The role of the chief nurse officer in ensuring patient safety and quality

Since 1999, dozens of organizations and hundreds of initiatives have emerged to improve the quality and safety of patient care, yet insufficient progress has been made. Attention has turned toward improving senior leadership team effectiveness. The authors describe a national project that examined the role of the senior leadership team in 8 hospitals in promoting quality and safety, with particular focus on the role of the chief nurse officer in this process.     

Impact of the unit-based patient safety officer

One organization assessed the association between increased caregiver hours per patient-day and a reduction in inpatient falls by adding a new role for a patient safety officer. Although the role was statistically significant in reducing patient falls by 50% on the intervention unit, fall reductions were not statistically significant when compared with the control unit.     

Factors associated with the safety of EMS helicopters

The accident rate for emergency medical service (EMS) helicopters is thought to be approximately twice the rate for other commercial (Part 135) helicopters. This observation has led to numerous news reports and to the publication of conclusions of a National Transportation Safety Board investigation. The data for these reports come from investigations of EMS helicopter accidents and incidents. The authors surveyed all listed civilian EMS helicopter programs to examine both helicopter ambulance mishaps and the number of safely completed missions. Epidemiological methods were then used to compare the safety records of different groups of EMS helicopters. The single most important factor identified was the number of flights made by the program during the study period: busy programs had an eightfold lower accident rate (P less than .0005) and a three-fold lower total mishap (accidents + incidents) rate (P less than .0005) than less active programs. Programs with the ability to fly under instrument flight rules (IFR) at the pilots discretion had no mishaps (P = .044) during the study period. Multivariate analysis shows this IFR capability to be marginally significant as an independent factor (P = .099).     

Seize the moment. The EMS role in organ donation

Often the first on scene, EMTs and paramedics can play a crucial role in facilitating organ donation. Find out how you can identify potential donors and, ultimately, make transplantation possible.     

The role of EMS systems in public health emergencies

INTRODUCTION: Until now, the public health response to the threat of an epidemic has involved coordination of efforts between federal agencies, local health departments, and individual hospitals, with no defined role for prehospital emergency medical services (EMS) providers. METHODS: Representatives from the local health department, hospital consortium, and prehospital EMS providers developed an interim plan for dealing with an epidemic alert. The plan allowed for the prehospital use of appropriate isolation procedures, prophylaxis of personnel, and predesignation of receiving hospitals for patients suspected of having infection. Additionally, a dual notification system utilizing an EMS physician and a representative from the Office of Infectious Diseases from the hospital group was implemented to ensure that all potential cases were captured. Initially, the plan was employed only for those cases arising from the Centers for Disease Control and Prevention (CDC)/Public Health Service (PHS) quarantine unit at the airport, but its use later was expanded to include all potential cases within the 9-1-1 system. RESULTS: In the two test situations in which it was employed, the plan incorporating the prehospital EMS sector worked well and extended the "surveillance net" further into the community. During the Pneumonic Plague alert, EMS responded to the quarantine facilities at the airport five times and transported two patients to isolation facilities. Two additional patients were identified and transported to isolation facilities from calls within the 9-1-1 system. In all four isolated cases, Pneumonic Plague was ruled out. During the Ebola alert, no potential cases were identified. CONCLUSIONS: The incorporation of the prehospital sector into an already existing framework for public health emergencies (i.e., epidemics), enhances the reach of the public safety surveillance net and ensure that proper isolation is continued from identification of a possible case to arrive at a definitive treatment facility.     

The nursing strategy officer: a new and evolving role

As health systems have become more expansive, strategic and operational planning processes have become more complex. Enterprise-wide strategic plans now address a broad set of considerations that have significant impact across the organization, particularly nursing and patient care programs. Synchronous implementation of organizational strategies can be very challenging. Organizational capacity is constantly challenged with competing agendas. To drive the successful implementation of organization-wide strategies and optimize success, Cleveland Clinic Foundation established a new role modeled after other industry sectors, the Associate Chief Nurse for Strategic Planning. This article describes the genesis and focus of this new, important role.