Dichloroacetate treatment of patients with severe lactic acidosis results in statistically significant but clinically unimportant changes in arterial-blood lactate concentrations and pH and fails to alter either hemodynamics or survival.

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Previous investigations have suggested that elevated airway pressures increase the risk of ventilator-induced pneumothorax. However, risk factor analysis using multivariate techniques has not been done. We investigated the hypothesis that airway pressures would not independently correlate with pneumothorax when underlying disease was considered. All ventilated patients over a 1 yr period in the Hohenburg Critical Care Unit at the University of Alabama were followed until death or discharge from the ICU. Ventilator data were collected daily and the presence of pneumomediastinum and pneumothorax determined by review of chest radiographs. Maximal values of airway pressures, minute ventilation, tidal volume, and respiratory rate, as well as age, sex, and underlying disease, were entered into logistic regression analysis. A total of 168 patients was studied, and 20 experienced pneumothorax. Multivariate analysis of the entire ventilated population revealed that only the presence of ARDS independently correlated with pneumothorax. A similar analysis performed on the ARDS population revealed independent correlation only with male sex. Trends toward elevation in airway pressures were seen that did not reach statistical significance. We conclude that development of pneumothorax is most closely correlated with underlying disease, specifically ARDS, and that the associations previously noted between airway pressures and barotrauma largely relate to the occurrence of high airway pressures in ARDS.

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BackgroundThe area of healthcare quality and patient safety is starting to use health information technology to prevent reportable events, identify them before they become issues, and act on events that are thought to be unavoidable. As healthcare organizations begin to explore the use of health information technology in this realm, it is often unclear where fiscal and human efforts should be focused.ObjectiveThe purpose of this study was to provide a foundation for understanding where to focus health information technology fiscal and human resources as well as expectations for the use of health information technology in healthcare quality and patient safety.MethodsA literature review was conducted to identify peer-reviewed publications reporting on the actual use of health information technology in healthcare quality and patient safety. Inductive thematic analysis with open coding was used to categorize a total of 41 studies. Three pre-set categories were used: prevention, identification, and action. Three additional categories were formed through coding: challenges, outcomes, and location.ResultsThis study identifies five main categories across seven study settings. A majority of the studies used health IT for identification and prevention of healthcare quality and patient safety issues. In this realm, alerts, clinical decision support, and customized health IT solutions were most often implemented. Implementation, interface design, and culture were most often noted as challenges.ConclusionsThis study provides valuable information as organizations determine where they stand to get the most “bang for their buck” relative to health IT for quality and patient safety. Knowing what implementations are being effectivity used by other organizations helps with fiscal and human resource planning as well as managing expectations relative to cost, scope, and outcomes. The findings from this scan of the literature suggest that having organizational champion leaders that can shepherd implementation, impact culture, and bridge knowledge with developers would be a valuable resource allocation to consider.

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Purpose The purpose of this paper is to understand the degree to which a quality and safety culture exists after healthcare workers in an academic medical center complete a quality improvement and patient safety education program focused on developing leaders to change the future of healthcare quality and safety. Design/methodology/approach The safety attitudes questionnaire (SAQ) short-form was used for measuring the culture of quality and safety among healthcare workers who were graduates of an academic medical center’s healthcare quality and safety program. A 53 percent response rate from program alumni resulted in 54 usable responses. Findings This study found that 42 (78 percent) of the respondents report that they are currently working in a healthcare quality and safety culture, with 25 (59 percent) reporting promotion into a leadership role after completion of the quality improvement education program. This compares favorably to AHRQ culture of safety survey results obtained by the same academic medical center within the year prior revealing only 63 percent of all inpatient employees surveyed reported working in a quality and safety culture. Research limitations/implications The study design precluded knowing to what degree a quality and safety culture, as measured by the SAQ, existed prior to attending the healthcare quality and safety program. Originality/value This study has practical value for other organizations considering a quality and safety education program. For organizations seeking to build capacity in quality and safety, training future leaders through a robust curriculum is essential. This may be achieved through development of an internal training program or through attending an outside organization for education.