This month we look at a number of items in the news that are follow-ups to columns we have previously published.
In our July 8, 2008 Patient Safety Tip of the Week “Medical Helicopter Crashes” we discussed the “epidemic” of crashes of helicopters and other medical rescue aircraft in the recent past. Since that column there have been two more medical helicopter crashes. In August a small plane on a medical mercy mission crashed in Easton, Massachusetts, killing a cancer patient and his wife plus the pilot. The plane was flying the cancer patient from Long Island to the Dana Farber Cancer Institute in Boston. Then last weekend a medical helicopter crashed in Maryland, resulting in four more deaths. Details about the former crash are not available at this time but the Maryland crash apparently occurred in foggy weather. In our previous column we noted medical helicopter flights are often riskier because of conditions such as night flying and inclement weather, both of which were present for the Maryland crash. We also talked about Dr. Bryan Bledsoe’s work that had questioned how many medical helicopter flights were truly indicated. Details about the Maryland crash are sketchy but apparently the planned trip was to a hospital only 25 miles away. A recent state audit of Maryland’s MedEvac helicopters, which are run by the Maryland State Police, had also uncovered a number of issues and questions.
It is very difficult to second guess the people on the ground (or at the helicopter control site or the regional emergency response center) who have to make on-the-spot decisions about appropriate triage of accident victims. However, each such incident should have a post-event analysis that includes an assessment as to whether the type of transportation used was the most appropriate one. We would expect that ultimately a checklist of a short series of questions (eg. What is the distance to the trauma center? What is the anticipated drive time? What are traffic conditions like at this time? What are the weather conditions like at this time? What is the condition of the accident victim(s)? etc.) would probably help the on-site and emergency response personnel quickly make a good decision about the type of transportation most appropriate for the situation.
Our February 26, 2008 Patient Safety Tip of the Week “The Hospital at Night Program: Reducing Risks at Our Most Vulnerable Time of the Day” by David Gozzard and Carol Haraden. This described a redesign of hospital structure and processes in anticipation of a significant limitation of work hours imposed by the European Union (the European Working Time Directive). As part of the redesign they collected data on the tasks performed off-hours and found that many tasks performed by doctors at night could be redistributed to nonmedical staff and that many tasks could be performed during daytime hours. For instance, leaving space in the OR schedule for emergencies reduced delays in regularly scheduled cases and reduced the likelihood of doing overflow cases at night. They also focused on communication and handoffs and made greater use of SBAR and written reports that were discussed verbally. And they made better use of the MEWS (Modified Early Warning System) to identify patients at risk of deterioration. Preliminary, largely anecdotal, experiences with the program have been positive.” mentioned one of the presentations at IHI’s Annual National Forum on Quality Improvement this past December “
We said it would be most interesting to see the effect of this program on hard outcome measures. Well, the first report of outcomes of this project are available at the Hospital at Night project website. Outcomes to date have been modest. It does appear that implementation has reduced the number of deaths within 2 days of admission and the number of deaths within 2 days of surgery/procedure. And it did result in the need for fewer transfers externally to other hospitals. And there were some modest improvements in productivity and efficiency measures such as number of hospital beds and average length of stay. While the improvements to date are not eye-popping, we like the concept behind this program and hope that future outcome measurements will demonstrate the effort is worthwhile.
In our July 2008 "What’s New in the Patient Safety World"” column we mentioned the issue of nosocomial infection spread via the radiology department. We noted Dr. Peter A. Rothschild had been running an excellent series on “Preventing infection in MRI: Best practices for infection control in and around MRI suites” on the radiology website AuntMinnie.com. That full paper is now available at a commercial website with eleven suggestions for infection control procedures for imaging centers and departments. Also available at that website is a short You Tube video clip. We’re somewhat bothered by the use of this paper in what appears to be a commercial venture marketing pads for MRI’s. Nevertheless, the paper is one we find quite useful in pointing out some of the hazards of the MRI/radiology suite.
The Alabama Hospital Association has announced its plan for member hospitals to use standardized color-coded wristbands starting January 1. Yellow will signify the patient is at risk for falls, red an allergy, and purple DNR. More than 20 states have now standardized on these three colors for wrist bands.
The American Hospital Association is now leading the charge to get all hospitals standardized on these colors. See the AHA Quality Advisory on Implementing Standardized Colors for Patient Alert Wristbands for advice on implementing, education and risk reduction strategies. Their materials include a state-by-state list of state hospital association efforts to standardize wristband colors.
The Joint Commission has released a new Sentinel Event Alert “Preventing errors relating to commonly used anticoagulants” This alert summarizes the sentinel events in the Joint Commission Sentinel Event Database related to anticoagulation and provides excellent discussion on contributing factors and risk reduction strategies.
Those of you who have been reading our columns for the past year have seen multiple discussions on the hazards of anticoagulation including Patient Safety Tips of the Week:
August 19, 2008 Arterial Line Issues
July 29, 2008 Heparin-Induced Thrombocytopenia
July 22, 2008 Lots New in the Anticoagulation Literature
July 15, 2008 Heparin Flushes.....Again!
July 17, 2007 Falls in Patients on Coumadin or Other Anticoagulants
And also the following “What’s New in the Patient Safety World” columns: