A reliable system to identify, mitigate, and escalate risk was associated with a near 50% reduction in UNSAFE transfers and SSEs.

Glutamine is essential for the function of lymphocytes and macrophages, where it serves, among other things, as a source of energy. Little information is available concerning the fuel that polymorphonuclear cells use for their metabolic and bactericidal functions. It was the purpose of this study to determine whether glutamine would enhance the in vitro bactericidal function of normal neutrophils and whether the amino acid would restore the observed impaired function in burn patients to or above the normal level. Twelve burn patients with total body surface area burns ranging from 32% to 87% were studied. At various postburn times, neutrophils were isolated and their ability to kill Staphylococcus aureus in the presence and absence of glutamine was determined and compared with that in normal subjects. Glutamine enhanced the bactericidal function of normal neutrophils. In every patient, at all but two postburn times, glutamine caused an improvement in the observed abnormal neutrophil bactericidal function and often restored it to or slightly above the normal level. Glutamine had no effect on the expression of C3b receptors (CR1 or CD35) or on phagocytosis by the cells. This study confirms the beneficial effects of glutamine in at least one arm of the immune system and adds evidence for the possible advantage of including this amino acid in the diets of burn and other trauma patients.

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BackgroundThe goal of this project was to implement a daily pre-operative huddle (briefing) for orthopedic cases and evaluate the impact of the daily huddle on surgeons’ perceptions of interruptions and operative delays.MethodsBaseline measurements on interruptions, delays, and questions were obtained. Then the daily pre-operative huddle was introduced. Surgeons completed a surgical outcomes worksheet for each day’s cases. Outcomes evaluated were primarily interruptions and delays starting cases before and following introduction of the huddle.Results19 baseline observations and 19 huddle-implemented observations of surgeon’s days were assessed. Overall, surgeon satisfaction increased and fewer delays occurred after introduction of huddles. Interruptions decreased in all categories including equipment, antibiotics, planned procedure and side. Time required for a huddle was less than one minute per case.ConclusionsIn this pilot study, a daily pre-operative huddle improved the flow of a surgeon’s day and satisfaction and indirectly provided indications of safety benefits by decreasing the number of interruptions and delays. Further studies in other surgical specialties should be conducted due to the promising results. Data was collected from three orthopedic surgeons in this phase; however, as a next step, data should be drawn from the rest of the orthopedic surgical team and other surgical subspecialties as well.

Population health expands the focus of health care from individual, in-person care to the proactive management of cohorts that can occur asynchronously from a clinical encounter. In its most successful form, the approach segments populations by defined characteristics and promotes outreach and engagement to deliver targeted interventions, even among those who have missed recent or routine care. The triple aim, supported by the Institutes for Health Care Improvement, emphasizes improving the health of populations, cost of care, and patient and care team experience and has influenced new approaches in primary care. In primary care settings such as community health centers, the goal of improving outcomes leverages technology to expand focus from point-of-care interventions to population-level approaches to deliver high-quality preventive services and chronic disease management that benefit entire families and communities. Developments in informatics have introduced technology tools for population management and underscored the need to align technology with effective processes and stakeholder engagement for success. Informed by a review of the literature and observations across multiple implementations of population health strategies in community health, in this conceptual paper, we describe the steps (process), domains of team expertise (people), and health information technology components (technology) that contribute to the success of a population health strategy. We also explore future opportunities to expand the reach and impact of population health through patient engagement, analytics, interventions to address social determinants of health, responses to emerging public health priorities, and prioritization-of-use cases by assessing community-specific needs.