Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

Background: Allocation of limited resources to improve quality, patient safety, and outcomes is a decision-making challenge health care leaders face every day. While much valuable health care management research has concentrated on administrative data analysis, this approach often falls short of providing actionable information essential for effective management of specific system implementations and complex systems. This comprehensive performance analysis of a hospital-wide system illustrates application of various analysis approaches to support understanding specific system behaviors and identify leverage points for improvement. The study focuses on performance of a hospital rescue system supporting early recognition and response to patient deterioration, which is essential to reduce preventable inpatient deaths. Methods: Retrospective analysis of tertiary care hospital inpatient and rescue data was conducted using a systems analysis approach to characterize: patient demographics; rescue activation types and locations; temporal patterns of activation; and associations of patient factors, including complications, with post-rescue care disposition and outcomes. Results: Increases in bedside consultations (20% per year) were found with increased rescue activations during periods of resource limitations and changes (e.g., shift changes, weekends). Cardiac arrest, respiratory failure, and sepsis complications present the highest risk for rescue and death. Distributions of incidence of rescue and death by day of patient stay may suggest opportunities for earlier recognition. Conclusions: Specific findings highlight the potential of using rescue-related risk and targeted resource deployment strategies to improve early detection of deterioration. The approach and methods applied can be used by other institutions to understand performance and allow rational incremental improvements to complex care delivery systems

Identifying the latent failures underpinning medication administration errors: an exploratory study

Objectives The primary aim of this article was to identify the latent failures that are perceived to underpin medication errors. Study Setting The study was conducted within three medical wards in a hospital in the United Kingdom. Study Design The study employed a cross-sectional qualitative design. Data Collection Methods Interviews were conducted with 12 nurses and eight managers. Interviews were transcribed and subject to thematic content analysis. A two-step inter-rater comparison tested the reliability of the themes. Principal Findings Ten latent failures were identified based on the analysis of the interviews. These were ward climate, local working environment, workload, human resources, team communication, routine procedures, bed management, written policies and procedures, supervision and leadership, and training. The discussion focuses on ward climate, the most prevalent theme, which is conceptualized here as interacting with failures in the nine other organizational structures and processes. Conclusions This study is the first of its kind to identify the latent failures perceived to underpin medication errors in a systematic way. The findings can be used as a platform for researchers to test the impact of organization-level patient safety interventions and to design proactive error management tools and incident reporting systems in hospitals

La Patología del Habla y Lenguaje Bilingüe

This project will first review the history of Bilingual Speech-Language Pathology in the United States of America. Bilingual Speech-Language Pathology is important in our diverse country where 245 languages are spoken. After a general overview of the field, I will focus on the Spanish language because it is the second most spoken language in the U.S. according to the U.S. Census in 2010. Then, I will review different aspects of Spanish linguistics such as phonology, morphology, and semantics. The understanding of such terms is pertinent to the practice of Bilingual Speech-Language Pathology. Bilingual Speech-Language Pathologists have many responsibilities because they work with patients from different cultures with varying dialects more so than Monolingual Speech-Language Pathologists. I will discuss the many difficulties that Bilingual Speech-Language Pathologists have to deal with and how the Spanish assessment process of patients differs than the prototypical English Assessment. After discussing Bilingual Speech-Language Pathology in general, I will specify my research to San Luis Obispo County in California. Although Spanish-speakers are not the majority in San Luis Obispo this does not mean necessary resources should not be available to the Spanish-speaking population. Lack of Bilingual Speech-Language Pathologists is a problem in San Luis Obispo County that should be changed. I have interviewed two certified monolingual Speech-Language Pathologists to hear their experiences and how they react or relate to certain issues pertaining to their field