Step-down units are cost-effective alternatives to coronary care units with non-inferior outcomes in the management of ST-elevation myocardial infarction patients after successful primary percutaneous coronary intervention

The Role of Intermediate Care in Supporting Critically Ill Patients and Critical Care Infrastructure

Intermediate care (IC) is used for patients who do not require the human and technological support of the intensive care unit (ICU) yet require more care and monitoring than can be provided on general wards. Though prevalent in many countries, there is marked variability in models of organization and staffing, as well as monitoring and interventions provided. In this article, the authors will discuss the historical background of IC, review the impact of IC on ICU and IC patient outcomes, and highlight where future studies can shed light on how to optimize IC organization and outcomes.

Intervention effect of encouraging mental and programmed nursing of patients in interventional operating room on their compliance and bad moods

BACKGROUND

Patients’ lack of correct understanding of cardiovascular disease and interventional therapy is often accompanied by varying degrees of fear, depression and anxiety. Negative emotion will affect the hemodynamic fluctuation of patients undergoing interventional surgery, which is not conducive to the smooth and safe operation of interventional surgery. Therefore, it is very important to implement effective nursing intervention in the operating room.

AIM

To explore the intervention effect of motivational psychological nursing combined with programmed nursing on compliance and bad mood of patients in interventional operating room.

METHODS

A total of 98 patients in the interventional operating room of our hospital from October 2019 to March 2021 were randomly divided into study group (n = 49) and control group (n = 49). The control group took routine nursing. However, the study group took motivational psychological nursing combined with procedural nursing on the basis of the control group. Statistics were made on rehabilitation compliance, Positive and Negative Affect Schedule of bad mood, Simplified Coping Styles Questionnaire score of coping style and satisfaction of intervention between the two groups before and after intervention.

RESULTS

The rehabilitation compliance of the study group (95.92%) was higher than that of the control group (81.63%) (P < 0.05). After intervention, the scores of upset, fear, irritability, tension and fear in the study group were respectively, which were lower than those in the control group (P < 0.05). After intervention, the score of positive coping in the study group was higher than that in the control group. However, the score of negative coping in the study group was lower than that in the control group (P < 0.05). The intervention satisfaction of the study group (93.88%) was higher than that of the control group (79.59%) (P < 0.05).

CONCLUSION

The intervention of motivational psychological nursing combined with procedural nursing can improve the rehabilitation compliance, and alleviate the bad mood. In addition, it can change their coping style to the disease, and the patients are more satisfied with the nursing work.

Shock Index Is a Validated Prediction Tool for the Short-Term Survival of Advanced Cancer Patients Presenting to the Emergency Department

Advanced cancer patients who are not expected to survive past the short term can benefit from early initiation of palliative care in the emergency department (ED). This discussion, however, requires accurate prognostication of their short-term survival. We previously found in our retrospective study that shock index (SI) is an ideal risk stratification tool in predicting the 60-day mortality risk of advanced cancer patients presenting to the ED. This study is a follow-up prospective validation study conducted from January 2019 to April 2021. A total of 410 advanced cancer patients who presented to the ED of a medical centre and could be followed-up feasibly were recruited. Univariate and multivariable logistic regression analyses were performed with receiver operator calibrating (ROC) curve analysis. Non-survivors had significantly lower body temperatures, higher pulse rates, higher respiratory rates, lower blood pressures, and higher SI. Each 0.1 increment of SI increased the odds of 60-day mortality by 1.591. Area under ROC curve was 0.7819. At optimal cut-off of 0.94, SI had 66.10% accuracy. These results were similar to our previous study, thus validating the use of SI in predicting the 60-day mortality of advanced cancer patients presenting to the ED. Identified patients may be offered palliative care.

Stable STEMI patients rarely require intensive-care level therapy after primary PCI

Background

The disposition of patients presenting with ST-elevation myocardial infarction (STEMI) is commonly the coronary care unit. Recent studies have suggested that low-risk STEMI patients could be managed in a lower-acuity setting immediately after percutaneous coronary intervention (PCI). We sought to determine the frequency of downstream intensive-care therapy used in our “stable” STEMI patients post-PCI.

Methods

A single-centre, retrospective review was completed of consecutive patients who underwent primary PCI for STEMI between 2013 and 2016. Post-PCI, patients were defined as being stable if they had not required intensive-care therapy or suffered significant complications. Intensive-care therapies and complications were defined as invasive/noninvasive ventilation, pacing, cardiac arrest, use of vasopressors/inotropes, dialysis, stroke, or major bleeding. This group of stable patients had their course followed to discharge.

Results

A total of 731 patients presented with STEMI for primary PCI. Of these, 132 patients (18%) required intensive-care therapies and/or had complications prior to PCI and were excluded. After PCI, 599 STEMI patients (82%) were defined as stable, according to the above definition. Of these, 11 patients (1.8%) required intensive-care therapies during their hospitalization. Zwolle scores were significantly higher in patients with complications (6.3 ± 4.4 vs 2.0 ± 1.5, P < 0.0001). The most frequent intensive-care complications and therapies were cardiac arrest (7 patients, 1%) and vasopressor use (4 patients, 0.7%). These complications most frequently occurred on the first admission day (6 patients, 1%).

Conclusions

Patients who are stable at the completion of their primary PCI rarely develop complications that require intensive care. These patients are easily identified for triage to a lower-acuity setting, alleviating congestion in cardiac care units and reducing hospitalization costs.

How the high acuity unit changes mortality in the intensive care unit: a retrospective before-and-after study

PURPOSE

High acuity units (HAU) are hospital units that provide patients with more acute care and closer monitoring than a general hospital ward but are not as resource intensive as an intensive care unit (ICU). Nevertheless, the impact of opening a HAU on ICU patient outcomes remains poorly defined. We investigated how the creation of a HAU impacted patient outcomes in the ICU.

METHODS

This historical cohort study compared ICU patient in-hospital mortality, ICU length of stay (LOS), and hospital LOS before and after the creation of a HAU in a tertiary-care hospital with a medical/surgical ICU between 1 January 2013 and 31 December 2017.

RESULTS

Data from 4,380 patients (984 in the pre-HAU group and 3,396 in the post-HAU group) were analyzed. In this cohort of ICU patients, 360 (37%) died in the pre-HAU group before the creation of a HAU, and 1,074 (32%) died in the post-HAU group after the creation of a HAU. The creation of a HAU was associated with lower relative risk of in-hospital mortality (adjusted risk ratio, 0.80; 95% confidence interval [CI], 0.72 to 0.89; P < 0.001). The creation of a HAU was also associated with reduced ICU and hospital LOS with a 12% increase in the rate of ICU discharge (adjusted sub-distribution hazard ratio [SHR], 1.12; 95% CI, 1.02 to 1.23; P = 0.02) and a 26% increase in the rate of hospital discharge (adjusted SHR, 1.26; 95% CI, 1.14 to 1.39; P < 0.001), when accounting for the competing risk of death.

CONCLUSIONS

These data support the hypothesis that the creation of a HAU may be associated with reduced in-hospital mortality, ICU LOS, and hospital LOS for ICU patients.