IMPORTANCELung cancer is the leading cause of cancer-related death in the US.OBJECTIVE To review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the US Preventive Services Task Force (USPSTF).
Critically ill patients are often unable to communicate, placing the onus on clinicians in ICUs to engage family members. In the United States, practice has gradually shifted toward including family members in ICU rounds (1). However, the novel coronavirus disease (COVID-19) pandemic dramatically altered hospital care in the United States. For example, early reports suggested many hospitals restricted access to visitors (2). We sought to understand changes to visitation policies and strategies used to communicate with family members because of COVID-19. We identified all hospitals with ICUs in the state of Michigan using the 2018 American Hospital Association annual survey database and by Internet searches. In early April, Michigan's statewide ICU occupancy was 71%, the fifth highest in the United States (3). Within each hospital, an ICU physician or nurse leader from a medical ICU was identified and surveyed over the telephone between April 6, 2020, and May 8, 2020. If the ICU leader was unavailable by telephone, an online survey was conducted. Participants were asked 1) whether their hospital made any changes to its visitation policy; 2) what changes were made; 3) whether their ICU had changed the way it routinely communicated with family members; and 4) what strategies their ICU was using to communicate with family members. x 2 and t tests were used to compare responding and nonresponding hospitals. All tests were two sided, with a P value of less than 0.05 considered significant. This research was deemed to be exempt from review by the University of Michigan Institutional Review Board (HUM00179422). We surveyed 49 out of 89 Michigan hospitals with ICUs (response rate = 55%). Characteristics between responding and nonresponding hospitals were similar (Table 1). All 49 responding hospitals had changes to their visitation policies because of COVID-19 (Figure 1). One hospital (2%) indicated
Effective quality improvement is a key factor in optimizing the care of hospitalized patients. Unfortunately, the US health care system has a poor safety record when compared to other major industries. For example, at 250 000 per year, medical errors are the third leading cause of death in the United States. Safety barrier management, a widely used methodology in high-risk industries such as commercial airline transportation and oil drilling, has not been widely used in traditional quality improvement efforts in health care, which rely more on standard lean Six Sigma quality approaches. The authors describe a quality improvement project that uses safety barrier analysis to help inform solutions to improve venous thromboembolism prophylaxis in hospitalized patients. This study found that safety barrier analysis helped inform solutions to improve venous thromboembolism prophylaxis at the study institution and can be a useful adjunct to standard lean Six Sigma methodologies for quality improvement in health care.
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