Healthcare quarterly (Toronto, Ont.)
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The purpose of this study was to determine the relationship between ambient workload and outcomes of patients in the intensive care unit (ICU). Measures of workload evaluated for each patient on each day of ICU admission were the number of new admissions, ICU census, "code blue" patients not admitted and Acute Physiology and Chronic Health Evaluation (APACHE) II scores and Multiple Organ Dysfunction Scores (MODSs) for admitted patients. Patients were defined as the patient at risk (the "index" patient) and the other patients in the ICU at the same time (the "non-index" patients). ⋯ A higher ICU census and MODS of the non-index patients on the day of ICU admission were associated with a shorter time to discharge alive (hazard rate [HR] 1.03 per patient, 95% CI: 1.01-1.06, and 1.07 per MODS point, 95% CI:1.01-1.15, respectively). The association between measures of ambient workload in the ICU and patient outcomes is variable. Future resource planning and studies of patient safety would benefit from a prospective analysis of these factors to define workload limits and tolerances.
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Health Link Alberta is a model of successful regional integration. Launched as a single-region service in 2000, Health Link Alberta was rolled out as a province-wide service in 2003, operating as one service from two sites (Calgary and Edmonton). Provincial integration of Health Link Alberta was successful because it took the time to establish collaborative governance structures, build relationships with regional and provincial stakeholders, recognize and accommodate regional and local needs, and develop the processes and tools that it needed to deliver a quality, consistent and accessible service for all Albertans. Within three years, Health Link Alberta achieved 63% awareness and 46% utilization among all Alberta households.
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Implementing evidence is the basis for improving the organization of care, with the ultimate goal of achieving optimal patient outcomes. As implementing evidence can be a challenging task due to human and system barriers, we propose an innovative framework to facilitate knowledge translation at the bedside. This model is based on a problem-solving approach that was tested in the field of critical care. This method can be adapted to any healthcare environment as the problems encountered when trying to implement guidelines and protocols are common.
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Many people assume that quality improvement (QI) projects pose no ethical issues in relation to participants or their rights. However, members of the Alberta Research Ethics Community Consensus Initiative (ARECCI) submit that all projects that generate knowledge, including QI projects, can create risks to participants that need to be identified, assessed and addressed in the context of the kind of project. ⋯ In this article, we use a case example to illustrate potential ethical issues raised by a QI project, and argue for an ethics review approach that is distinct from that used with research projects. We propose six considerations with guidelines to help assess (and ultimately minimize and mitigate) the risk for participants in QI projects and assist in the appropriate ethical management of these projects.
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This study investigated the safety of discharge of seniors (aged 65 and over) from Quebec emergency departments (EDs) to the community. Data from a 2006 survey of key informants at 103 Quebec adult non-psychiatric EDs were linked to data on a sample of 172,927 seniors who were discharged home from one of the EDs during the period February 2004-January 2005. ⋯ A minority of EDs, regardless of their size and the characteristics of patients treated, systematically provided services to improve the safety of discharge. Resources and services need to be improved in EDs, particularly those that serve higher-risk populations (e.g., systematic approaches to the identification and management of high-risk seniors, with appropriate referrals to community services), in the hospital (e.g., increased accessibility to acute care beds) and in the community (e.g., increased accessibility to home care, outpatient geriatric assessment and primary medical care).