Leveraging Vascular Access Team to increase safety and access to care

Using a pager platform to receive vascular access consults related to peripheral intravenous catheter (PIV)/central line care and maintenance needs has resulted in significant time and delays in treatment lost by bedside nursing and vascular access staff. The goal of this project is to develop a nursing consult order set to replace the paging process to improve transparency and communication among team members, reduce delays in IV therapy administration, and improve efficiency

Improving Patient Experience and Education by Leveraging Technology

It is estimated that 65% of the population are visual learners. With that in mind, a team of cardiac nurses in a large academic tertiary hospital developed a quality improvement project to hopefully improve patient engagement as well the patients’ perception that the nurses explained things in a manner that they could understand. Baseline patient survey scores for the question, “Nurses Explained Things In A Way That I Understand”, were under the 75thpercentile for a period of 9 months. A root cause analysis was conducted and it demonstrated numerous reasons for this score. Several countermeasures were instituted to include the use of I Pads for patient education. In conjunction with the hospital IT specialists, cardiac educational materials were developed and videos chosen for I Pad use. A daily KPI was established to track progress of their i Pad usage goal. Follow-up survey results demonstrated significant improvement post I Pad implementation to the question “Nurses Explained Things In A Way That I Understand”. Next steps include further education of nursing staff on educating patients in the use of I Pads as well as adding other cardiovascular educational materials

Strategies to Increase Early Discharges to Reduce Avoidable Patient Days and Improve Patient Flow

CREATING ALGORITHMS TO INCREASE THE NUMBERS OF HOSPITAL MORNING DISCHARGES RESULTING IN IMPROVED PATIENT FLOW Discharging a percentage of patients early in the day helps to improve patient flow. This results in a reduction of Emergency Department congestion as well as peaks in patient numbers in the early to late afternoon on patient care units. A cardiac unit in an academic tertiary medical center created a goal to increase the number of their discharges by 11 AM and to streamline key discharge planning activities. A root cause analysis was initiated and after identifying several barriers, two KPIs were developed using improvement measures of operational excellence. Post KPI inception, metric goals were exceeded within the established timeline. Next steps include reviewing DRG specific readmission rates to make sure there are no negative impacts as a result of the established countermeasures. In addition, the unit will provide coaches for other care units interested in adopting these strategies

Metamemory as evidence of animal consciousness: the type that does the trick

The question of whether nonhuman animals are conscious is of fundamental importance. There are already good reasons to think that many are, based on evolutionary continuity and other considerations. However, the hypothesis is notoriously resistant to direct empirical test. Numerous studies have shown behaviour in animals analogous to consciously-produced human behaviour. Fewer probe whether the same mechanisms are in use. One promising line of evidence about consciousness in other animals derives from experiments on metamemory. A study by Hampton (Proc Natl Acad Sci USA 98(9): 5359-5362, 2001) suggests that at least one rhesus macaque can use metamemory to predict whether it would itself succeed on a delayed matching-to-sample task. Since it is not plausible that mere meta-representation requires consciousness, Hampton's study invites an important question: what kind of metamemory is good evidence for consciousness? This paper argues that if it were found that an animal had a memory trace which allowed it to use information about a past perceptual stimulus to inform a range of different behaviours, that would indeed be good evidence that the animal was conscious. That funcitonal characterisation can be tested by investigating whether successful performance on one metamemory task transfers to a range of new tasks. The paper goes on to argue that thinking about animal consciousnes in this way helps in formulating a more precise functional characterisation of the mechanisms of conscious awareness

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field