The purpose of this article is to study morbidity and mortality conferences and their conformity to medical incident analysis models. Structured interviews with morbidity and mortality conference leaders of 12 (75%) clinical departments at Johns Hopkins Hospital were conducted. Reported morbidity and mortality conference goals included medical management (75%), teaching (58%), and patient safety and quality improvement (42%). Methods for case identification, selection, presentation, and analysis varied among departments. Morbidity and mortality conferences were attended mostly by physicians from the respective departments. One (8%) department had a standard approach for eliciting input from all providers on the case, another (8%) used a structured tool to explore underlying system factors, and 7 (58%) departments had a plan for assigning follow-up on recommendations. There is wide variation in how morbidity and mortality conferences are conducted across departments and little conformity to known models for analyzing medical incidents. Models for best practices in conducting morbidity and mortality conferences are needed.

Background. Noroviruses are enterically transmitted and are a frequent cause of gastroenteritis, affecting 23 million people annually in the United States. We describe a norovirus outbreak and its control in a tertiary care hospital during February-May 2004.Methods. Patients and health care workers met the case definition if they had new onset of vomiting and/or diarrhea during the outbreak period. Selected stool samples were tested for norovirus RNA. We also determined outbreak costs, including the estimated lost revenue associated with unit closures, sick leave, and cleaning expenses.Results. We identified 355 cases that affected 90 patients and 265 health care workers and that were clustered in the coronary care unit and psychiatry units. Attack rates were 5.3% (7 of 133) for patients and 29.9% (29 of 97) for health care workers in the coronary care unit and 16.7% (39 of 233) for patients and 38.0% (76 of 200) for health care workers in the psychiatry units. Thirteen affected health care workers (4.9%) required emergency department visits or hospitalization. Detected noroviruses had 98%-99% sequence identity with representatives of a new genogroup II.4 variant that emerged during 2002-2004 in the United States (e.g., Farmington Hills and other strains) and Europe. Aggressive infection-control measures, including closure of units and thorough disinfection using sodium hypochlorite, were required to terminate the outbreak. Costs associated with this outbreak were estimated to be $657,644.Conclusions. The significant disruption of patient care and cost of this single nosocomial outbreak support aggressive efforts to prevent transmission of noroviruses in health care settings.

To study the effect of an intervention on prevention of respiratory arrest and cardiopulmonary arrest (CPA) and to characterize ward CPAs by preceding signs and symptoms and initial cardiac rhythm.Design: A before-and-after interventional trial (12 months preintervention and 12 months postintervention).Setting: A tertiary care, academic children's hospital.Participants: Admitted patients who subsequently had either the code team or pediatric medical emergency team (PMET) called or who had a respiratory arrest or CPA on the wards.Intervention: Transition from a traditional code team to a PMET that responds to clinically deteriorating children in noncritical care areas.Outcome Measures: Combined rate of respiratory arrests and CPAs, rate of CPAs, and rate of respiratory ar-rests on the wards and agreement between independent reviewers on categorization of CPAs.

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BACKGROUND:Slow hospital discharges reduce efficiency and compromise care for patients awaiting a bed. Although efficient discharge is a widely held goal, the natural history of the discharge process has not been well studied.OBJECTIVE:To describe the discharge process and identify factors associated with longer and later discharges.DESIGN:Prospective cohort study.SETTING:A general medicine ward without house‐staff coverage, in a tertiary care hospital (The Johns Hopkins Hospital) in Baltimore, Maryland, from January 1, 2005 to April 30, 2005.PATIENTS:Two hundred and nine consecutively discharged adult inpatients.MEASUREMENTS:Discharge time (primary outcome) and discharge duration (secondary outcome).RESULTS:Median discharge time was 3:09 PM (25th% to 75th%: 1:08 to 5:00 PM). In adjusted analysis, discharge time was associated with ambulance used on discharge (1.5 hours), prescriptions filled prior to discharge (1.4 hours), subspecialty consult prior to discharge (1.2 hours), and procedure prior to discharge (1.1 hours). Median duration of the discharge process was 7 hours 34 minutes (25th% to 75th%: 4.0 to 22.0 hours). Discharge duration was associated with discharge to a location other than home (28.9 hours), and with need for consultation (14.8 hours) or a procedure (13.4 hours) prior to discharge (all P values <0.05).CONCLUSIONS:Discharge time and duration have wide variability. Longer and later discharges were associated with procedures and consults. Successful efforts to decrease time of discharge will require broad institutional effort to improve delivery of interdepartmental services. Journal of Hospital Medicine 2009;4:226–233. © 2009 Society of Hospital Medicine.