Institute for Healthcare Improvement. Optimizing patient flow: Moving patients smoothly through acute care settings. Institute for Healthcare Improvement. 2003.

Because waits, delays, and cancellations are so common in health care, patients and providers assume that waiting is simply part of the care process. But recent work on assessing the reasons for delays suggests otherwise.

Bell K, Warren R, Sivec HD. The Providence active palliative care benefit: An interview with Karen Bell and Rick Warren. Innovations in End-of-Life Care. 2003;5(4).

This article focuses on how the Providence Health System in Portland, Oregon, USA, designed and implemented a seamless continuum of care for patients approaching the end of life.

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Teno JM, Licks S, Lynn J, et al. Do advance directives provide instructions that direct care? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Journal of the American Geriatric Society. 1997;45(4):519-20

In this article, conclusions from studies on advance directives (ADs) on decision-making show that advance directives placed in the medical records of seriously ill patients often did not guide medical decision-making beyond naming a healthcare proxy or documenting general preferences in a standard living will format.

Teno J, Lynn J, Wenger N, et al. Advance directives for seriously ill hospitalized patients: Effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment Journal of the American Geriatric Society. 1997;45(4):519-20.

This article demonstrates that research undertaken to assess the effectiveness of written advance directives (ADs) in the care of seriously ill, hospitalized patients, has shown that seriously ill patients, ADs did not substantially enhance physician-patient communication or decision-making about resuscitation.

Grond S, Zech D, Schug SA, Lynch J, Lehmann KA. Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life. Journal of Pain and Symptom Managment. 1991;6(7):411-422

In this article, the efficacy of the World Health Organization's guidelines for cancer pain relief was examined in 401 dying patients. Results have shown that Nonpharmacological measures play only a very minor role and that cancer pain can be treated satisfactorily until death.

Ferrell BR, Eberts MT, McCaffery M, Grant M. Clinical decision-making and pain. Cancer Nursing. 1991;146(6):289-297

Pain management is intimately linked to decision-making and the barriers to effective pain management are numerous. A tentative model of decision making related to pain is presented in this article.

Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ, et al. Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine. 1994;330(9):592-596

Pain is often inadequately treated in patients with cancer. Do the guidelines help? Despite published guidelines for pain management, this report has found that many patients with cancer have considerable pain and receive inadequate analgesia.

Campbell ML, Frank RR. Experience with an end-of-life practice at a university hospital. Critical Care Medicine. 1997;25(1):197-202

This article looks at the hands-on approach to the care of dying patients, and supports the idea that palliative care service can provide patients, families, and clinicians with the type of support needed for satisfactory end-of-life care.

Reinertsen J. Zen and the art of physician autonomy maintenance. Annals of Internal Medicine. 2003;138:992-995.

This article calls for physicians to practice the science of medicine as a profession, but also to practice the art of medicine as an individual profession.

Wilson T, Berwick DM, Cleary P. What do collaborative improvement projects do? Experience from seven countries. Joint Commission Journal on Quality and Safety. 2003;29(2):85-93.

Leaders interviewed for this article thought the critical determinants of how effective the collaboratives are include: sponsorship, topic, ideas for improvements, participants, senior leadership support, preliminary work and learning, and strategies for learning about and making improvements.

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