The risk of medical errors increases upon transfer out of the intensive care unit (ICU). Discrepancies in the documented care plan between notes at the time of transfer may contribute to ...communication errors. We sought to determine the frequency of clinically meaningful discrepancies in the documented care plan for patients transferred from the pediatric ICU to the medical wards and identified risk factors.
Two physician reviewers independently compared the transfer note and handoff document of 50 randomly selected transfers. Clinically meaningful discrepancies in the care plan between these two documents were identified using a coding procedure adapted from healthcare failure mode and effects analysis. We assessed the influence of risk factors via multivariable regression.
We identified 34 clinically meaningful discrepancies in 50 patient transfers. Fourteen transfers (28%) had ≥1 discrepancy, and ≥2 were present in 7 transfers (14%). The most common discrepancy categories were differences in situational awareness notifications and documented current therapy. Transfers with handoff document length in the top quartile had 10.6 (95% CI: 1.2-90.2) times more predicted discrepancies than transfers with handoff length in the bottom quartile. Patients receiving more medications in the 24 hours prior to transfer had higher discrepancy counts, with each additional medication increasing the predicted number of discrepancies by 17% (95% CI: 6%-29%).
Clinically meaningful discrepancies in the documented care plan pose legitimate safety concerns and are common at the time of transfer out of the ICU among complex patients.
Speech signal components that are desynchronized from the veridical temporal pattern lose intelligibility. In contrast, audiovisual presentations with large desynchrony in visible and audible speech ...streams are perceived without loss of integration. Under such conditions, the limit of desynchrony that permits audiovisual integration is also adaptable. A new project directly investigated the potential for adaptation to consistent desynchrony with unimodal auditory sine-wave speech. Listeners transcribed sentences that are highly intelligible, with veridical temporal properties. Desynchronized variants were created by leading or lagging the tone analog of the second formant relative to the rest of the tones composing the sentences, in 50-msec steps, ranging from 250-msec lead to 250-msec lag. In blocked trials, listeners only tolerated desynchronies <50 msec, and exhibited no gain in intelligibility to consistent desynchrony. Unimodal auditory and bimodal audiovisual forms of perceptual integration evidently exhibit different temporal characteristics, an indication of distinct perceptual functions.
Researchers have claimed that listeners tolerate large temporal distortion when integrating the spectral components of speech. In some estimates, perceivers resolve linguistic attributes at spectral ...desynchronies as great as the duration of a syllable. We obtained new measures of perceptual tolerance of auditory asynchrony, using sine-wave synthesis in order to require perceivers to resolve the speech stream dynamically. Listeners transcribed sentences in which the tone analogue of a second formant was desynchronized relative to the remaining tones of a sentence, with desynchrony ranging from a 250-msec lead to a 250-msec lag. Intelligibility declined symmetrically from 72% at synchrony to 7% at 6100 msec. This finding of narrow asynchrony tolerance indicates a time-critical feature of the auditory perceptual organization of speech
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