To emerge from a significant quality crisis, hospital administration recognized the need for physician leadership to drive improvements. A framework is presented for a physician-led Quality Summit to select best practice initiatives for implementation over 1 year. Results demonstrated statistically significant reductions in ventilator-associated pneumonia, decreasing from the first quarter 2009 baseline of 8.34 per 1000 ventilator days to 3.32 per 1000 ventilator days in second quarter 2010 (P = .0055). During the same time frame, catheter-associated urinary tract infections decreased from 4.35 per 1000 catheter days to 0.98 per 1000 catheter days (P = .0438), and severe sepsis/septic shock mortality declined from 33% to 13% (P = .0084). The customized World Health Organization Surgical Safety Checklist was used in 93% of surgeries within 1 month of adoption. Venous thromboembolism screening for adults became routine. The annual Quality Summit cycle engages physicians to introduce and spread quality improvement.

No abstract

No abstract

ImpressionThis is a 51-year-old female with lobular carcinoma of the breast, estrogen receptor (ER) positive, progesterone receptor (PR) negative, metastatic to bone. The patient is status post adjuvant chemotherapy and radiation for T3 N2 M0 stage IIIA disease, originally diagnosed in 1995. The patient had 3 years of hormonal therapy with tamoxifen, but in 1999, CA 27, 29 levels increased, and a bone scan was then suspicious for metastatic disease. The patient was treated with aromatase inhibitors; however a follow-up bone scan revealed progression of disease, and the patient was subsequently started on Aredia. Past medical history is significant for hypothyroidism. Review of systems reveals fatigue, anorexia, and a weight loss of 12 pounds, which is approximately 10% of usual body weight. The patient has pain management issues with resulting limitation in physical activity. Labs in September 2000 revealed anemia, leukopenia, and elevated liver enzymes (AST and LDH); CA 27, 29 was significantly elevated at 1822. The immune panel reveals a low percentage of T helper cells. Current symptoms suggest progression of bone metastases, possibly causing sacral nerve root involvement and back pain, as well as possible orthostatic hypotension, intermittent claudication, hypothyroidism, not well controlled with current therapy, and menopausal symptoms.