1
|
Mahran GSK, Gadallah MA, Ahmed AE, Abouzied WR, Obiedallah AA, Sayed MMM, Abbas MS, Mohamed SAA. Development of a Discharge Criteria Checklist for COVID-19 Patients From the Intensive Care Unit. Crit Care Nurs Q 2023; 46:227-238. [PMID: 36823749 DOI: 10.1097/cnq.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This study aims to develop and validate a checklist of discharge readiness criteria for COVID-19 patients from the intensive care unit (ICU). We conducted a Delphi design study. The degree of agreement among 7 experts had been evaluated using the content validity index (CVI) through a 4-point Likert scale. The instrument was validated with 17 items. All the experts rated all items as very relevant which scored the item-CVI 1, which validates all checklist items. Using the mean of all items, the scale-CVI was calculated, and it was 1. This meant validation of the checklist as a whole. With regard to the overall checklist evaluation, the mean expert proportion of the instrument was 1, and the S-CVI/UA was 1. This discharge criteria checklist improves transition of care for COVID-19 patients and can help nurses, doctors, and academics to discharge COVID-19 patients from the ICU safely.
Collapse
Affiliation(s)
- Ghada S K Mahran
- Departments of Critical Care and Emergency Nursing (Dr Mahran) and Pediatric Nursing (Drs Gadallah and Ahmed), Faculty of Nursing, Assiut University, Assiut, Egypt; Department of Critical and Emergency Care Nursing, Faculty of Nursing, South Valley University, Qena, Egypt (Dr Abouzied); and Departments of Internal Medicine, Cardiology and Critical Care Medicine Unit (Dr Obiedallah), Anesthesia and Intensive Care (Drs Sayed and Abbas), and Chest Diseases and Tuberculosis (Dr Mohamed), Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Predictive Modeling for Readmission to Intensive Care: A Systematic Review. Crit Care Explor 2023; 5:e0848. [PMID: 36699252 PMCID: PMC9829260 DOI: 10.1097/cce.0000000000000848] [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] [Indexed: 01/27/2023] Open
Abstract
To evaluate the methodologic rigor and predictive performance of models predicting ICU readmission; to understand the characteristics of ideal prediction models; and to elucidate relationships between appropriate triage decisions and patient outcomes. DATA SOURCES PubMed, Web of Science, Cochrane, and Embase. STUDY SELECTION Primary literature that reported the development or validation of ICU readmission prediction models within from 2010 to 2021. DATA EXTRACTION Relevant study information was extracted independently by two authors using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Bias was evaluated using the Prediction model Risk Of Bias ASsessment Tool. Data sources, modeling methodology, definition of outcomes, performance, and risk of bias were critically evaluated to elucidate relevant relationships. DATA SYNTHESIS Thirty-three articles describing models were included. Six studies had a high overall risk of bias due to improper inclusion criteria or omission of critical analysis details. Four other studies had an unclear overall risk of bias due to lack of detail describing the analysis. Overall, the most common (50% of studies) source of bias was the filtering of candidate predictors via univariate analysis. The poorest performing models used existing clinical risk or acuity scores such as Acute Physiologic Assessment and Chronic Health Evaluation II, Sequential Organ Failure Assessment, or Stability and Workload Index for Transfer as the sole predictor. The higher-performing ICU readmission prediction models used homogenous patient populations, specifically defined outcomes, and routinely collected predictors that were analyzed over time. CONCLUSIONS Models predicting ICU readmission can achieve performance advantages by using longitudinal time series modeling, homogenous patient populations, and predictor variables tailored to those populations.
Collapse
|
3
|
Allen J, Currey J, Jones D, Considine J, Orellana L. Development and Validation of the Medical Emergency Team-Risk Prediction Model for Clinical Deterioration in Acute Hospital Patients, at Time of an Emergency Admission. Crit Care Med 2022; 50:1588-1598. [PMID: 35866655 DOI: 10.1097/ccm.0000000000005621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To develop and validate a prediction model to estimate the risk of Medical Emergency Team (MET) review, within 48 hours of an emergency admission, using information routinely available at the time of hospital admission. DESIGN Development and validation of a multivariable risk model using prospectively collected data. Transparent Reporting of a multivariable model for Individual Prognosis Or Diagnosis recommendations were followed to develop and report the prediction model. SETTING A 560-bed teaching hospital, with a 22-bed ICU and 24-hour Emergency Department in Melbourne, Australia. PATIENTS A total of 45,170 emergency admissions of 30,064 adult patients (≥18 yr), with an inpatient length of stay greater than 24 hours, admitted under acute medical or surgical hospital services between 2015 and 2017. MEASUREMENTS AND MAIN RESULTS The outcome was MET review within 48 hours of emergency admission. Thirty candidate variables were selected from a routinely collected hospital dataset based on their availability to clinicians at the time of admission. The final model included nine variables: age; comorbid alcohol-related behavioral diagnosis; history of heart failure, chronic obstructive pulmonary disease (COPD), or renal disease; admitted from residential care; Charlson Comorbidity Index score 1 or 2, or 3+; at least one planned and one emergency admission in the last year; and admission diagnosis and one interaction (past history of COPD × admission diagnosis). The discrimination of the model was comparable in the training (C-statistics 0.82; 95% CI, 0.81-0.83) and the validation set (0.81; 0.80-0.83). Calibration was reasonable for training and validation sets. CONCLUSIONS Using only nine predictor variables available to clinicians at the time of admission, the MET-risk model can predict the risk of MET review during the first 48 hours of an emergency admission. Model utility in improving patient outcomes requires further investigation.
Collapse
Affiliation(s)
- Joshua Allen
- Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, VIC, Australia
| | - Judy Currey
- Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, VIC, Australia
| | - Daryl Jones
- DEPM Monash University, Level 6 The Alfred Centre (Alfred Hospital), Melbourne, VIC, Australia
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research-Eastern Health Partnership, VIC, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
4
|
Fletcher LR, Coulson TG, Story DA, Hiscock RJ, Marhoon N, Nazareth JM. The association between unanticipated prolonged post-anaesthesia care unit length of stay and early postoperative deterioration: A retrospective cohort study. Anaesth Intensive Care 2022; 50:295-305. [PMID: 35549560 DOI: 10.1177/0310057x211059191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate whether there was an association between an unanticipated prolonged post-anaesthesia care unit (PACU) length of stay and early postoperative deterioration, as defined as the need for a rapid response team activation, within the first seven days of surgery. We conducted a single-centre retrospective cohort study of adult surgical patients, who stayed at least one night in hospital, and were not admitted to critical care immediately postoperatively, between 1 July 2017 and 30 June 2019. A total of 11,885 cases were analysed. PACU length of stay was significantly associated with rapid response team activation on both univariate (odds ratio (OR) per increment 1.57, 95% confidence intervals (CI) 1.45 to 1.69, P < 0.001) and multivariate analysis (OR per increment 1.41, 95% CI 1.28 to 1.55, P < 0.001). Patients who stayed less than one hour were at low risk of deterioration (absolute risk 3.7%). In patients staying longer than one hour, the absolute increase in risk was small but observable within six hours of PACU discharge. Compar\ed to a one-hour length of stay, a five-hour stay had a relative risk of 4.9 (95% CI 3.7 to 6.1). Other factors associated with rapid response team activation included non-elective surgery (OR 1.78, P < 0.001) and theatre length of stay (OR per increment 1.61, P < 0.001). PACU length of stay was also independently associated with predefined complications and unplanned intensive care unit admission postoperatively. In our cohort, an unanticipated prolonged PACU length of stay of over one hour was associated with an increased incidence of rapid response team activation in the first seven days postoperatively.
Collapse
Affiliation(s)
- Luke R Fletcher
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.,Data Analytics Research and Evaluation Centre (DARE), Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
| | - Timothy G Coulson
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.,Department of Anaesthesiology and Perioperative Medicine, Alfred Health and Monash University.,Department of Critical Care (DoCC), University of Melbourne, Melbourne, Victoria, Australia
| | - David A Story
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.,Department of Anaesthesiology and Perioperative Medicine, Alfred Health and Monash University
| | - Richard J Hiscock
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Nada Marhoon
- Data Analytics Research and Evaluation Centre (DARE), Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
| | - Justin M Nazareth
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.,Department of Anaesthesiology and Perioperative Medicine, Alfred Health and Monash University.,Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| |
Collapse
|
5
|
Boots R, Mead G, Rawashdeh O, Bellapart J, Townsend S, Paratz J, Garner N, Clement P, Oddy D. Temperature Profile and Adverse Outcomes After Discharge From the Intensive Care Unit. Am J Crit Care 2022; 31:e1-e9. [PMID: 34972850 DOI: 10.4037/ajcc2022223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A predictive model that uses the rhythmicity of core body temperature (CBT) could be an easily accessible clinical tool to ultimately improve outcomes among critically ill patients. OBJECTIVES To assess the relation between the 24-hour CBT profile (CBT-24) before intensive care unit (ICU) discharge and clinical events in the step-down unit within 7 days of ICU discharge. METHODS This retrospective cohort study in a tertiary ICU at a single center included adult patients requiring acute invasive ventilation for more than 48 hours and assessed major clinical adverse events (MCAEs) and rapid response system activations (RRSAs) within 7 days of ICU discharge (MCAE-7 and RRSA-7, respectively). RESULTS The 291 enrolled patients had a median mechanical ventilation duration of 139 hours (IQR, 50-862 hours) and at admission had a median Acute Physiology and Chronic Health Evaluation II score of 22 (IQR, 7-42). At least 1 MCAE or RRSA occurred in 64% and 22% of patients, respectively. Independent predictors of an MCAE-7 were absence of CBT-24 rhythmicity (odds ratio, 1.78 [95% CI, 1.07-2.98]; P = .03), Sequential Organ Failure Assessment score at ICU discharge (1.10 [1.00-1.21]; P = .05), male sex (1.72 [1.04-2.86]; P = .04), age (1.02 [1.00-1.04]; P = .02), and Charlson Comorbidity Index (0.87 [0.76-0.99]; P = .03). Age (1.03 [1.01-1.05]; P = .006), sepsis at ICU admission (2.02 [1.13-3.63]; P = .02), and Charlson Comorbidity Index (1.18 [1.02-1.36]; P = .02) were independent predictors of an RRSA-7. CONCLUSIONS Use of CBT-24 rhythmicity can assist in stratifying a patient's risk of subsequent deterioration during general care within 7 days of ICU discharge.
Collapse
Affiliation(s)
- Rob Boots
- Rob Boots is an associate professor, Thoracic Medicine, Royal Brisbane and Women’s Hospital, and Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gabrielle Mead
- Gabrielle Mead is an honors student, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Oliver Rawashdeh
- Oliver Rawashdeh is a senior lecturer,, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Judith Bellapart
- Judith Bellapart is a senior specialist, Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, and Burns, Trauma and Critical Care, The University of Queensland
| | - Shane Townsend
- Shane Townsend is director, Intensive Care Services, Royal Brisbane and Women’s Hospital
| | - Jenny Paratz
- Jenny Paratz is an associate professor and a senior research fellow, Burns, Trauma and Critical Care Research Centre, The University of Queensland School of Medicine
| | - Nicholas Garner
- Nicholas Garner is a PhD student, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Pierre Clement
- Pierre Clement is the clinical information systems manager, Department of Intensive Care Services, Royal Brisbane and Women’s Hospital
| | - David Oddy
- David Oddy is the clinical data manager, Department of Intensive Care Services, Royal Brisbane and Women’s Hospital
| |
Collapse
|
6
|
Explainable Machine Learning on AmsterdamUMCdb for ICU Discharge Decision Support: Uniting Intensivists and Data Scientists. Crit Care Explor 2021; 3:e0529. [PMID: 34589713 PMCID: PMC8437217 DOI: 10.1097/cce.0000000000000529] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Unexpected ICU readmission is associated with longer length of stay and increased mortality. To prevent ICU readmission and death after ICU discharge, our team of intensivists and data scientists aimed to use AmsterdamUMCdb to develop an explainable machine learning–based real-time bedside decision support tool.
Collapse
|
7
|
Hervé MEW, Zucatti PB, Lima MADDS. Transition of care at discharge from the Intensive Care Unit: a scoping review. Rev Lat Am Enfermagem 2020; 28:e3325. [PMID: 32696919 PMCID: PMC7365613 DOI: 10.1590/1518-8345.4008.3325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE to map the available evidence on the components of the transition of care, practices, strategies, and tools used in the discharge from the Intensive Care Unit (ICU) to the Inpatient Unit (IU) and its impact on the outcomes of adult patients. METHOD a scoping review using search strategies in six relevant health databases. RESULTS 37 articles were included, in which 30 practices, strategies or tools were identified for organizing and executing the transfer process, with positive or negative impacts, related to factors intrinsic to the Intensive Care Unit and the Inpatient Unit and cross-sectional factors regarding the staff. The analysis of hospital readmission and mortality outcomes was prevalent in the included studies, in which trends and potential protective actions for a successful care transition are found; however, they still lack more robust evidence and consensus in the literature. CONCLUSION transition of care components and practices were identified, in addition to factors intrinsic to the patient, associated with worse outcomes after discharge from the Intensive Care Unit. Discharges at night or on weekends were associated with increased rates of readmission and mortality; however, the association of other practices with the patient's outcome is still inconclusive.
Collapse
|
8
|
Ueno R, Xu L, Uegami W, Matsui H, Okui J, Hayashi H, Miyajima T, Hayashi Y, Pilcher D, Jones D. Value of laboratory results in addition to vital signs in a machine learning algorithm to predict in-hospital cardiac arrest: A single-center retrospective cohort study. PLoS One 2020; 15:e0235835. [PMID: 32658901 PMCID: PMC7357766 DOI: 10.1371/journal.pone.0235835] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although machine learning-based prediction models for in-hospital cardiac arrest (IHCA) have been widely investigated, it is unknown whether a model based on vital signs alone (Vitals-Only model) can perform similarly to a model that considers both vital signs and laboratory results (Vitals+Labs model). METHODS All adult patients hospitalized in a tertiary care hospital in Japan between October 2011 and October 2018 were included in this study. Random forest models with/without laboratory results (Vitals+Labs model and Vitals-Only model, respectively) were trained and tested using chronologically divided datasets. Both models use patient demographics and eight-hourly vital signs collected within the previous 48 hours. The primary and secondary outcomes were the occurrence of IHCA in the next 8 and 24 hours, respectively. The area under the receiver operating characteristic curve (AUC) was used as a comparative measure. Sensitivity analyses were performed under multiple statistical assumptions. RESULTS Of 141,111 admitted patients (training data: 83,064, test data: 58,047), 338 had an IHCA (training data: 217, test data: 121) during the study period. The Vitals-Only model and Vitals+Labs model performed comparably when predicting IHCA within the next 8 hours (Vitals-Only model vs Vitals+Labs model, AUC = 0.862 [95% confidence interval (CI): 0.855-0.868] vs 0.872 [95% CI: 0.867-0.878]) and 24 hours (Vitals-Only model vs Vitals+Labs model, AUC = 0.830 [95% CI: 0.825-0.835] vs 0.837 [95% CI: 0.830-0.844]). Both models performed similarly well on medical, surgical, and ward patient data, but did not perform well for intensive care unit patients. CONCLUSIONS In this single-center study, the machine learning model predicted IHCAs with good discrimination. The addition of laboratory values to vital signs did not significantly improve its overall performance.
Collapse
Affiliation(s)
- Ryo Ueno
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
- Australian and New Zealand Intensive Care Research Center, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- * E-mail:
| | - Liyuan Xu
- Department of Computer Science, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Wataru Uegami
- Anatomical Pathology, Kameda Medical Center, Chiba, Japan
| | - Hiroki Matsui
- Clinical Research Support Division, Kameda Medical Center, Chiba, Japan
| | - Jun Okui
- Post-Graduate Education Center, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Hayashi
- Post-Graduate Education Center, Kameda Medical Center, Chiba, Japan
| | - Toru Miyajima
- Post-Graduate Education Center, Kameda Medical Center, Chiba, Japan
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Center, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daryl Jones
- Australian and New Zealand Intensive Care Research Center, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
| |
Collapse
|
9
|
Sanson G, Marino C, Valenti A, Lucangelo U, Berlot G. Is my patient ready for a safe transfer to a lower-intensity care setting? Nursing complexity as an independent predictor of adverse events risk after ICU discharge. Heart Lung 2020; 49:407-414. [PMID: 32067723 DOI: 10.1016/j.hrtlng.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients discharged from intensive care units (ICUs) are at risk for adverse events (AEs). Establishing safe discharge criteria is challenging. No available criteria consider nursing complexity among risk factors. OBJECTIVES To investigate whether nursing complexity upon ICU discharge is an independent predictor for AEs. METHODS Prospective observational study. The Patient Acuity and Complexity Score (PACS) was developed to measure nursing complexity. Its predictive power for AEs was tested using multivariate regression analysis. RESULTS The final regression model showed a very-good discrimination power (AUC 0.881; p<0.001) for identifying patients who experienced AEs. Age, ICU admission reason, PACS, cough strength, PaCO2, serum creatinine and sodium, and transfer to Internal Medicine showed to be predictive of AEs. Exceeding the identified PACS threshold increased by 3.3 times the AEs risk. CONCLUSIONS The level of nursing complexity independently predicts AEs risk and should be considered in establishing patient's eligibility for a safe ICU discharge.
Collapse
Affiliation(s)
- Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Strada di Fiume 447, 34100 Trieste, Italy.
| | - Cecilia Marino
- Department of Perioperative Medicine, Intensive Care and Emergency, University Hospital, Trieste, Italy.
| | - Andrea Valenti
- Department of Perioperative Medicine, Intensive Care and Emergency, University Hospital, Trieste, Italy.
| | - Umberto Lucangelo
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Strada di Fiume 447, 34100 Trieste, Italy; Department of Perioperative Medicine, Intensive Care and Emergency, University Hospital, Trieste, Italy.
| | - Giorgio Berlot
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Strada di Fiume 447, 34100 Trieste, Italy; Department of Perioperative Medicine, Intensive Care and Emergency, University Hospital, Trieste, Italy.
| |
Collapse
|