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Improving the efficacy of rapid response operations in acute care delivery is of critical importance to improve patient safety and care quality. In this paper, continuous improvement methods have been developed to identify the bottleneck responses in rapid response operations. Specifically, the bottleneck response for decision time (BN-τ) and its variability (BN-cv), and response-time performance bottleneck (BN-rtp) have been introduced, and bottleneck indicators based on the data collected on the hospital floor have been developed. To illustrate the applicability of the method, a case study at University of Kentucky Chandler Hospital is presented. [ABSTRACT FROM PUBLISHER]

The number of potentially preventable hospital deaths in the US is astonishingly high. To improve patient safety and reduce hospital mortality, rapid response teams have been developed and implemented to provide a quick evaluation and treatment to patients with clinical signs of deterioration. In this paper, we present a preliminary study on modeling and analysis of the rapid response process in acute care delivery. Specifically, such a process is modeled as a complex network with split, merge and parallel structures. An analytical model is developed to evaluate the mean and variability of the decision time in the system, as well as the probability that such a decision is made within a desired time interval. In addition, system theoretic properties are investigated to provide directions for performance improvement. [ABSTRACT FROM PUBLISHER]

Medication prescribing in paediatrics is complex and compounded by the need to provide age and weight related doses, and errors continue to be problematic. Electronic medication systems (EMS) can reduce errors through dosing calculators and computerised decision support. However, evidence on costs and benefits of these systems is limited, particularly in paediatric hospitals. This paper presents the development of a cost-benefit analysis (CBA) framework to assess the impact of an EMS implementation in a paediatric tertiary hospital. An innovative component of the framework is the incorporation of the impact of the effects of the EMS for both the health system as well as for patients and their wider family networks, allowing a net social benefit assessment. We describe the impact of non-clinical out-of-pocket costs of admission and use discrete choice experiments to measure both medication related harm and the importance of medication safety to families and members of the community. [ABSTRACT FROM AUTHOR]

Exploring the link in actual practice between interprofessional collaboration on health care teams and patient-centered care, this paper has a twofold purpose. First, we propose and develop the notion of joint emplotment to conceptualize the collaborative sensemaking work (Weick, Sutcliffe, & Obstfeld, 2005) observed in the acute care context, in particular in rapid-paced daily interprofessional team meetings. Joint emplotment refers to the means by which teams construct and negotiate shared understandings; that is, how they collectively make sense of the information and issues that are discussed during team meetings by narratively weaving them together to plan their future actions. Second, we empirically demonstrate the usefulness of this notion for understanding a core element of patient-centered care, namely how different perspectives of the patient's situation are made relevant and meaningful in team talk. We draw on illustrative data from a longitudinal naturalistic study of communication practices in daily interprofessional team meetings in acute care to show how perspective get established and negotiated in joint emplotment, and why this is important for patient-centeredness. [ABSTRACT FROM AUTHOR]

Utilizing a qualitative methodology, the current study explored the decision-making process related to the medical do-not-resuscitate (DNR) status and issues of withdrawal/withholding of aggressive medical treatment for patients in an acute care hospital. This study also sought to assess the influence of the broader social context in relation to the manner in which decisions are made at the end-of-life. Data gathered from this study served to illuminate the high degree of variation that exists in the ordering of the DNR status and in factors related to other end-of-life healthcare decisions. Variations in use of DNR based on health care and medical staff knowledge, patient/family characteristics, and communication barriers were but a few of the factors that appeared to play a role in the decisions and timing of DNR orders. Furthermore, macro-level forces related to biomedicalization of aging and to the political economy of health were also found to be highly influential upon how and when decisions were made at the level of the patient’s bedside. Cost of care, type of health insurance (e.g., managed care), bed capacity issues, and general public opinion provided an underlying framework upon which the final health care decisions were made. It is anticipated that information obtained from this study will allow for a deeper understanding of the DNR process than has been possible through current quantitative studies and will contribute positively toward meeting patients’ needs at the end of life for care delivered in a competent, consistent, and compassionate manner. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]