Donald Moorman

Sustained effectiveness of a primary-team-based rapid response system.

Objective:Laws and regulations require many hospitals to implement rapid-response systems. However, the optimal resource intensity for such systems is unknown. We sought to determine whether a rapid-response system that relied on a patient’s usual care providers, not a critical-care–trained rapid-response team, would improve patient outcomes. Design, Setting, and PatientsAn interrupted time-series analysis of over a 59-month period. Setting:Urban, academic hospital. Patients:One hundred seven-one thousand, three hundred forty-one consecutive adult admissions. Intervention:In the intervention period, patients were monitored for predefined, standardized, acute, vital-sign abnormalities or marked nursing concern. If these criteria were met, a team consisting of the patient’s existing care providers was assembled. Measurements and Main Results:The unadjusted risk of unexpected mortality was 72% lower (95% confidence interval 55%–83%) in the intervention period (absolute risk: 0.02% vs. 0.09%, p < .0001). The unadjusted in-hospital mortality rate was not significantly lower (1.9% vs. 2.1%, p = .07). After adjustment for age, gender, race, season of admission, case mix, Charlson Comorbidity Index, and intensive care unit bed capacity, the intervention period was associated with an 80% reduction (95% confidence interval 63%–89%, p < .0001) in the odds of unexpected death, but no significant change in overall mortality [odds ratio 0.91 (95% confidence interval 0.82–1.02), p = .09]. Analyses that also adjusted for secular time trends confirmed these findings (relative risk reduction for unexpected mortality at end of intervention period: 65%, p = .0001; for in-hospital mortality, relative risk reduction = 5%, p = .2). Conclusions:A primary-team–based implementation of a rapid response system was independently associated with reduced unexpected mortality. This system relied on the patient’s usual care providers, not an intensive care unit based rapid response team, and may offer a more cost-effective approach to rapid response systems, particularly for systems with limited intensivist availability.

Strategies for Preventing Wrong Site, Wrong Procedure, Wrong Patient Surgery

Note from column coordinator Charlotte Guglielmi: It is my pleasure to introduce a new column for our journal. I have heard time and time again that nurses need to better understand the different perspectives that each member of the surgical team brings to the table on topics that affect the care we deliver to our patients. We know that teamwork and effective communication enhance the safe care of patients. This column will provide a venue for colleagues from multiple disciplines to share opinions and commentary on some of the most critical clinical issues that face all of us. As each topic is identified, a critical question will be posed to the authors who will respond from their perspective. Linda Groah, AORN executive director and chief executive officer, will conclude each discussion with a summary of AORN’s response to the issue. I am

Cognitive Changes Following Aortic Reconstruction

A symbol/language integration task and a memory scanning task were administered to two groups of surgical patients (aortic reconstruction and laparoscopy) and to aged-matched nonsurgical controls, 1 week prior to surgery, on the day of discharge from the hospital, and 2 and 8 weeks after discharge. In patients undergoing aortic reconstruction, a significant impairment of cognitive processing (as detected preoperatively) was accentuated at time of discharge. Significant improvement in performance on both tasks was found, however, in the 2- and 8-week postdischarge sessions. In fact, during these later sessions, performance on the memory scanning task became equivalent to that of control participants. Thus, pre- and postoperative impairments in patients undergoing repair of an aortic aneurysm do not appear to be the consequence of short-term memory loss per se, but may be related to a more general slowing of the information processing system.