Background: The number of peripherally inserted central catheter (PICC) lumens has been associated with thrombotic and infectious complications. Policies that limit use of multi-lumen PICCs may improve safety and reduce cost. In this simulation-based study, our objective was to estimate the clinical and cost tradeoffs of policies that limit use of multi-lumen PICCs. Methods: Simulation-based analysis [...]

Background: While peripherally inserted central catheters (PICCs) are important in caring for patients, they are associated with central line-associated bloodstream infection (CLABSI). Antimicrobial PICCs are novel devices that may reduce the risk of CLABSI, but data are conflicting.   Methods: We performed a systematic review and meta-analysis to evaluate whether antimicrobial PICCs reduce the risk [...]

Background: The American Board of Internal Medicine expects all general internists to be competent, at least “with regard to their knowledge and understanding,” in bedside paracentesis, thoracentesis, central venous catheterization, and lumbar puncture, among other less invasive procedures.  Unfortunately, increasing patient loads with a focus on efficiency caused a shift away from our hospitalist group [...]

Background: Sepsis, severe sepsis, and septic shock combined, are estimated to affect between 650,000 and 750,000 Americans annually, and has an associated mortality rate between 20 to 50%.  Early identification of patients with sepsis is critical, as treatment delays are associated with significant increases in mortality. The electronic health record (EHR) contains near-real-time physiologic parameters, [...]

Background: Active patient engagement improves patient  outcomes.  Patient activated rapid response teams are one potential method to encourage patient involvement, however outcomes of this intervention have not been evaluated.  The University of Pittsburgh Medical Center developed and implemented a patient and family initiated rapid response system called Condition Help.  All hospitalized patients are educated at [...]

Background: In-hospital mortality attributable to sepsis is higher than overall population mortality (Gaieski DF et al, 2013; Dombrovskiy VY, 2007). Furthermore, the rates of severe sepsis are increasing annually (Dombrovskiy VY,2007). Early detection and early intervention have been shown effective at reducing mortality among in-patients (Dombrovskiy VY, 2007). Internal data suggests that the identification of [...]

Background: Discussion of medical errors in patient care is often not formally taught in most residencies or medical schools.  Yet the skill set needed for addressing patient adverse events when they occur and preventing similar occurrences in the future is instrumental for the practice of medicine. A Morbidity and Mortality Conference (M&M) is one way [...]

Background: TeamSTEPPS (Strategies and Tools to Enhance Performance and Patient Safety) has been shown to improve patient safety by improving teamwork and communication skills amongst all members of the interdisciplinary team. Methods: We developed a 4-hour TeamSTEPPS multi-disciplinary training session, conducted in our simulation center. We invited 90 core members of the medicine service to [...]

Background: The total cost for treatment of pressure ulcers in the United States is estimated at more than $11 billion annually. The Braden Scale is a risk stratification tool that assesses a patient’s risk of developing a pressure ulcer. It allows clinicians to develop risk-appropriate preventative interventions. Though used widely in the acute care setting, [...]

Background: Quality and patient safety initiatives are often role-specific with minimal emphasis on cross-discipline collaboration and communication. Prior to project implementation, each discipline’s patient care plans were made in silos without an aligned emphasis on quality and safety initiatives. With implementation of a daily interdisciplinary safety brief based on a shared mental model, our aim [...]