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Emamian N, Miller T, Glick Z, Day L, Becker L, Singh A, Shi T, Rea J, Boswell K, Tran QK. Association between measures of resuscitation in the critical care resuscitation unit and in-hospital mortality among patients with sepsis. J Am Coll Emerg Physicians Open 2024; 5:e13281. [PMID: 39193082 PMCID: PMC11345497 DOI: 10.1002/emp2.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 06/19/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024] Open
Abstract
Objectives We hypothesized that lactate clearance and reduction of the Sequential Organ Failure Assessment (SOFA) score during patients' critical care resuscitation unit (CCRU) stay would be associated with lower in-hospital mortality. Methods This was a retrospective study of adult patients who had sepsis diagnoses and were admitted to the CCRU in 2018. Multivariable logistic regression analysis was performed to assess the association of clinical factors, lactate clearance, and SOFA reduction with hospital mortality. Results A total of 401 patients with lactate clearance data and 455 patients with SOFA score data were included in the study. The mean (SD) lactate and SOFA score on admission were 2.2 (1.8) mmol/L and 4.4 (4.3), respectively. Average lactate clearance was 0.1 (2.6) mmol/L, and average SOFA score reduction was 0.65 (5.9). Patients with a one point reduction in SOFA score during their CCRU stay had a 31% reduction of mortality (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.62-0.77, p < 0.001). SOFA score reduction was associated with lower hospital mortality for both surgical patients (OR 0.69, 95% CI 0.58-0.81, p < 0.001) and non-surgical patients (OR 0.71 95% CI 0.06-0.83, p < 0.001). Conclusion SOFA score reduction, but not lactate clearance during the CCRU stay, was associated with lower odds of in-hospital mortality. These findings suggest that resuscitative efforts leading to an early improvement in SOFA score may benefit patients with sepsis.
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Affiliation(s)
- Nikki Emamian
- Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Taylor Miller
- Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Zoe Glick
- Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Lauren Day
- Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Lauren Becker
- Departments of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Aditi Singh
- Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Tesia Shi
- Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Jeffrey Rea
- Program in TraumaUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Kimberly Boswell
- Program in TraumaUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Quincy K. Tran
- Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- Program in TraumaUniversity of Maryland School of MedicineBaltimoreMarylandUSA
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Tran QK, Ternovskaia A, Downing JV, Cheema M, Kowansky T, Vashee I, Sayal J, Wu J, Singh A, Haase DJ. The Impact of the Critical Care Resuscitation Unit on Quaternary Care Accessibility for Rural Patients: A Comparative Analysis. Crit Care Res Pract 2024; 2024:9599855. [PMID: 39220227 PMCID: PMC11362575 DOI: 10.1155/2024/9599855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/06/2024] [Indexed: 09/04/2024] Open
Abstract
Background Previous research suggests that patients from rural areas who are critically ill with complex medical needs or require time-sensitive subspecialty interventions face worse healthcare outcomes and delays in care when compared to those from urban areas. The critical care resuscitation unit (CCRU) at our quaternary care center was established to expedite the transfer of critically ill patients or those who need time-sensitive intervention. This study investigates if disparities exist in treatments and outcomes among patients transferred to the CCRU from rural versus urban hospitals. Methods This is a retrospective study of adult, nontrauma patients admitted to the CCRU via interhospital transfer from outside facilities from January 1 to December 31, 2018. Patients transferred from within our institution or with missing clinical data were excluded. Multivariable logistic regressions were performed to measure the association between patients' demographic and clinical factors with in-hospital mortality. Results We analyzed 1381 nontrauma patients, and 484 (35%) were from rural areas. Median age was 59 [47-69], and 629 (46%) were female. Median sequential organ failure assessment was 3 ([1-6], p=0.062) for both patients transferred from urban and rural hospitals. There was no significant difference between groups with respect to most demographic and clinical factors, as well as types of interventions after CCRU arrival, including emergent surgical interventions within 12 hours of arrival at the CCRU. Rural patients were more likely to be transferred for care by the acute care emergency surgery service than were patients from urban areas and were transferred over a significantly greater distance (difference of 53 kilometers (km), 95% CI: -58.9-51.7 km, P < 0.001). Transfer from rural areas was not associated with increased odds of in-hospital mortality (OR: 0.90, 95% CI: 0.60, 1.36; P=0.63). Conclusion Thirty-five percent of patients transferred to the CCRU came from rural areas, which house 25% of the state population of Maryland. Patients transferred from rural counties to the CCRU faced greater transport distances, but they received the same level of care upon arrival at the CCRU and had the same odds of in-hospital mortality as patients transferred from urban hospitals.
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Affiliation(s)
- Quincy K. Tran
- Department of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
- The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of Medicine, Baltimore, MD, USA
- The Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anastasia Ternovskaia
- The Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica V. Downing
- Department of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
- The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of Medicine, Baltimore, MD, USA
- The Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Minahil Cheema
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Taylor Kowansky
- The Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
| | - Isha Vashee
- The Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
| | - Jasjot Sayal
- The Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
| | - Jasmine Wu
- The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of Medicine, Baltimore, MD, USA
| | - Aditi Singh
- The Research Associate Program in Emergency Medicine and Critical CareDepartment of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel J. Haase
- Department of Emergency MedicineUniversity of Maryland School of Medicine, Baltimore, MD, USA
- The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
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Tran QK, Ternovskaia A, Chen N, Faisal M, Yardi I, Emamian N, Kim A, Kowansky T, Niles E, Sahadzic I, Chasm R, Sjeklocha L, Haase DJ, Downing J. Air or Ground Transport to the Critical Care Resuscitation Unit: Does It Really Matter? Air Med J 2024; 43:295-302. [PMID: 38897691 DOI: 10.1016/j.amj.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/14/2023] [Accepted: 01/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Critically ill patients requiring urgent interventions or subspecialty care often require transport over significant distances to tertiary care centers. The optimal method of transportation (air vs. ground) is unknown. We investigated whether air transport was associated with lower mortality for patients being transferred to a specialized critical care resuscitation unit (CCRU). METHODS This was a retrospective study of all adult patients transferred to the CCRU at the University of Maryland Medical Center in 2018. Our primary outcome was hospital mortality. The secondary outcomes included the length of stay and the time to the operating room (OR) for patients undergoing urgent procedures. We performed optimal 1:2 propensity score matching for each patient's need for air transport. RESULTS We matched 198 patients transported by air to 382 patients transported by ground. There was no significant difference between demographics, the initial Sequential Organ Failure Assessment score, or hospital outcomes between groups. One hundred sixty-four (83%) of the patients transported via air survived to hospital discharge compared with 307 (80%) of those transported by ground (P = .46). Patients transported via air arrived at the CCRU more quickly (127 [100-178] vs. 223 [144-332] minutes, P < .001) and were more likely (60 patients, 30%) to undergo urgent surgical operation within 12 hours of CCRU arrival (30% vs. 17%, P < .001). For patients taken to the OR within 12 hours of arriving at the CCRU, patients transported by air were more likely to go to the OR after 200 minutes since the transfer request (P = .001). CONCLUSION The transportation mode used to facilitate interfacility transfer was not significantly associated with hospital mortality or the length of stay for critically ill patients.
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Affiliation(s)
- Quincy K Tran
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Anastasia Ternovskaia
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nelson Chen
- University of Maryland School of Medicine, Baltimore, MD
| | - Manal Faisal
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Isha Yardi
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nikki Emamian
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Abigail Kim
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Taylor Kowansky
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Erin Niles
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Iana Sahadzic
- The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rose Chasm
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Lucas Sjeklocha
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel J Haase
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jessica Downing
- Program in Trauma, The R Adam Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
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4
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Tran QK, Widjaja A, Plotnikova A, Yang J, Epstein J, Aquino A, Albelo F, Kowansky T, Vashee I, Austin S, Haase DJ, Esposito E. Direct Discharge from the Critical Care Resuscitation Unit: Results from a Longitudinal Assessment. Crit Care Res Pract 2023; 2023:2213185. [PMID: 37937161 PMCID: PMC10627715 DOI: 10.1155/2023/2213185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/20/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
Background The critical care resuscitation unit (CCRU) facilitates interhospital transfer (IHT) of critically ill patients for immediate interventions. Due to these patients' acuity, it is uncommon for patients to be directly discharged home from this unit, but it does happen on occasion. Since there is no literature regarding outcomes of patients being discharged from a resuscitation unit, our study investigated these patients' outcome at greater than 12 months after being discharged directly from the CCRU. Methods We performed a retrospective cohort study of all adult patients directly discharged from the CCRU between January 01, 2017, and December 31, 2020. The primary outcome was number of ED visits or hospitalizations within 6 months. Secondary outcomes were number of ED visits or hospitalizations within 6, 12, and >12 months from CCRU discharge. Results We analyzed 145 patients' records. Mean age was 56 (standard deviation [SD] ± 19), with a majority being male (72%) and Caucasian (58%). The most common discharge destination was home (139 patients, 96% of total subjects) versus hospice (2%) or nursing facilities (2%). Most patients (55%) did not have any hospital revisits within the first 6 months of discharge, while 31% had 1-2 revisits, and 14% had ≥3 revisits. The most common discharge diagnoses were soft tissue infection (16.5%), aortic dissection (14%), and stroke (11%). Factors which were associated with a greater likelihood of any return hospital visit within 6 months receiving mechanical ventilation during CCRU stay (coefficient -2.23, 95% CI 0.01-0.87, P=0.036), while high hemoglobin on CCRU discharge was associated with no ED revisit (coeff. 0.42, 95% CI 1.15-2.06, P=0.004). Conclusions Most patients who were discharged from the CCRU did not require any hospital revisits in the first 6 months. Requiring mechanical ventilation and having soft tissue infection were associated with high unplanned hospital revisits following discharge. Further research is needed to validate these findings.
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Affiliation(s)
- Quincy K. Tran
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Austin Widjaja
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anya Plotnikova
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jerry Yang
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacob Epstein
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexa Aquino
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fernando Albelo
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Taylor Kowansky
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Isha Vashee
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samuel Austin
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel J. Haase
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Esposito
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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5
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Bosco S, Sahni N, Jain A, Arora P, Raj V, Yaddanapudi L. Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit. Indian J Crit Care Med 2023; 27:580-582. [PMID: 37636858 PMCID: PMC10452780 DOI: 10.5005/jp-journals-10071-24502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023] Open
Abstract
Background and aim Delay in the transfer of critically ill patients from the emergency department (ED) to intensive care units (ICUs) may worsen clinical outcomes. This prospective, observational study was done to find the incidence of delayed transfer. Materials and methods After approval from the institute ethics committee and written informed consent, all patients admitted to ICU from ED over 6 months were divided into groups I and II as patients getting transferred to ICU within 30 minutes of the decision or not, respectively. The factors affecting the immediate transfer and clinical outcome of all patients were noted. Monthly feedback was given to the ED team. Results Out of 52 ICU admissions from ED, 35 (67.3%) patients were not transferred within 30 minutes, and the most frequent factor preventing immediate transfer was ED-related (54%). A statistically significant difference was found in acute physiology and chronic health evaluation (APACHE II) score, clinical deterioration during transfer, longer duration of mechanical ventilation and length of stay, and higher mortality with patients transferred immediately to ICU. A reduction of 42.6% was noted in transfer time from the first month to the last month of study. Conclusion The incidence of delayed transfer of patients from ED to ICU was 67.3% with ED-related factors being the most frequent cause of delay (54.2%). How to cite this article Bosco S, Sahni N, Jain A, Arora P, Raj V, Yaddanapudi L. Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit. Indian J Crit Care Med 2023;27(8):580-582.
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Affiliation(s)
- Shinto Bosco
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeru Sahni
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Arora
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vipin Raj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakshminarayana Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Austin S, Tran QK, Pourmand A, Matta A, Haase D. Comments on "Economic Evaluation of Ultrasound-guided Central Venous Catheter Confirmation vs Chest Radiography in Critically Ill Patients: A Labor Cost Model". West J Emerg Med 2023; 24:368-369. [PMID: 36976610 PMCID: PMC10047744 DOI: 10.5811/westjem.2022.10.59187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 03/29/2023] Open
Affiliation(s)
- Samuel Austin
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Department of Surgical Critical Care, Baltimore, Maryland
| | - Quincy K Tran
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Ali Pourmand
- George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC
| | - Ann Matta
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Department of Surgical Critical Care, Baltimore, Maryland
| | - Daniel Haase
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Department of Surgical Critical Care, Baltimore, Maryland
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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Teeter WA, Tran QK, Haase DJ. Critical Care Resuscitation Unit Model Shows Benefit for Patients, Patient Flow Metrics, and the Medical System. Crit Care Med 2022; 50:e816-e817. [PMID: 36394412 DOI: 10.1097/ccm.0000000000005688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- William A Teeter
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
- R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
- R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel J Haase
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
- R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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Association between resuscitation in the critical care resuscitation unit and in-hospital mortality. Am J Emerg Med 2022; 60:96-100. [DOI: 10.1016/j.ajem.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022] Open
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Is the Critical Care Resuscitation Unit Sustainable: A 5-Year Experience of a Beneficial and Novel Model. Crit Care Res Pract 2022; 2022:6171598. [PMID: 35912041 PMCID: PMC9325651 DOI: 10.1155/2022/6171598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background. The 6-bed critical care resuscitation unit (CCRU) is a unique and specialized intensive care unit (ICU) that streamlines the interhospital transfer (IHT—transfer between different hospitals) process for a wide range of patients with critical illness or time-sensitive disease. Previous studies showed the unit successfully increased the number of ICU admissions while reducing the time of transfer in the first year of its establishment. However, its sustainability is unknown. Methods. This was a descriptive retrospective analysis of adult, non-trauma patients who were transferred to an 800-bed quaternary medical center. Patients transferred to our medical center between January 1, 2014 and December 31, 2018 were eligible. We used interrupted time series (ITS) and descriptive analyses to describe the trend and compare the transfer process between patients who were transferred to the CCRU versus those transferred to other adult inpatient units. Results. From 2014 to 2018, 50,599 patients were transferred to our medical center; 31,582 (62%) were non-trauma adults. Compared with the year prior to the opening of the CCRU, ITS showed a significant increase in IHT after the establishment of the CCRU. The CCRU received a total of 7,788 (25%) IHTs during this period or approximately 20% of total transfers per year. Most transfers (41%) occurred via ground. Median and interquartile range [IQR] of transfer times to other ICUs (156 [65–1027] minutes) were longer than the CCRU (46 [22–139] minutes,
). For the CCRU, the most common accepting services were cardiac surgery (16%), neurosurgery (11%), and emergency general surgery (10%). Conclusions. The CCRU increases the overall number of transfers to our institution, improves patient access to specialty care while decreasing transfer time, and continues to be a sustainable model over time. Additional research is needed to determine if transferring patients to the CCRU would continue to improve patients’ outcomes and hospital revenue.
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Palmer J, Gelmann D, Engelbrecht-Wiggans E, Hollis G, Hart E, Ali A, Haase DJ, Tran Q. Invasive arterial blood pressure monitoring may aid in the medical management of hypertensive patients with acute aortic disease. Am J Emerg Med 2022; 59:85-93. [DOI: 10.1016/j.ajem.2022.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/17/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022] Open
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Predicting Outcomes for Interhospital Transferred Patients of Emergency General Surgery. Crit Care Res Pract 2022; 2022:8137735. [PMID: 35463803 PMCID: PMC9033401 DOI: 10.1155/2022/8137735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Interhospital transferred (IHT) emergency general surgery (EGS) patients are associated with high care intensity and mortality. However, prior studies do not focus on patient-level data. Our study, using each IHT patient’s data, aimed to understand the underlying cause for IHT EGS patients’ outcomes. We hypothesized that transfer origin of EGS patients impacts outcomes due to critical illness as indicated by higher Sequential Organ Failure Assessment (SOFA) score and disease severity. Materials and Methods. We conducted a retrospective analysis of all adult patients transferred to our quaternary academic center’s EGS service from 01/2014 to 12/2016. Only patients transferred to our hospital with EGS service as the primary service were eligible. We used multivariable logistic regression and probit analysis to measure the association of patients’ clinical factors and their outcomes (mortality and survivors’ hospital length of stay [HLOS]). Results. We analyzed 708 patients, 280 (39%) from an ICU, 175 (25%) from an ED, and 253 (36%) from a surgical ward. Compared to ED patients, patients transferred from the ICU had higher mean (SD) SOFA score (5.7 (4.5) vs. 2.39 (2),
), longer HLOS, and higher mortality. Transferring from ICU (OR 2.95, 95% CI 1.36–6.41,
), requiring laparotomy (OR 1.96, 95% CI 1.04–3.70,
), and SOFA score (OR 1.22, 95% CI 1.13–1.32,
) were associated with higher mortality. Conclusions. At our academic center, patients transferred from an ICU were more critically ill and had longer HLOS and higher mortality. We identified SOFA score and a few conditions and diagnoses as associated with patients’ outcomes. Further studies are needed to confirm our observation.
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Solà-Muñoz S, Azeli Y, Trenado J, Jiménez X, Bisbal R, López À, Morales J, García X, Sánchez B, Fernández J, Soto MÁ, Ferreres Y, Cantero C, Jacob J. Effect of a Prioritization Score on the Inter-Hospital Transfer Time Management of Severe COVID-19 Patients. A Quasi-Experimental Intervention Study. Int J Qual Health Care 2022; 34:6548674. [PMID: 35289365 PMCID: PMC8992311 DOI: 10.1093/intqhc/mzac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/21/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background The overburdening of the healthcare system during the coronavirus disease 19 (COVID-19) pandemic is driving the need to create new tools to improve the management of inter-hospital transport for patients with a severe COVID-19 infection. Objective The aim of this study was to analyse the usefulness of the application of a prioritization score (IHTCOVID-19) for inter-hospital transfer of patients with COVID-19 infection. Methods The study has a quasi-experimental design and was conducted on the Medical Emergency System, the pre-hospital emergency department of the public company belonging to the Autonomous Government of Catalonia that manages urgent healthcare in the region. Patients with a severe COVID-19 infection requiring inter-hospital transport were consecutively included. The pre-intervention period was from 1 to 31 March 2020, and the intervention period with the IHTCOVID-19 score was from 1 to 30 April 2020 (from 8 am to 8 pm). The prioritization score comprises four priority categories, with Priority 0 being the highest and Priority 3 being the lowest. Inter-hospital transfer (IHT) management times (alert-assignment time, resource management time and total central management time) and their variability were evaluated according to whether or not the IHTCOVID-19 score was applied. Results A total of 344 IHTs were included: 189 (54.9%) in the pre-intervention period and 155 (45.1%) in the post-intervention period. The majority of patients were male and the most frequent age range was between 50 and 70 years. According to the IHTCOVID-19 score, 12 (3.5%) transfers were classified as Priority 0, 66 (19.4%) as Priority 1, 247 (71.8%) as Priority 2 and 19 (5.6%) as Priority 3. Overall, with the application of the IHTCOVID-19 score, there was a significant reduction in total central management time [from 112.4 (inter-quartile range (IQR) 281.3) to 89.8 min (IQR 154.9); P = 0.012]. This significant reduction was observed in Priority 0 patients [286.2 (IQR 218.5) to 42.0 min (IQR 58); P = 0.018] and Priority 1 patients [130.3 (IQR 297.3) to 75.4 min (IQR 91.1); P = 0.034]. After applying the IHTCOVID-19 score, the average time of the process decreased by 22.6 min, and variability was reduced from 618.1 to 324.0 min. Conclusion The application of the IHTCOVID-19 score in patients with a severe COVID-19 infection reduces IHT management times and variability.
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Affiliation(s)
- Silvia Solà-Muñoz
- Address reprint requests to: Silvia Solà-Muñoz, Area of Research and Development, Sistema d’Emergències Mèdiques, Pablo Iglesias 101-115, L’Hospitalet de Llobregat, Barcelona 08908, Spain. Tel: +34 93 264 44 00; E-mail:
| | - Youcef Azeli
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Sociedad Española de Medicina de Urgencias y Emergencias, Red de Investigación de Emergencias Prehospitalarias RINVEMER, nuñez de balboa 116 3° office 9, Madrid 28020, Spain
- Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili (IISPV), Avda, Josep Laporte, 2 Planta 0 – E2 color taronja, Reus, Tarragona 43204, Spain
| | - Josep Trenado
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Intensive Care Unit, Hospital Universitari Mutua de Terrassa, Plaça del Doctor Robert, 5, Terrassa, Barcelona 08221, Spain
| | - Xavier Jiménez
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Sociedad Española de Medicina de Urgencias y Emergencias, Red de Investigación de Emergencias Prehospitalarias RINVEMER, nuñez de balboa 116 3° office 9, Madrid 28020, Spain
| | - Roger Bisbal
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Àngels López
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Jorge Morales
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Xaime García
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Bernat Sánchez
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - José Fernández
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Av. Colom 16-20, Tortosa, Tarragona 43500, Spain
- Unidat de Recerca, Gerència Territorial Terres de l´Ebre, Institut Català de la Salut, Ctra. de la Simpàtica, 44, Tortosa, Tarragona 43500, Spain
| | - Maria Ángeles Soto
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Yolanda Ferreres
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Cristina Cantero
- Area of Research and Development, Clinical Department, Sistema d’Emergències Mèdiques de Catalunya, C. Pablo Iglesias 101-155, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Javier Jacob
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Universitat de Barcelona, Carrer de la Feixa Llarga, s/n, Barcelona 08907, Spain
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Ahmad M, Qurneh A, Saleh M, Aladaileh M, Alhamad R. The effect of implementing adult trauma clinical practice guidelines on outcomes of trauma patients and healthcare providers. Int Emerg Nurs 2022; 61:101143. [DOI: 10.1016/j.ienj.2021.101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 12/16/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
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14
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Preserving Equity and Quality in the Push to Increase Access to Critical Care Services. Crit Care Med 2022; 50:150-153. [PMID: 34914645 DOI: 10.1097/ccm.0000000000005161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Regionalization of Critical Care in the United States: Current State and Proposed Framework From the Academic Leaders in Critical Care Medicine Task Force of the Society of the Critical Care Medicine. Crit Care Med 2021; 50:37-49. [PMID: 34259453 DOI: 10.1097/ccm.0000000000005147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions. DATA SOURCES AND STUDY SELECTION Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product. DATA EXTRACTION AND SYNTHESIS The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations. CONCLUSIONS Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively.
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16
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Blood pressure management in emergency department patients with spontaneous intracerebral hemorrhage. Blood Press Monit 2021; 25:318-323. [PMID: 32740294 DOI: 10.1097/mbp.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the well documented importance of blood pressure management in patients with spontaneous intracerebral hemorrhage (sICH), little is known about whether emergency departments (EDs) are able to achieve close monitoring and precise management. Our study characterizes ED monitoring and management of blood pressure in sICH patients. METHODS This is a retrospective study of adults with sICH and elevated intracranial pressure. Patients who were admitted from any referring ED to our CCRU from 1 August 2013 to 30 September 2015 were included. We graphically assessed the association between average minutes between blood pressure measurements and average minutes between administration of antihypertensives. We also performed logistic regression to evaluate factors associated with close blood pressure monitoring and the achievement of goal blood pressure in patients with sICH who presented with hypertension. RESULTS Of 115 patients, 73 presented to the ED with SBP above 160 mmHg. Length of stay in the ED was significantly associated with a longer period between blood pressure measurements. Longer periods between blood pressure measurements were a significant determinant of failure to achieve blood pressure goal in sICH patients. Longer periods between blood pressure measurements were significantly associated with longer periods between administration of antihypertensives. CONCLUSION Our study suggests that blood pressure monitoring is related to the frequency of blood pressure interventions and achievement of adequate blood pressure control in patients with sICH. There is significant variability in EDs' achievement of the recommended close blood pressure monitoring and management in patients with sICH.
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17
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Tran QK, Dave S, Haase DJ, Tiffany L, Gaasch S, Chang WTW, Jones K, Kole MJ, Wessell A, Schwartzbauer G, Scalea TM, Menaker J. Transfer of Patients with Spontaneous Intracranial Hemorrhage who Need External Ventricular Drain: Does Admission Location Matter? West J Emerg Med 2021; 22:379-388. [PMID: 33856326 PMCID: PMC7972373 DOI: 10.5811/westjem.2020.10.47795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/17/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Patients with spontaneous intracranial hemorrhage (sICH) are associated with high mortality and require early neurosurgical interventions. At our academic referral center, the neurocritical care unit (NCCU) receives patients directly from referring facilities. However, when no NCCU bed is immediately available, patients are initially admitted to the critical care resuscitation unit (CCRU). We hypothesized that the CCRU expedites transfer of sICH patients and facilitates timely external ventricular drain (EVD) placement comparable to the NCCU. METHODS This is a pre-post study of adult patients transferred with sICH and EVD placement. Patients admitted between January 2011-July 2013 (2011 Control) were compared with patients admitted either to the CCRU or the NCCU (2013 Control) between August 2013-September 2015. The primary outcome was time interval from arrival at any intensive care units (ICU) to time of EVD placement (ARR-EVD). Secondary outcomes included time interval from emergency department transfer request to arrival, and in-hospital mortality. We assessed clinical association by multivariable logistic regressions. RESULTS We analyzed 259 sICH patients who received EVDs: 123 (48%) CCRU; 81 (31%) 2011 Control; and 55 (21%) in the 2013 Control. The groups had similar characteristics, age, disease severity, and mortality. Median ARR-EVD time was 170 minutes [106-311] for CCRU patients; 241 minutes [152-490] (p < 0.01) for 2011 Control; and 210 minutes [139-574], p = 0.28) for 2013 Control. Median transfer request-arrival time for CCRU patients was significantly less than both control groups. Multivariable logistic regression showed each minute delay in ARR-EVD was associated with 0.03% increased likelihood of death (odds ratio 1.0003, 95% confidence interval, 1.0001-1.006, p = 0.043). CONCLUSION Patients admitted to the CCRU had shorter transfer times when compared to patients admitted directly to other ICUs. Compared to the specialty NCCU, the CCRU had similar time interval from arrival to EVD placement. A resuscitation unit like the CCRU can complement the specialty unit NCCU in caring for patients with sICH who require EVDs.
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Affiliation(s)
- Quincy K Tran
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Sagar Dave
- University of Maryland Medical Center, Department of Surgical Critical Care, Baltimore, Maryland
| | - Daniel J Haase
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Laura Tiffany
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Shannon Gaasch
- University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Wan-Tsu W Chang
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Kevin Jones
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Matthew J Kole
- University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland
| | - Aaron Wessell
- University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland
| | - Gary Schwartzbauer
- University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland.,University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland
| | - Thomas M Scalea
- University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland.,University of Maryland School of Medicine, Department of Surgery, Baltimore, Maryland
| | - Jay Menaker
- University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland.,University of Maryland School of Medicine, Department of Surgery, Baltimore, Maryland
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18
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Gilliam W, Barr JF, Bruns B, Cave B, Mitchell J, Nguyen T, Palmer J, Rose M, Tanveer S, Yum C, Tran QK. Factors associated with refractory pain in emergency patients admitted to emergency general surgery. World J Emerg Med 2021; 12:12-17. [PMID: 33505544 DOI: 10.5847/wjem.j.1920-8642.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oligoanalgesia in emergency departments (EDs) is multifactorial. A previous study reported that emergency providers did not adequately manage patients with severe pain despite objective findings for surgical pathologies. Our study aims to investigate clinical and laboratory factors, in addition to providers' interventions, that might have been associated with oligoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies. METHODS We conducted a retrospective study of adult patients who were transferred directly from referring EDs to the emergency general surgery (EGS) service at a quaternary academic center between January 2014 and December 2016. Patients who were intubated, did not have adequate records, or had mild pain were excluded. The primary outcome was refractory pain, which was defined as pain reduction <2 units on the 0-10 pain scale between triage and ED departure. RESULTS We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory pain had significantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and less frequent pain medication administration (median [interquartile range], 3 [3-5] vs. 4 [3-7], P=0.001), when compared to patients with no refractory pain. Multivariable logistic regression showed that the number of pain medication administration (odds ratio [OR] 0.80, 95% confidence interval [95% CI] 0.68-0.98) and ED serum lactate levels (OR 3.80, 95% CI 2.10-6.80) were significantly associated with the likelihood of refractory pain. CONCLUSIONS In ED patients transferring to EGS service, elevated serum lactate levels were associated with a higher likelihood of refractory pain. Future studies investigating pain management in patients with elevated serum lactate are needed.
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Affiliation(s)
| | - Jackson F Barr
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Brandon Bruns
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201, USA.,Department of Surgery, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Brandon Cave
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Jordan Mitchell
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Tina Nguyen
- Louisiana State University, Louisiana 70803, USA
| | - Jamie Palmer
- University of Maryland School of Medicine, Baltimore 21201, USA
| | - Mark Rose
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Safura Tanveer
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Chris Yum
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Quincy K Tran
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201, USA.,Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
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Tran QK, Famuyiwa O, Haase DJ, Holland K, Lawner B, Matta S, McGuin L, Menaker J, Menne A, Ngono EE, Niles E, O'Connor J, Scalea T, Galvagno S. Care Intensity During Transport to the Critical Care Resuscitation Unit: Transport Clinician's Role. Air Med J 2020; 39:473-478. [PMID: 33228897 DOI: 10.1016/j.amj.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients are often transferred between hospitals for a higher level of care. Critically ill patients require high-intensity care after transfer, but their care intensity during transport is unknown. We studied transport clinicians' management for patients who had time-sensitive or critical illnesses and were transferred to a critical care resuscitation unit (CCRU) at a quaternary academic center. METHODS We prospectively surveyed transport clinicians who brought interhospital transport patients to the CCRU between March 1, 2019, and January 8, 2020. The primary outcome was care intensity during transport, which was defined as new interventions rendered by transport clinicians. RESULTS We analyzed 852 surveys. Seventy-four percent of transports occurred by ground, and 54% originated from emergency departments. Up to 19% of patients received 2 or more interventions, whereas 29% received at least 1 intervention during transport. Ventilator management occurred in 25% of cases. When adjusting for known confounders, respiratory failure or acute respiratory distress syndrome, air transport, and contacting the CCRU attending physicians en route were associated with a higher likelihood of an intervention during transport. CONCLUSION Transport clinicians provided new interventions in 48% of patients being transferred to the CCRU. Patients with respiratory failure or acute respiratory distress syndrome and those transported by helicopter emergency medical services were more likely to receive interventions en route.
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Affiliation(s)
- Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | - Olufisola Famuyiwa
- Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel J Haase
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Kaitlynn Holland
- The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, MD
| | - Benjamin Lawner
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Maryland ExpressCare Critical Care Transport, University of Maryland Medical Center, Baltimore, MD
| | - Samuel Matta
- John Hopkins Lifeline, John Hopkins Medical Institution, Baltimore, MD
| | - Leigha McGuin
- Maryland ExpressCare Critical Care Transport, University of Maryland Medical Center, Baltimore, MD
| | - Jay Menaker
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Ashley Menne
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Edgard E Ngono
- Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Erin Niles
- The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, MD
| | - James O'Connor
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Thomas Scalea
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Samuel Galvagno
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
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Jayaprakash N, Pflaum-Carlson J, Gardner-Gray J, Hurst G, Coba V, Kinni H, Deledda J. Critical Care Delivery Solutions in the Emergency Department: Evolving Models in Caring for ICU Boarders. Ann Emerg Med 2020; 76:709-716. [PMID: 32653331 DOI: 10.1016/j.annemergmed.2020.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 03/21/2020] [Accepted: 05/01/2020] [Indexed: 10/23/2022]
Abstract
The National Academy of Medicine has identified emergency department (ED) crowding as a health care delivery problem. Because the ED is a portal of entry to the hospital, 25% of all ED encounters are related to critical illness. Crowding at both an ED and hospital level can thus lead to boarding of a number of critically ill patients in the ED. EDs are required to not only deliver immediate resuscitative and stabilizing care to critically ill patients on presentation but also provide longitudinal care while boarding for the ICU. Crowding and boarding are multifactorial and complex issues, for which different models for delivery of critical care in the ED have been described. Herein, we provide a narrative review of different models of delivery of critical care reported in the literature and highlight aspects for consideration for successful local implementation.
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Affiliation(s)
- Namita Jayaprakash
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
| | - Jacqueline Pflaum-Carlson
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Jayna Gardner-Gray
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Gina Hurst
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Victor Coba
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Surgical Critical Care, Henry Ford Hospital, Detroit, MI
| | - Harish Kinni
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - John Deledda
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
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