In 2001, the ORs at Banner Baywood Medical Center were struggling—physicians were dissatisfied, case volume was down, and 13 staff positions were vacant. "There was a general lack of urgency. There just was no culture of efficiency," says Christine Halowell, RN, MS-HSA, CNOR, director of perioperative services for the Mesa,…

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Shared governance (SG) has become a hallmark on the journey to achieve Magnet status by demonstrating exemplary professional practice. SG is an integral part of Magnet hospitals, which achieve this status through the Magnet Recognition Program. The American Nurses Credentialing Center developed the program to recognize organizations for nursing excellence.…

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Hardwiring the process for giving and discontinuing prophylactic antibiotics for surgery helped a university hospital drive up compliance with national guidelines, the July 2008 Journal of the American College of Surgeons reports. Finding education wasn't enough, the authors developed a process with "hard stops" at key points before and after…

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Arecount of surgical sponges may prolong a case, but does it affect the patient's outcome? Do patients fare better if an OR uses a certain staffing pattern? How does OR staff experience relate to outcomes? AkkeNeel Talsma, RN, PhD These are examples of questions a nurse researcher at the University…

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For the first time in the US, surgeons at New York-Presbyterian Hospital/ Columbia University Medical Center in July removed a woman's gallbladder without any external incisions. Using the technique called NOTES (natural-orifice transluminal endoscopic surgery), a team of surgeons led by Marc Bessler, MD, inserted a flexible endoscope into the…

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Undisciplined use of cell phones and other such devices in the OR may pose a distraction and compromise patient care, the American College of Surgeons (ACS) ACS suggests use of cellular devices in the OR be guided by the following: Surgeons should be considerate of the duties of OR personnel…

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Three infection control organizations have joined with the American Hospital Association and the Joint Commission to publish a compendium of what they say are science-based, user-friendly strategies to prevent 6 types of health care-associated infections (HAIs). The strategies were developed in the face of rising patient concern about hospital infections…

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Sixth and final article in a series on performance management. This article completes the series on performance management, published monthly since June 2008. The first article gave an overview of the performance management process. The next 4 articles covered the job description, initial competencies, orientation, goal setting, on-going competencies, coaching…

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A surgeon blows up at the staff because an instrument is missing from a set. A new nurse is in tears after a senior RN snaps at her for asking how to set up a piece of equipment. A resident won't respond when a nurse asks about a medication order.…

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When an orthopedic surgeon threw a pair of scissors in the OR last summer at North Shore Medical Center's Salem Hospital, a policy was in place to address the incident. Introducing a "civility and respect" policy was one of the first things Marc Rubin, MD, did when becoming chief of…

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Patients can be the eyes and ears for detecting physician behavior that poses a risk to patient safety, a Vanderbilt group has learned. Over 10 to 15 years, Vanderbilt has developed a model for addressing inappropriate behavior that relies on unsolicited patient complaints as an early warning system for at-risk…

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The Joint Commission's new Leader-ship Standards, effective Jan 1, 2009, call for a code of conduct and a process for addressing disruptive behavior. In a Sentinel Event Alert in July, the commission made its case for why bad behavior is a safety threat and outlined 11 recommendations for addressing it.…

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Ambulatory surgery centers (ASCs) are preparing to join hospitals, physicians, and other health care providers in reporting quality data to the Centers for Medicare and Medicaid Services (CMS). Though it's unlikely ASC quality reporting will be required in 2009, ASCs need to start preparing, according to David Shapiro, MD. He…

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By passing then overriding President Bush's veto of legislation that would have reduced Medicare payments to physicians, Congress demonstrated an often-forgotten fact citizen voices can make a difference. On July 15, the House voted to reinstate HR 6331, the Medicare Improvements for Patients and Providers Act of 2008. The act…

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Two things are true about information technology: It is critical for organizations to succeed, or even survive, and it is expensive. For one small ambulatory surgery center (ASC) striving to meet financial and growth objectives, ingenuity proved to be the answer. At The Center for Special Surgery at Texas Center…

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