Brian H. Nathanson

Error identification and recovery by student nurses using human patient simulation: Opportunity to improve patient safety

This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. Another common error was related to physician interactions. The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance.

Emergency department patients who stay more than 6 hours contribute to crowding

BACKGROUND Admitted and discharged patients with prolonged emergency department (ED) stays may contribute to crowding by utilizing beds and staff time that would otherwise be used for new patients. OBJECTIVES To describe patients who stay > 6 h in the ED and determine their association with measures of crowding. METHODS This was a retrospective, observational study carried out over 1 year at a single, urban, academic ED. RESULTS Of the 96,562 patients seen, 16,017 (17%) stayed > 6 h (51% admitted). When there was at least one patient staying > 6 h, 60% of the time there was at least one additional patient in the waiting room who could not be placed in an ED bed because none was open. The walk-out rate was 0.34 patients/hour when there were no patients staying in the ED > 6 h, vs. 0.77 patients/hour walking out when there were patients staying > 6 h in the ED (p < 0.001). When the ED contained more than 3 patients staying > 6 h, a trend was noted between increasing numbers of patients staying in the ED > 6 h and the percentage of time the ED was on ambulance diversion (p = 0.011). CONCLUSION In our ED, having both admitted and discharged patients staying > 6 h is associated with crowding.

Eye Tracking as a Debriefing Mechanism in the Simulated Setting Improves Patient Safety Practices

Introduction:Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. Methods:An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. Results:All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking–only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as “Compares patient stated name with name on ID band.” Conclusions:Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

Pharmacy-nursing intervention to improve accuracy and completeness of medication histories

Medication errors are common in hospitalized patients and present a serious threat to patient safety.[1][1],[2][2] The medication reconciliation process, the first step of which is knowing the patient’s current medications, has been identified as key to preventing medication errors.[3][3]–[6][4

Is outpatient emergency department care profitable? Hourly contribution margins by insurance for patients discharged from an emergency department

STUDY OBJECTIVE We determine the contribution margin per hour (ie, profit) by facility evaluation and management (E&M) billing level and insurance type for patients treated and discharged from an urban, academic emergency department (ED). METHODS Billing and demographic data for patients treated and discharged from an ED with greater than 100,000 annual visits between 2003 and 2009 were collected from hospital databases. The primary outcome was contribution margin per patient per hour. Contribution margin by insurance type (excluding self-pay) was determined at the patient level by subtracting direct clinical costs from contractual revenue. Hospital overhead and physician expenses and revenue were not included. RESULTS In 523,882 outpatient ED encounters, contribution margin per hour increased with increasingly higher facility billing level for patients with commercial insurance (

An analysis of US emergency department visits from falls from skiing, snowboarding, skateboarding, roller-skating, and using nonmotorized scooters

70 for E&M level 1 to

An evaluation of a collaborative, safety focused, nurse-pharmacist intervention for improving the accuracy of the medication history.

177 at E&M level 5) but decreased for patients with Medicare (

Patient Identification Errors Are Common in a Simulated Setting

44 for E&M level 1 to

How much teamwork exists between nurses and junior doctors in the intensive care unit

29 at E&M level 5) and Medicaid (

Providers Do Not Verify Patient Identity during Computer Order Entry

73 for E&M level 1 to -