Chojnowski D. Protecting patients from harm: Taking aim at heart failure. Nursing2007. 2007 Nov;37(11):50-55.

This article, the fourth in a series highlighting clinical interventions promoted in IHI's 5 Million Lives Campaign, describes how to apply best practices for managing heart failure to help achieve this goal: “deliver reliable, evidence-based care for congestive heart failure to avoid readmissions.”

Katz PS. Doctor, don't be a hero: Getting VAP to zero takes teamwork. ACP Hospitalist. 2007 Sept;9-11.

Giving up a little of his traditional role in ventilator-associated pneumonia (VAP) has paid off in a lighter workload and better patient outcomes for one hospitalist at Bloomington Hospital in Indiana. 

Whittington J, White R, Haig KM, Slock M. Using an automated risk assessment report to identify patients at risk for clinical deterioration. Joint Commission Journal on Quality and Patient Safety. 2007 Sept;33(9):569-574.

Several studies have shown that patients frequently display physical evidence of deterioration as much as 8 to 12 hours before a cardiac arrest or critical event requiring some form of intensive intervention or rescue. This article discusses the use of an automated risk assessment based on key physiologic measures to help with early recognition and treatment of deteriorating hospitalized patients.

Armitage M, Eddleston J, Stokes T. Recognising and responding to acute illness in adults in hospital: Summary of NICE guidance. British Medical Journal. 2007;335(7613):258-259.

This article summarizes the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) in the UK on improving clinical staff's recognition of deteriorating health and response to acute illness in adults in hospital. The NICE recommendations are based on systematic reviews of best available evidence.

Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine. 2006 Dec 28;355(26):2725-2732.

The authors studied an evidence-based intervention that comprises five specific procedures to see how well they might reduce the incidence of catheter-related bloodstream infections in ICU patients: hand washing; full barrier precautions; cleaning skin with chlorhexidine; avoiding the femoral site; and removing catethers as soon as no longer needed. Results showed that the infection rate reduced by up to 66 percent with minimal new costs to implement the intervention.

Suresh G, Cahill J. How "user friendly" is the hospital for practicing hand hygiene? An ergonomic evaluation. Joint Commission Journal on Quality and Safety. 2007 Mar;33(3):171-179.

In this article, the authors describe an ergonomics-based tool — SWAG (for the four main hand hygiene resources: Sinks, Waste receptacles, Alcohol-based hand rub dispensers, and Gloves) — that was developed and implemented to assess the ergonomic characteristics that facilitate usage of these resources in ICUs and individual patient rooms.

Bailey P, Thomsen GE, Spuhler VJ, et al. Early activity is feasible and safe in respiratory failure patients. Critical Care Medicine. Jan 2007;35(1):139-145.

This article describes a study which hoped to determine whether early activity is feasible and safe in respiratory failure patients. From June 1, 2003, through December 31, 2003, the authors assessed safety and feasibility of early activity in all consecutive respiratory failure patients who required mechanical ventilation for >4 days admitted to their respiratory intensive care unit (RICU).

Levy MM. A view from the other side. Critical Care Medicine. Feb 2007;35(2):603-604.

The author states that the evolution of our understanding of care for critical illness should include a different approach to families and visiting hours in the ICU — one that balances the need of family members to be with their loved ones at a time of critical illness, and the need of ICU clinicians to conduct efficient bedside care.

Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM. Visiting hours policies in New England intensive care units: Strategies for improvement. Critical Care Medicine. Feb 2007;35(2):497-501.

Only one third of ICUs in New England have open visiting policies. The authors explore nursing concerns with an unrestricted ICU and solutions that may provide guidance for other ICUs considering adopting an open visiting hours policy.

Zell BL, Goldmann DA. Healthcare-associated infection and antimicrobial resistance: Moving beyond description to prevention. Infection Control and Hospital Epidemiology. Mar 2007;28(3):261-264. Epub 2007 Feb 20.

This editorial seeks to put epidemiological studies of the impact of nosocomial infections on morbidity, mortality, and cost in perspective. Rather than continuing to devote a lot of energy to describing the problem, the authors argue it is time for aggressive improvement, focusing on evidence-based interventions and 'zero tolerance.'

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