IntroductionIn-hospital cardiac arrest (IHCA) affects 200 000 adults in the USA each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a programme of ‘mock codes’ improves group-level performance of IHCA skills. Our primary outcome of interest was change in cardiopulmonary resuscitation (CPR) fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesised that a sustained programme of mock codes would translate to greater than 10% improvement in each of these core metrics over the first 3 years of the programme.MethodsWe conducted mock codes in an urban teaching hospital between August 2012 and October 2015. Mock codes occurred on Telemetry and Medical/Surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital’s ‘Code Blue’ team, and data were recorded by trained observers. Data were summarised using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model.ResultsFifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per 6-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly.ConclusionsWhile we observed a significant improvement in CPR fraction over the course of this programme of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.
Objectives: Adverse events that affect patient safety are a significant concern in pediatrics. Increasing situational awareness, identifying errors and near misses, and reporting them using organizational incident reporting systems enables mitigation of harm. Methods:We designed and tested a brief, interactive, and easily replicable simulation activity for medical students, and emergency medicine interns and pediatric interns to strengthen their skills and enhance their self-efficacy in identifying and reporting patient safety hazards. Hazards fell into the categories of situational safety, patient identification and privacy, infection prevention, treatment errors, and issues with electronic health records (EHRs). Results:The simulation training significantly increased the self-efficacy of medical students and interns in identifying and reporting patient safety hazards. Learners were very satisfied with the simulation training, successfully recognized key patient safety hazards, provided feedback to improve the training, and improved their ability to report hazards through organizational incident reporting systems. Patient safety hazards associated with patient misidentification were recognized most frequently, whereas safety hazards associated with EHRs were missed with the greatest frequency. Conclusions:The simulation training enabled learners to identify hazards and near misses and enhanced their ability to report hazards through organizational incident reporting systems. Learners at all levels of training identified safety hazards at comparable rates, which demonstrates the role that trainees play in critically observing clinical settings with fresh eyes and identifying and reporting patient safety hazards. Interventions to promote patient safety need to prioritize building situational awareness of potential hazards associated with EHR use.
Study Objective: It is estimated that 2.1 million people in the United States abuse prescription opioid pain medications. Hydrocodone-containing products are the most frequently prescribed opioids in U.S. emergency departments (ED). In 2012, the Centers for Disease Control and Prevention linked the rise in prescription opioid use to an increase in drug overdoses and opioid abuse. We sought to measure national prescribing patterns for hydrocodone/acetaminophen (HD/A) among veterans seeking emergency medical care, and to see if patterns have changed since this medication was reclassified by the Drug Enforcement Agency in 2014. Methods: We conducted a retrospective cohort study of ED visits within the Veterans Health Administration (VA) between January 2009 and June 2015. We looked at age, sex and ethnicity demographics, comorbidities, utilization measures, diagnoses, and prescriptions. Data was obtained from the VA Informatics and Computing Infrastructure (VINCI). In addition, for each visit, characteristics were organized by year to identify trends in prescribing habits. Patients were excluded if age, sex, or diagnosis was missing from their chart. Descriptive statistics were used. The chisquare test, with 95% intervals, was used to examine differences between characteristics among groups. Pearson's correlation coefficient was used to evaluate prescribing trends per year. Multivariate logistic regression was used to determine the characteristics that best predicted who received a prescription for HD/A. Approval was granted by the institutional IRB. Results: During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for HD/A. The most common diagnosis associated with a prescription was back pain (16.2% of all HD/A scripts). Prescriptions peaked at 80,776 in 2011 (8.7% of visits), and declined to 35,031 (5.6%) during the first half of 2015 (r ¼-0.99, p <0.001). The percentage of HD/A ED prescriptions limited to 12 pills increased from 22% (13,949) in 2009 to 31% (11,026) in the first half of 2015. A prescription was more likely for patients with a pain score
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