***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Clinical h and over is a necessary process for the continuation of safe patient care ; however , deficiencies in the h and over process can introduce error . While the number of h and over studies increases , few have vali date d implemented improvements with repeated audit . Objective To improve the morning h and over round on a busy critical care unit and assess sustainability of improvement through repeated audit . Design / Methods A quality improvement process based on prospect i ve observational assessment of the doctor 's shift-change h and over was carried out , assessing the content of clinical information and effects of distractions , location and timing . The effect of a  training session for the junior doctors with the introduction of a st and ardised h and over protocol  was assessed . Results The content of clinical information improved after the training session with introduction of a st and ardised protocol , but returned to baseline with a new cohort of untrained doctors . Distractions were associated with increased h and over times for individual patients and for total h and over time . Overall , h and over time was shortest in the coffee room compared with ward and lecture theatre h and overs . Individual patient h and over time was positively correlated with clinical content scores . Four indices of critical illness all positively correlated with increased h and over time . Conclusions Early specific training is vital for quality clinical h and over . Distractions during h and over cause inefficiency and can adversely affect information transfer . Changing h and over location according to local environment can yield improved efficiency , structure and ease of management . Adequate time must be allocated for clinical h and over especially when dealing with very sick and complex patients A critical care clinical pharmacy specialist was assigned to the burn center to make scheduled rounds with the physicians and to attend the weekly multidisciplinary burn team rounds . A prospect i ve 6-month study was completed to 1 ) determine the clinical impact of the pharmacist 's interventions and 2 ) quantify cost savings generated by these interventions . Prospect i ve data concerning clinical interventions by the pharmacist were collected during a 6-month period . Each intervention was independently review ed by two attending burn surgeons to determine its importance . A total of 165 interventions in 76 patients were documented . Following an independent review of each intervention by burn surgery attendings , 121 of 165 interventions were felt to have improved overall patient care , 42 of 165 prevented possible drug-related toxicity or organ dysfunction , 1 of 165 prevented a possible life-threatening event , and only 1 of 165 was considered insignificant . Drug changes suggested by the pharmacist result ed in a savings of $ 11,081.14 for the 6-month period . The integration of the critical care pharmacist into clinical rounds results in significant cost avoidance and improves overall patient care CONTEXT Pharmacist review of medication orders in the intensive care unit ( ICU ) has been shown to prevent errors , and pharmacist consultation has reduced drug costs . However , whether pharmacist participation in the ICU at the time of drug prescribing reduces adverse events has not been studied . OBJECTIVE To measure the effect of pharmacist participation on medical rounds in the ICU on the rate of preventable adverse drug events ( ADEs ) caused by ordering errors . DESIGN Before-after comparison between phase 1 ( baseline ) and phase 2 ( after intervention implemented ) and phase 2 comparison with a control unit that did not receive the intervention . SETTING A medical ICU ( study unit ) and a coronary care unit ( control unit ) in a large urban teaching hospital . PATIENTS Seventy-five patients r and omly selected from each of 3 groups : all admissions to the study unit from February 1 , 1993 , through July 31 , 1993 ( baseline ) and all admissions to the study unit ( postintervention ) and control unit from October 1 , 1994 , through July 7 , 1995 . In addition , 50 patients were selected at r and om from the control unit during the baseline period . INTERVENTION A senior pharmacist made rounds with the ICU team and remained in the ICU for consultation in the morning , and was available on call throughout the day . MAIN OUTCOME MEASURES Preventable ADEs due to ordering ( prescribing ) errors and the number , type , and acceptance of interventions made by the pharmacist . Preventable ADEs were identified by review of medical records of the r and omly selected patients during both preintervention and postintervention phases . Pharmacists recorded all recommendations , which were then analyzed by type and acceptance . RESULTS The rate of preventable ordering ADEs decreased by 66 % from 10.4 per 1000 patient-days ( 95 % confidence interval [ CI ] , 7 - 14 ) before the intervention to 3.5 ( 95 % CI , 1 - 5 ; P<.001 ) after the intervention . In the control unit , the rate was essentially unchanged during the same time periods : 10.9 ( 95 % CI , 6 - 16 ) and 12.4 ( 95 % CI , 8 - 17 ) per 1000 patient-days . The pharmacist made 366 recommendations related to drug ordering , of which 362 ( 99 % ) were accepted by physicians . CONCLUSIONS The presence of a pharmacist on rounds as a full member of the patient care team in a medical ICU was associated with a substantially lower rate of ADEs caused by prescribing errors . Nearly all the changes were readily accepted by physicians OBJECTIVE To evaluate the  clinical pharmacists ' interventions  in an intensive care unit ( ICU ) setting with regard to their acceptance by the medical team , frequency , clinical significance , and targeted patient 's outcomes . METHODS This is a prospect i ve , non-comparative , observational study evaluating the  clinical pharmacist interventions in an ICU setting from December 2002 to May 2003 . The study was conducted in a 19-bed Cardiac-Surgery ICU at King Faisal Specialist Hospital & Research Center , a tertiary-care hospital in Riyadh , Saudi Arabia . The clinical pharmacist performed daily multi-disciplinary team rounds , with documentation of all his interventions . On the same day , a physician , who is a part of the team , verified all interventions for validity and clinical significance . The institutional Office of Research Affairs approved the study . RESULTS The clinical pharmacist intervened 394 times on the 600 patients [ 0.66 intervention-per-patient ] . The medical team accepted almost all interventions ( 94.3 % ) . The main drug-related problems were the following : no drug prescribed for medical condition ( 33.2 % ) , inappropriate dosing regimen ( 28.9 % ) , and no indication for drug use ( 14.3 % ) . Approximately 55.7 % of the interventions targeted enhancing therapeutic outcomes , whilst 21.8 % of interventions result ed in the prevention of an adverse drug reaction . The interventions that may have result ed in decreasing mortality , preventing , or reducing organ damage , or decreasing hospitalization , represented 8.1 % of all interventions . CONCLUSION Participation of a clinical pharmacist in the daily multidisciplinary team rounds in an ICU setting significantly reduces unfavorable morbidities and enhances therapeutic outcomes We prospect ively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit ( MICU ) using nurses ' and residents ' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care . Either readmission to the MICU or death was considered a negative patient outcome . Nurses ' reports of collaboration were significantly ( p = 0.02 ) and positively associated with patient outcome , controlling for severity of illness . Patient predicted risk of negative outcome decreased from 16 % , when the nurse reported no collaboration in decision making , to 5 % when the process was fully collaborative . There was an interaction of collaboration with availability of alternative choices in the transfer decision-making situation . When alternatives were available , collaboration was more strongly associated with patient outcome . There was no significant relationship between  residents ' reports of collaboration and patient outcomes . The correlation between amount of collaboration reported by nurses and residents about the same decisions was quite low ( r = 0.10 ) BACKGROUND The Joint Commission on the Accreditation of Healthcare Organizations reports that communication breakdowns are responsible for 85 % of sentinel events in hospitals . Patients in surgical ICUs are the most vulnerable to communication errors . Fellows and residents are an integral part of the surgical ICU team , but little is known about resident-fellow communication and its impact on surgical ICU patient outcomes . The objective of this study is to describe  resident-fellow  patient care communication patterns in the surgical ICU and correlate established communication patterns with short-term outcomes . STUDY DESIGN A prospect i ve observational trial was conducted for 136 consecutive surgical ICU days . We evaluated  resident-fellow communication of four cardiorespiratory events : hypotension , new arrhythmias , tachypnea , and desaturation . We prospect ively defined three short-term outcomes : improved , not improved , and worse . An intervention was attempted to improve communication . RESULTS Three hundred twelve events were collected ( 166 observational and 146 interventional ) . PGY3 residents covered approximately 60 % of days in both phases . PGY3 residents were responsible for 73 % of communication errors in the observational phase and 59 % of communication errors in the interventional phase . Communication errors were more likely in the late shift ( p < 0.0001 ) . The late shift was responsible for 77 % of all communication errors . Communication errors result ed in worse short-term outcomes for cardiorespiratory events ( p < 0.0002 ) . Effective communication was a significant predictor of improved short-term outcomes ( p < 0.0003 ) . The intervention decreased communication errors in the late shift by 10 % ( p < 0.052 ) . CONCLUSIONS Communication errors occurred more frequently during the late shift . These communication errors were associated with worsened short-term outcomes . Improved communication in the surgical ICU is a fruitful target to improve clinical outcomes Objective : To improve communication during daily rounds using sequential interventions . Design : Prospect i ve cohort study . Setting : Multidisciplinary pediatric intensive care unit in a university hospital . Subjects : The multidisciplinary rounding team in the pediatric intensive care unit , including attending physicians , physician trainees , and nurses . Interventions : Daily rounds on 736 patients were observed over a 9-month period . Sequential interventions were timed 8–12 wks apart : 1 ) implementing a new resident daily progress note format ; 2 ) creating a performance improvement “ dashboard ” ; and 3 ) documenting patients ' daily goals on bedside whiteboards . Measurements and Main Results : After all interventions , team agreement with the attending physician 's stated daily goals increased from 56.9 % to 82.7 % ( p < .0001 ) . Mean agreement increased for each provider category : 65.2 % to 88.8 % for fellows ( p < .0001 ) , 55.0 % to 83.8 % for residents ( p < .0001 ) , and 54.1 % to 77.4 % for nurses ( p < .0001 ) . In addition , significant improvements were noted in provider behaviors after interventions . Barriers to communication ( bedside nurse multitasking during rounds , interruptions during patient presentations , and group disassociation ) were reduced , and the use of communication facilitators ( review of the prior day 's goals , inclusion of bedside nurse input , and order read-back ) increased . The percentage of providers reporting being “ very satisfied ” or “ satisfied ” with rounds increased from 42.6 % to 78.3 % ( p < .0001 ) . Conclusions : Shared agreement of patients ' daily goals among key healthcare providers can be increased through process-oriented interventions . Improved agreement will potentially lead to improved quality of patient care and reduced medical errors BACKGROUND The incidence of ventilator-associated pneumonia ( VAP ) in trauma patients can be decreased with use of the ventilator bundle ( VAPB ) . Our VAP rate remained high despite the adoption of the VAPB . To better implement the VAPB , a multidisciplinary team composed of the surgical intensive care unit ( SICU ) nursing staff , physician , and respiratory therapist review ed briefly a checklist of VAPB goals for each patient before morning attending rounds . We hypothesized that such daily goal rounds ( GR ) focused on the VAPB would decrease the VAP rate . METHODS A pre-GR ten-month period ( November 2006 to August 2007 ) was compared with the ten-month period ( September 2007 to June 2008 ) with daily GRs . The occurrence of VAPs was tallied prospect ively in all intubated trauma patients using the National Nosocomial Infection Surveillance criteria . Patient characteristics and outcome data were obtained from our trauma registry and medical records . Patient characteristics were similar in the 85 pre-GR patients and the 89 GR patients . RESULTS The number of VAPs decreased 67 % in the GR patients ( 15 pre-GR vs. 5 GR ; p=0.02 ) ; however , the all-cause mortality rate remained similar ( 16.5 % vs. 21.3 % ; p=0.41 ) . When patients were divided into those with and without VAP , there was a significant increase in mean ventilator , SICU , and hospital days in patients with VAP ( p=0.01 for all ) . There were only two deaths among trauma patients with VAP . CONCLUSION Daily multidisciplinary GRs focused on the VAPB can decrease the incidence of VAP significantly in trauma patients .  Ventilator- 
    Output:
    
Identified facilitators suggest that the quality of  rounds is improved when conducted by a multidisciplinary group of providers , with explicitly defined roles , using a st and ardized structure and goal -oriented approach that includes a best practice s checklist .
Barriers to quality patient care rounds include poor information retrieval and documentation , interruptions , long rounding times , and allied healthcare provider perceptions of not being valued by rounding physicians .