAL OUTCOMES FOLLOWING TRAUMATIC BRAIN INJURY CHRISTINE GREISS D.O. Christine Greiss, D.O. Rutgers- New Jersey Medical School Peter P.

More information

Collaborative Care Plan for PAIN

Collaborative Care Plan for PAIN 1. Pain Assessment *Patient s own description of pain is the most reliable indicator for pain assessment. Pain intensity to be assessed using the ESAS (Edmonton Symptom Assessment Scale) Use 5 th Vital

More information

Medication Error. Medication Errors. Transitions in Care: Optimizing Intern Resources

Medication Error. Medication Errors. Transitions in Care: Optimizing Intern Resources Transitions in Care: Optimizing Intern Resources DeeDee Hu PharmD, MBA Clinical Specialist Critical Care and Cardiology PGY1 Program Director Memorial Hermann Memorial City Medical Center Medication Error

More information

AMERICAN BURN ASSOCIATION BURN CENTER VERIFICATION REVIEW PROGRAM Verificatoin Criterea EFFECTIVE JANUARY 1, 2015. Criterion. Level (1 or 2) Number

AMERICAN BURN ASSOCIATION BURN CENTER VERIFICATION REVIEW PROGRAM Verificatoin Criterea EFFECTIVE JANUARY 1, 2015. Criterion. Level (1 or 2) Number Criterion AMERICAN BURN ASSOCIATION BURN CENTER VERIFICATION REVIEW PROGRAM Criterion Level (1 or 2) Number Criterion BURN CENTER ADMINISTRATION 1. The burn center hospital is currently accredited by The

More information

By Debra Davidson, PhD, MSA, MS Luciane Tarter, RN, BSN. SBIRT grant for Behavioral Health APCP. Mo Health Net Health Home Program SBIRT

By Debra Davidson, PhD, MSA, MS Luciane Tarter, RN, BSN. SBIRT grant for Behavioral Health APCP. Mo Health Net Health Home Program SBIRT By Debra Davidson, PhD, MSA, MS Luciane Tarter, RN, BSN 1 2 Team Based Care for Chronic Illness Our journey: 24 months APCP: Advanced Primary Care Practice Grant for Medicare : NCQA Level 3 by 2014 MoHealth

More information

Change Management for Health IT: Preparing for your Next Challenge

Change Management for Health IT: Preparing for your Next Challenge Change Management for Health IT: Preparing for your Next Challenge Krystyna Hommen BSc MBA President and CEO, Excelleris Technologies Laurie Poole BScN MHSA Vice President, Telemedicine Solutions, OTN

More information

Stroke Rehab Across the Continuum of Care in Quinte Region

Stroke Rehab Across the Continuum of Care in Quinte Region Stroke Rehab Across the Continuum of Care in Quinte Region Adrienne Bell Smith Manager of Rehab Therapies QHC Karen Brown Manger Client Services, Hospital Access South East CCAC Disclosure of Potential

More information

Long-Term Care/Rehab Facility Reduces Noise, Delivers Improved Satisfaction

Long-Term Care/Rehab Facility Reduces Noise, Delivers Improved Satisfaction Case Study Long-Term Care/Rehab Facility Reduces Noise, Delivers Improved Satisfaction Responder 5 technology positively changes environment for patients and caregivers, resulting in better quality care.

More information

RN Care Manager Assessment: The 4 Domains

RN Care Manager Assessment: The 4 Domains RN Care Manager Assessment: The 4 Domains Access to Care Experience with Provider(s) Getting Needed Services Coordination of Care Medical Home / Services Risk Medical Neighborhood Social Support Home Environment

More information

Conflict of Interest Disclosure

Conflict of Interest Disclosure Leveraging Clinical Decision Support for Optimal Medication Management Anne M Bobb, BS Pharm., Director Quality Informatics Children s Memorial Hospital, Chicago IL, February 20, 2012 DISCLAIMER: The views

More information

AS THE POPULATION AGES and mortality from critical

AS THE POPULATION AGES and mortality from critical 536 ORIGINAL ARTICLE Early Physical Medicine and Rehabilitation for Patients With Acute Respiratory Failure: A Quality Improvement Project Dale M. Needham, MD, PhD, Radha Korupolu, MBBS, MS, Jennifer M.

More information

The Fall Prevention Center of Excellence is supported by the Archstone Foundation

The Fall Prevention Center of Excellence is supported by the Archstone Foundation FllPr Fall Prevention: n Translating Knowledge Into Action 2009 ASA/NCOA Joint Conference Workshop March 18, 2009 - Las Vegas, NV Addressing Falls in Facility-Based Communities Steven C. Castle, M.D. Professor

More information

2/14/2015. Liz Cooke RN NP

2/14/2015. Liz Cooke RN NP Liz Cooke RN NP Quality of Life studies with HCT pts began at City of Hope in 1991 for Tool validation Retrospective Chart Review in 2000 of 100 HCT patients looking at readmission patterns. (published

More information

James Bell May 2011 GBL

James Bell May 2011 GBL James Bell May 2011 GBL Day 1 M 32, lives alone, data analyst 12 noon - presented CDAT seeking help - wrong borough, referred to local service - went home, agitated and hallucinating - Took large dose

More information

Nurse Staffing Plan Survey Results 8-13-14

Nurse Staffing Plan Survey Results 8-13-14 Nurse Staffing Plan Survey Results 8-13-14 Accreditation Status (Profit/Not for Profit) 8.57 9.7 9.13 10 11 18.84 19.89 HPPD Med Surg MED/SURG 1 2 3 4 5 6 7 Formula For HPPD Determination System Generated

More information

Depression: Facility Assessment Checklists

Depression: Facility Assessment Checklists Depression: Facility Assessment Checklists A facility system assessment is a starting point for a quality improvement project. The checklists included in this booklet will be most useful if you take a

More information

Building a Plan for Process Improvement

Building a Plan for Process Improvement Building a Plan for Process Improvement (Rapid Fire PI Workshop) Lynn Hundley MSN,APRN,CNRN,CCNS,ANVP Melissa Richardson MSN,RN,SCRN Questions Does your organization have legacy problems that go unresolved?

More information

Neuroscience/Trauma Intensive Care Unit

Neuroscience/Trauma Intensive Care Unit Neuroscience/Trauma Intensive Care Unit 6ICU Ronald Reagan UCLA Medical Center 757 Westwood Plaza, 6th Floor Los Angeles, CA 90095-7403 Main Phone: (310) 267-7641 About Our Unit We want you to feel welcome

More information

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy

Phenobarbital in Severe Alcohol Withdrawal Syndrome. Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Phenobarbital in Severe Alcohol Withdrawal Syndrome Jordan Rowe Pharm.D. Candidate UAMS College of Pharmacy Disclosure: No relevant financial relationship exists. Objectives 1. Describe the pathophysiology

More information