(Press-News.org) CHICAGO --- Caring for patients in a medical intensive care unit in a hospital and flying a 747 are complicated tasks that require tracking thousands of important details, some of which could get overlooked. That's why the pilot has a checklist and a copilot to make sure nothing slips by.
A new Northwestern Medicine study shows the attending physician in the intensive care unit could use a copilot, too. The mortality rate plummeted 50 percent when the attending physician in the intensive care unit had a checklist – a fairly new concept in medicine -- and a trusted person prompting him to address issues on the checklist if they were being overlooked. Simply using a checklist alone did not produce an improvement in mortality.
"Attending physicians are good at thinking about big picture issues like respiratory failure or whatever diagnosis brought a patient to the intensive care unit, but some important details are overlooked because it's impossible for one person to remember and deal with all those details," said Curtis Weiss, M.D., the lead investigator and a fellow in pulmonary and critical care medicine at Northwestern University Feinberg School of Medicine.
Weiss conducted the study in the medical intensive care unit at Northwestern Memorial Hospital. The study was published online in the American Journal of Respiratory and Critical Care Medicine and will appear in an upcoming print issue.
"We showed the checklist itself is just a sheet of paper," Weiss said. "It's how doctors interact with it and best implement it that makes it most effective. That's how we came up with prompting."
A checklist is a useful tool only if a physician gets continual reminders to use it to promote decision making, Weiss said, "rather than just being a piece of paper that gets shoved in someone's face like busy work."
For the study, Weiss and colleagues developed a checklist to be used by physicians in the medical intensive care unit. The checklist focused on important issues the researchers believed were being overlooked by physicians during daily rounds.
The checklist included six important parameters often overlooked such as testing whether a patient can be taken off a ventilator and the duration of empiric antibiotics (for suspected but not confirmed infections) and central venous catheters.
"We observed that physicians sometimes wrote information on the checklist but were not using it to improve their decision making," Weiss explained.
The study was designed to determine whether prompting physicians to use the checklist would affect the decisions they made about managing their patients' care.
One team of physicians had face-to-face, frequent prompting by a resident physician to address issues on the checklist, only if the issues were overlooked during daily rounds. The other team of physicians continued to use the checklist without such prompting.
The prompted physician team oversaw the care of 140 patients; the unprompted team oversaw 125 patients.
The prompting by a physician not actively involved in the patients' care reduced mortality by 50 percent over three months. The saved lives may have resulted in part from reducing the time patients were on ventilators (thus reducing cases of ventilator-associated pneumonia) as well as reducing the number of days patients were on empiric antibiotics and central catheters. Prompting also cut patients' intensive care unit length of stay, on average, by more than one day.
Researchers also wanted to see if using a checklist alone (without prompting) made any difference. They compared a pre-study group of almost 1,300 patients to patients in the study whose physicians used the checklist alone. The results: a checklist alone did not improve mortality or reduce the length of stay.
Having a subtle approach with the physicians was one key to the success of the prompting, Weiss said.
"We didn't mandate that they had to change their management; it was nuanced," Weiss said. "It was 'do you plan to continue the antibiotics today?' not 'you should stop the antibiotics.'"
Weiss concedes hospitals aren't likely to hire physicians just to be prompters. But perhaps nurses or even an electronic version of the verbal prompting could be equally effective, he said.
"It should be fresh eyes or someone from the existing team who is assigned to concentrate on these issues," Weiss said. "What matters is that someone is specifically thinking about these issues."
###Northwestern Medicine is a leader in this new area of research and is actively investigating alternatives such as an electronic checklist in its intensive care units that follow the same principles Weiss employed in his study.
Nudging doctors in intensive care unit reduces deaths
Physicians for critically ill need 'copilots' to remind them of important details
2011-06-23
ELSE PRESS RELEASES FROM THIS DATE:
Sharing wisdom, teacher to teacher
2011-06-23
CAMBRIDGE, Mass. -- How do you teach math students to speak and write effectively about what they do? Crucially, how do you teach their teachers — themselves mathematicians — how to impart and evaluate these skills?
Faced with this problem, a group of instructors in MIT's Department of Mathematics decided that many heads are better than one. They began brainstorming ways to encourage teacher-to-teacher collaboration, bridging educators with similar challenges in different courses and from semester to semester. Now, they've developed a tool they believe will be useful ...
Molecular glue sticks it to cancer
2011-06-23
Imagine dropping dish soap into a sink full of greasy water. What happens? As soon as the soap hits the water, the grease recoils—and retreats to the edges of the sink.
Now, what if the sink was a cancer cell, the globs of grease were cancer-promoting proteins and the dish soap was a potential drug? According to new research from the University of Toronto Mississauga, such a drug could force the proteins to the cell's membrane (a.k.a., the edge of the sink)—and make the cancer cell more vulnerable to chemotherapy.
"This is a totally new approach to cancer therapy," ...
University of Minnesota engineering researchers discover source for generating 'green' electricity
2011-06-23
University of Minnesota engineering researchers in the College of Science and Engineering have recently discovered a new alloy material that converts heat directly into electricity. This revolutionary energy conversion method is in the early stages of development, but it could have wide-sweeping impact on creating environmentally friendly electricity from waste heat sources.
Researchers say the material could potentially be used to capture waste heat from a car's exhaust that would heat the material and produce electricity for charging the battery in a hybrid car. Other ...
Positive results for unprotected left main coronary artery PCI with drug-eluting stents
2011-06-23
Patients with normal left ventricular function who undergo elective unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with drug-eluting stents (DES) had favorable outcomes according to new research. Results of the multicenter, retrospective study are reported in the June issue of Catheterization and Cardiovascular Interventions, a journal published by Wiley-Blackwell on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).
For patients with ULMCA disease, coronary artery bypass grafting (CABG), known commonly ...
Gold nanoparticles help earlier diagnosis of liver cancer
2011-06-23
PROVIDENCE, R.I. [Brown University] — Hepatocellular carcinoma is the most common cancer to strike the liver. More than 500,000 people worldwide, concentrated in sub-Saharan Africa and Southeast Asia, are diagnosed with it yearly. Most of those afflicted die within six months.
A big obstacle to treatment of liver cancer is the lack of early diagnosis. Current techniques, including ultrasound, CT and MRI scans, spot tumors only when they have grown to about 5 centimeters in diameter. By that time, the cancer is especially aggressive, resisting chemotherapy and difficult ...
Plant growth rate, stem length unaffected by rice hull, peat substrate
2011-06-23
WEST LAFAYETTE, IN—Plant growth retardants, or PGRs, are used in greenhouse operations to produce uniform, compact, and marketable plants. Although PGRs can be applied using a variety of methods, most common applications are foliar sprays or substrate "drenches". Research has shown that drenches provide more uniform results and increase the duration of effectiveness compared with sprays, but the efficacy of drenches can be affected by factors such as the amount of solution applied and the substrate components used.
Organic components such as parboiled rice hulls are becoming ...
Pest preferences for cranberry cultivars determined
2011-06-23
EAST WAREHAM, MA—Cranberry is an important commercial crop in states such as Massachusetts, Wisconsin, New Jersey, Washington, and Oregon. Insects and disease can pose serious problems for growers trying to realize profits in heavy cranberry production regions. Since cranberry is a perennial crop, pest damage can have a particularly significant negative impact in the next growing season.
By studying feeding preferences of insects, entomologists have reported that several insects prefer some cranberry cultivars over others. For instance, several insect herbivores have ...
Optimal topdressing applications for athletic fields determined
2011-06-23
EAST LANSING, MI—The practice of "topdressing" athletic fields with sand has been used by turfgrass professionals for years. Topdressing is essential to maintaining safe and healthy turf, and using porous sand allows the turfgrass system to retain the necessary pore space for adequate drainage, even in heavy foot traffic.
While sand-based athletic fields may be preferred by schools and municipalities, conversion to a sand-based system is expensive. Complete renovation is often cost-prohibitive and renders the field temporarily unusable. Because of these drawbacks, complete ...
Angioplasty with stents may be safe in long-term for low-risk heart patients
2011-06-23
Heart bypass surgery is considered the gold standard for most patients with left main coronary artery disease, one of the most serious types of heart disease and one that affects thousands.
But a new UCLA study reports favorable long-term outcomes for lower-risk patients with this condition who underwent angioplasty with medication-coated stents, rather than bypass surgery.
A more minimally invasive procedure than surgery, angioplasty is performed by snaking a tiny wire up through an artery in the groin to the blocked area of the heart. The clogged artery is cleaned ...
Slowing the spread of drug-resistant diseases is goal of new research area
2011-06-23
In the war between drugs and drug-resistant diseases, is the current strategy for medicating patients giving many drug-resistant diseases a big competitive advantage?, asks a research paper that will be published in the Proceedings of the National Academy of Sciences. The paper argues for new research efforts to discover effective ways for managing the evolution and slowing the spread of drug-resistant disease organisms. The ultimate goal of this new research effort is to develop a new science-based model for drug-resistance management that will inform treatment guidelines ...
LAST 30 PRESS RELEASES:
KAIST Develops Retinal Therapy to Restore Lost Vision
Adipocyte-hepatocyte signaling mechanism uncovered in endoplasmic reticulum stress response
Mammals were adapting from life in the trees to living on the ground before dinosaur-killing asteroid
Low LDL cholesterol levels linked to reduced risk of dementia
Thickening of the eye’s retina associated with greater risk and severity of postoperative delirium in older patients
Almost one in ten people surveyed report having been harmed by the NHS in the last three years
Enhancing light control with complex frequency excitations
New research finds novel drug target for acute myeloid leukemia, bringing hope for cancer patients
New insight into factors associated with a common disease among dogs and humans
Illuminating single atoms for sustainable propylene production
New study finds Rocky Mountain snow contamination
Study examines lactation in critically ill patients
UVA Engineering Dean Jennifer West earns AIMBE’s 2025 Pierre Galletti Award
Doubling down on metasurfaces
New Cedars-Sinai study shows how specialized diet can improve gut disorders
Making moves and hitting the breaks: Owl journeys surprise researchers in western Montana
PKU Scientists simulate the origin and evolution of the North Atlantic Oscillation
ICRAFT breakthrough: Unlocking A20’s dual role in cancer immunotherapy
How VR technology is changing the game for Alzheimer’s disease
A borrowed bacterial gene allowed some marine diatoms to live on a seaweed diet
Balance between two competing nerve proteins deters symptoms of autism in mice
Use of antifungals in agriculture may increase resistance in an infectious yeast
Awareness grows of cancer risk from alcohol consumption, survey finds
The experts that can outsmart optical illusions
Pregnancy may reduce long COVID risk
Scientists uncover novel immune mechanism in wheat tandem kinase
Three University of Virginia Engineering faculty elected as AAAS Fellows
Unintentional drug overdoses take a toll across the U.S. unequally, study finds
A step toward plant-based gelatin
ECMWF unveils groundbreaking ML tool for enhanced fire prediction
[Press-News.org] Nudging doctors in intensive care unit reduces deathsPhysicians for critically ill need 'copilots' to remind them of important details