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Berry D, Street M, Hall K, Sprogis SK, Considine J. Recognising and Responding to Clinical Deterioration in Adult Patients in Isolation Precautions for Infection Control: A Retrospective Cohort Study. Int J Qual Health Care 2022; 34:6552208. [PMID: 35323935 DOI: 10.1093/intqhc/mzac020] [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: 08/01/2021] [Revised: 02/02/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patient isolation is widely used as a strategy for prevention and control of infection but may have unintended consequences for patients. Early recognition and response to acute deterioration is an essential component of safe, quality patient care and has not been explored for patients in isolation. Primary aims of this study were to: i) describe the timing, frequency, and nature of clinical deterioration during hospital admission for patients with isolation precautions for infection control and ii) compare the characteristics of patients who did and did not deteriorate during their initial period of isolation precautions for infection control. METHODS This retrospective cohort study was conducted across three sites of a large Australian health service. The study sample were adult patients (≥18 years) admitted into isolation precautions within 24-hours of admission from 1 July to 31 December 2019. RESULTS There were 634 patients who fulfilled the study inclusion criteria. One in eight patients experienced at least one episode of clinical deterioration during their time in isolation with most episodes of deterioration occurring within the first two days of admission. Timely Medical Emergency Team calls occurred in almost half the episodes of deterioration; however, the same proportion (47.2%) of deterioration episodes resulted in no Medical Emergency Team activation (afferent limb failure). In the 24-hours preceding each episode of clinical deterioration (n=180), 81.6% (n=147) of episodes were preceded by vital signs fulfilling pre-Medical Emergency Team criteria.Patients who deteriorated during isolation for infection control were older (median age 74.0 vs 71.0 years, P=0.042); more likely to live in a residential care facility (21.0% vs 7.2%, P=0.006); had a longer initial period of isolation (4.0 vs 2.9 days, P=<000.1) and hospital length of stay (median 4.9 vs 3.2 days, P=<0.001) and were more likely to die in hospital (12.3% vs 4.3%, P<0.001). CONCLUSION Patients in isolation precautions experienced high Medical Emergency Team afferent limb failure and most fulfilled pre-Medical Emergency Team criteria in the 24-hours preceding episodes of deterioration. Timely recognition and response to clinical deterioration continue to be essential in providing safe, quality patient care regardless of the hospital-care environment.
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Affiliation(s)
- D Berry
- Centre for Quality and Patient Safety - Eastern Health Partnership, Box Hill, Vic, Australia.,School of Nursing and Midwifery & Institute for Health Transformation, Deakin University, Geelong, Vic, Australia.,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research & Institute for Health Transformation, Deakin University, Geelong, Vic, Australia
| | - M Street
- Centre for Quality and Patient Safety - Eastern Health Partnership, Box Hill, Vic, Australia.,School of Nursing and Midwifery & Institute for Health Transformation, Deakin University, Geelong, Vic, Australia.,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research & Institute for Health Transformation, Deakin University, Geelong, Vic, Australia
| | - K Hall
- Eastern Health, Box Hill, Vic, Australia
| | - S K Sprogis
- School of Nursing and Midwifery & Institute for Health Transformation, Deakin University, Geelong, Vic, Australia
| | - J Considine
- Centre for Quality and Patient Safety - Eastern Health Partnership, Box Hill, Vic, Australia.,School of Nursing and Midwifery & Institute for Health Transformation, Deakin University, Geelong, Vic, Australia.,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research & Institute for Health Transformation, Deakin University, Geelong, Vic, Australia
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Kramer S, Omonaiye O, Digby R, Berry D, Considine J, Dunning T, Hutchinson AM, Hutchinson A, Manias E, Rasmussen B, Bucknall T. An evaluation of interventions to improve outcomes for hospitalized patients in isolation: A systematic review. Am J Infect Control 2022; 50:193-202. [PMID: 34525405 DOI: 10.1016/j.ajic.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/16/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Isolation is effective in preventing transmission of infectious disease. However, it has been shown to have negative effects including increased anxiety and poor physical outcomes. OBJECTIVES To summarize the effects of interventions to improve safety and outcomes for patients in isolation DESIGN: Systematic review (PROSPERO protocol registration - CRD42020222779). SETTING Acute hospital PARTICIPANTS: Intervention studies including patients in preventative or protective isolation in a single room. METHODS MEDLINE, Global Health, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Excerpta Medica database were searched from 1996-October 2020. Two independent reviewers screened references and assessed risk of bias. One reviewer extracted data and was checked by another. Main outcomes were Quality of Life and mortality. RESULTS We identified 16,698 references and included 6 studies with different study designs. Average age ranged from 4-71 years. Samples sizes were small (range 10-49 participants) apart from one non-randomized controlled trial including >600 participants. Interventions were music therapy (n = 3), psychological counseling (n = 2) and exercise training (n = 1). One study reporting on Quality of Life and found no change after exercise. None of the studies reported on mortality. Due to heterogeneous results no meta-analyses were performed. CONCLUSIONS There is a lack of high-quality evidence for effective comprehensive interventions to manage adverse effects associated with isolation. Future studies should investigate the effect of multi-component interventions using rigorous methods to improve outcomes for hospitalized isolated patients.
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Affiliation(s)
- Sharon Kramer
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia.
| | - Olumuyiwa Omonaiye
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Robin Digby
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia
| | - Debra Berry
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety, Research-Eastern Health Partnership, Nursing Research, Box Hill, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety, Research-Eastern Health Partnership, Nursing Research, Box Hill, Australia
| | - Trisha Dunning
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Barwon Health Partnership, Nursing Research, Geelong, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Monash Health Partnership, Nursing Research, Clayton, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Epworth Healthcare Partnership, Nursing Research, Melbourne, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Western Health Partnership, Nursing Research, Sunshine, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia
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Tsai CS, Huang TH, Su PL, Chen CZ, Chen CW, Ko WC, Lee NY. The occurrence of and risk factors for developing acute critical illness during quarantine as a response to the COVID-19 pandemic. J Formos Med Assoc 2021; 121:81-88. [PMID: 33551312 PMCID: PMC7825802 DOI: 10.1016/j.jfma.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/16/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/PURPOSE Early detection and timely quarantine measures are necessary to control disease spread and prevent nosocomial outbreaks of Coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate the impact of a quarantine strategy on patient safety and quality of care. METHODS This retrospective cohort study enrolled patients admitted to the quarantine ward in a tertiary hospital in southern Taiwan. The incidence and causes of acute critical illness, including clinical deterioration and unexpected complications during the quarantine period, were reviewed. Further investigation was performed to identify risk factors for acute critical illness during quarantine. RESULTS Of 320 patients admitted to the quarantine ward, more than two-thirds were elderly, and 37.8% were bedridden. During the quarantine period, 68 (21.2%) developed acute critical illness, which more commonly occurred among patients older than 80 years and with a bedridden status, nasogastric tube feeding, or dyspnea symptoms. Bedridden status was an independent predictor of acute critical illness. Through optimization of sampling for COVID-19 and laboratory schedules, both the duration of quarantine and the proportion of acute critical illness among bedridden patients during quarantine exhibited a decreasing trend. There was no COVID-19 nosocomial transmission during the study period. CONCLUSION The quarantine ward is a key measure to prevent nosocomial transmission of COVID-19 but may carry a potential negative impact on patient care and safety. For patients with multiple comorbidities and a bedridden status, healthcare workers should remain alert to rapid deterioration and unexpected adverse events during quarantine.
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Affiliation(s)
- Chin-Shiang Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Tang-Hsiu Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Po-Lan Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chiung-Zuei Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chang-Wen Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
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Can continuous remote vital sign monitoring reduce the number of room visits to patients suspected of COVID-19: A quasi-experimental study. Int J Nurs Stud 2021; 115:103868. [PMID: 33465579 PMCID: PMC7778830 DOI: 10.1016/j.ijnurstu.2020.103868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 01/16/2023]
Abstract
Background Continuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet. Objectives To assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment. Design and methods We performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used. Results During the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts. Conclusion Introduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.
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