Over 28 months, a systems approach to reducing nosocomial infection rates after trauma decreased nosocomial infections: UTI (76.3%), BSI (74.1%), and VAP (24.9%). Our experience suggests that infection reduction requires (1) an evidence-based plan; (2) MD and staff education/commitment; (3) electronic documentation; and (4) auditors to monitor and ensure compliance.

Objective To describe the characteristics at enrolment and outcomes of doctors in a substance dependence monitoring programme in Canada.Design Prospective descriptive study.Setting Provincial physician health programme, Canada.Participants All 100 doctors consecutively admitted to a substance dependence monitoring programme and followed until completion of monitoring or on leaving the programme. Main outcome measure Relapse during long term monitoring for five years.Results Ninety per cent of the doctors enrolled on the programme were men, 66% were married or living with a partner, 44% had had previous treatment for substance dependence, and 36% had had previous psychiatric treatment. Smokers were over-represented compared with the general population of US doctors (38% v 5%). During the monitoring period 71% of participants had no known relapse. An additional 14% went on to complete the programme, after some form of relapse. In total, 85% of the doctors successfully completed the programme.Conclusion In this cohort of doctors enrolled on the Ontario Physician Health Program for substance dependence, most were men who were dependent on alcohol or opioids. Smokers were over-represented compared with the general population of US doctors. Eighty five per cent successfully completed the programme.

The shortage of frontline nursing staff and their managers in acute care organizations necessitates strategies to both use and recognize the unique knowledge and skills of these individuals. The authors describe one organization's successful implementation of a shared decision-making structure that promotes an empowering work environment in which professional fulfillment and personal satisfaction can flourish. With support and opportunity, leaders are developed across all levels of nursing.

In 2006, JCAHO defined the second of its National Patient Safety goals as to "Improve the effectiveness of communication among caregivers". The SBAR protocol gives practical guidelines for person-toperson communication but may not be appropriate in its current form for more complex contexts. This paper presents a case study showing communication processes in one ICU and illustrates important principles of complex clinical communication. The case study is based on observational and interview data from a bedside nurse, a charge nurse, a resident and a fellow over 12 hours each in a major trauma ICU. Artefacts were also collected and annotated. Five types of interconnected communication events are described in the sequence in which they occur. Each communication event is described in terms of its purpose, participants, process, and support tools. Four principles are defined.