6,168 research outputs found

    The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units

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    BACKGROUND: Executive walk rounds (EWRs) are a widely used but unstudied activity designed to improve safety culture in hospitals. Therefore, we measured the impact of EWRs on one important part of safety culture – provider attitudes about the safety climate in the institution. METHODS: Randomized study of EWRs for 23 clinical units in a tertiary care teaching hospital. All providers except physicians participated. EWRs were conducted at each unit by one of six hospital executives once every four weeks for three visits. Providers were asked about their concerns regarding patient safety and what could be done to improve patient safety. Suggestions were tabulated and when possible, changes were made. Provider attitudes about safety climate measured by the Safety Climate Survey before and after EWRs. We report mean scores, percent positive scores (percentage of providers who responded four or higher on a five point scale (agree slightly or agree strongly), and the odds of EWR participants agreeing with individual survey items when compared to non-participants. RESULTS: Before EWRs the mean safety climate scores for nurses were similar in the control units and EWR units (78.97 and 76.78, P = 0.458) as were percent positive scores (64.6% positive and 61.1% positive). After EWRs the mean safety climate scores were not significantly different for all providers nor for nurses in the control units and EWR units (77.93 and 78.33, P = 0.854) and (56.5% positive and 62.7% positive). However, when analyzed by exposure to EWRs, nurses in the control group who did not participate in EWRs (n = 198) had lower safety climate scores than nurses in the intervention group who did participate in an EWR session (n = 85) (74.88 versus 81.01, P = 0.02; 52.5% positive versus 72.9% positive). Compared to nurses who did not participate, nurses in the experimental group who reported participating in EWRs also responded more favorably to a majority of items on the survey. CONCLUSION: EWRs have a positive effect on the safety climate attitudes of nurses who participate in the walk rounds sessions. EWRs are a promising tool to improve safety climate and the broader construct of safety culture

    Insensitivity of alkenone carbon isotopes to atmospheric CO<sub>2</sub> at low to moderate CO<sub>2</sub> levels

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    Atmospheric pCO2 is a critical component of the global carbon system and is considered to be the major control of Earth’s past, present and future climate. Accurate and precise reconstructions of its concentration through geological time are, therefore, crucial to our understanding of the Earth system. Ice core records document pCO2 for the past 800 kyrs, but at no point during this interval were CO2 levels higher than today. Interpretation of older pCO2 has been hampered by discrepancies during some time intervals between two of the main ocean-based proxy methods used to reconstruct pCO2: the carbon isotope fractionation that occurs during photosynthesis as recorded by haptophyte biomarkers (alkenones) and the boron isotope composition (δ11B) of foraminifer shells. Here we present alkenone and δ11B-based pCO2 reconstructions generated from the same samples from the Plio-Pleistocene at ODP Site 999 across a glacial-interglacial cycle. We find a muted response to pCO2 in the alkenone record compared to contemporaneous ice core and δ11B records, suggesting caution in the interpretation of alkenone-based records at low pCO2 levels. This is possibly caused by the physiology of CO2 uptake in the haptophytes. Our new understanding resolves some of the inconsistencies between the proxies and highlights that caution may be required when interpreting alkenone-based reconstructions of pCO2

    Sensitivity of clumped isotope temperatures in fossil benthic and planktic foraminifera to diagenetic alteration

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    Applying the clumped isotope (Δ47) thermometer to foraminifer microfossils offers the potential to significantly improve paleoclimate reconstructions, owing to its insensitivity to the isotopic composition of seawater (unlike traditional oxygen isotope (δ18O) analyses). However, the extent to which primary Δ47 signatures of foraminiferal calcites can be overprinted during diagenesis is not well known. Here, we present Δ47 data as well as high-resolution (∼10 kyr) δ18O and δ13C middle Eocene time series, measured on benthic and planktic foraminifera from ODP/IODP Sites 1408, 1409, 1410, 1050, 1260 and 1263 in the Atlantic Ocean. The sites examined span various oceanographic regimes, including the western tropical to mid-latitude North Atlantic, and the eastern mid-latitude South Atlantic. Comparing data from contemporaneous foraminifera with different preservation states, we test the effects of diagenetic alteration on paleotemperature reconstructions for the deep and surface ocean. We find that overall, primary Δ47 signatures appear similarly sensitive to diagenetic overprinting as δ18O, with differences in sensitivity depending on pore fluid chemistry and the amount of secondary calcite. Where planktic foraminifera are significantly altered, sea surface temperatures derived from Δ47 and δ18O values are biased towards cool temperatures. In comparison, Δ47 and δ18O values of benthic and well preserved planktic foraminifera are less affected by diagenesis and thus likely to yield robust foraminiferal calcification temperatures. With independent estimates of diagenetic calcite fractions, secondary overprints could be corrected for, using end-member modeling and Δ47-based temperatures from benthic foraminifera

    The Correlation Between Neonatal Intensive Care Unit Safety Culture and Quality of Care

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    OBJECTIVES: Key validated clinical metrics are being used individually and in aggregate (Baby-MONITOR) to monitor the performance of neonatal intensive care units (NICUs). The degree to which perceptions of key components of safety culture, safety climate, and teamwork are related to aspects of NICU quality of care is poorly understood. The objective of this study was to test whether NICU performance on key clinical metrics correlates with caregiver perceptions of safety culture. STUDY DESIGN: Cross-sectional study of 6253 very low-birth-weight infants in 44 NICUs. We measured clinical quality via the Baby-MONITOR and its nine risk-adjusted and standardized subcomponents (antenatal corticosteroids, hypothermia, pneumothorax, healthcare-associated infection, chronic lung disease, retinopathy screen, discharge on any human milk, growth velocity, and mortality). A voluntary sample of 2073 of 3294 eligible professional caregivers provided ratings of safety and teamwork climate using the Safety Attitudes Questionnaire. We examined NICU-level variation across clinical and safety culture ratings and conducted correlation analysis of these dimensions. RESULTS: We found significant variation in clinical and safety culture metrics across NICUs. Neonatal intensive care unit teamwork and safety climate ratings were correlated with absence of healthcare-associated infection (r = 0.39 [P = 0.01] and r = 0.29 [P = 0.05], respectively). None of the other clinical metrics, individual or composite, were significantly correlated with teamwork or safety climate. CONCLUSIONS: Neonatal intensive care unit teamwork and safety climate were correlated with healthcare-associated infections but not with other quality metrics. Linkages to clinical measures of quality require additional research

    Correction: The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units [ISRCTN85147255]

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    Eric J. Thomas is with the Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA -- J. Bryan Sexton is with the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Quality and Safety Research Group, The Johns Hopkins University School of Medicine, Baltimore, USA -- Torsten B. Neilands is with the Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, CA, USA -- Allan Frankel is with the Partners Healthcare System, Prudential Tower, Boston, MA, USA -- Robert L. Helmreich is with the Department of Psychology, The University of Texas at Austin, Austin, TX, USAFollowing publication of this article [1], the study was included in the International Standard Randomised Controlled Trial Number (ISRCTN) Register and assigned the number [email protected]
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