Why can’t the ICU be more like a cockpit?

Posted by  | Designing Safer Systems, Preventing Patient Harm

In the world of patient safety, we’re constantly reinforcing the importance of teamwork and communication, both among clinicians and with patients. That’s because we know that patient harm so often occurs when vital information about a patient’s care is omitted, miscommunicated or ignored. Yet for all we do to improve how humans work together, clinicians(...)

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To gauge hospital quality, patients deserve more outcome measures

Posted by  | Measurement of Safety and Quality, Preventing Patient Harm

Patients, providers and the public have much to celebrate. This week, the Centers for Medicare and Medicaid Services’ Hospital Compare website added central line-associated bloodstream infections in intensive care units to its list of publicly reported quality of care measures for individual hospitals. Why is this so important? There is universal support for the idea that(...)

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Memorable patients, unforgettable lessons

Posted by  | Patient-Centered Care, Preventing Patient Harm

Every clinician has encountered patients whose memories stay with them for years. The patients who stick usually are not the ones for whom the clinician made a brilliant diagnosis or provided evidence-based therapies. They are the patients who touched clinicians' hearts, the ones they formed a relationship with, the ones in whom  they saw themselves or a loved one—ultimately, the(...)

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A safety checklist for patients

Posted by  | Preventing Patient Harm

Far too many patients are harmed rather than helped from their interactions with the health care system. While reducing this harm has proven to be devilishly difficult, we have found that checklists help. Checklists help to reduce ambiguity about what to do, to prioritize what is most important, and to clarify the behaviors that are(...)

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Health care needs greater accountability, not excuses

Posted by  | Measurement of Safety and Quality, Organizational and Cultural Change

I recently spoke to an executive in the energy industry who had a joint replacement at a hospital in New York. His wound developed an infection, which required four additional hospital admissions and several operations. He asked me about hand hygiene in hospitals. Proudly, I told him that, at Johns Hopkins Hospital, we are at 80(...)

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Patient-centered care means treating the individual

Posted by  | Patient-Centered Care, Preventing Patient Harm

I hope you’ll take the time to check out our podcast project, The Heart of Caring, which highlights stories that deepen our understanding of patient- and family-centered care. A recently added story comes from physician Dan Munoz, who recalls a decision about whether to place a 99-year-old patient on a ventilator. It’s often considered humane to withhold(...)

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Tell your story: Excellence in patient- and family-centered care

Posted by  | Patient-Centered Care

Last year, Sarah Andryauskas, then a new nurse in our emergency department, was caring for a patient with diabetes who had trouble maintaining healthy blood glucose levels. His disease had contributed to several hospital visits over the preceding months and years. As health care providers, it’s tempting to attribute such repeat visits to patient noncompliance.(...)

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Part II: ISO clinician leaders in patient safety and quality

Posted by  | Designing Safer Systems, Organizational and Cultural Change, Preventing Patient Harm

I recently gave a talk to the American Medical Student Association. The energy in the room was palpable. The students were excited, passionate and hopeful. We spoke about the urgent need to reduce preventable harm and to enhance value, and we discussed that they will need to be the ones to lead these efforts. Yet,(...)

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