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Pawlik MT, Dendl LM, Achajew LA, Zeman F, Blecha S, Jung M, Schleder S, Schreyer AG. Clinical Value and Operational Risks of MRI in ICU patients - A Retrospective Analysis Performed at a University Medical Center. ROFO-FORTSCHR RONTG 2024; 196:371-380. [PMID: 37967821 DOI: 10.1055/a-2193-0021] [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: 11/17/2023]
Abstract
PURPOSE Intensive care unit (ICU) patients have a high risk of developing complications when leaving the ICU for diagnostic procedures or therapeutic interventions. Our study examined the frequency of adverse events associated with magnetic resonance imaging (MRI) of intensive care patients and the extent of changes in therapy due to the MRI scan to weigh the risks associated with the scan against the potential benefits of an MR scan, using a change in therapy as an indicator of benefit. MATERIALS AND METHODS 4434 ICU patients (January to December 2015) were identified by Hospital Information System (SAP-R/3 IS-H, Walldorf, Germany), ICU patient data management system Metavision (iMDsoft, Israel), and Radiology Information System (Nexus.medRIS, Version 8.42, Nexus, Germany). All intensive care and medical records (HIS) and MRI reports (RIS) were matched and further evaluated in a retrospective case-to-case analysis for biometric data, mechanical ventilation, ICU requirements, planned postoperative vs. emergency diagnostic requirements, complications and impact on further diagnosis or therapy. RESULTS Out of 4434 ICU patients, 322 ICU patients (7.3 %) underwent a total of 385 MRI examinations. 167 patients needed a total of 215 emergency scans, while 155 patients underwent 170 planned postoperative MRI exams. 158 (94.6 %) out of 167 emergency scan patients were ventilated under continuous intravenous medication and monitoring. In the planned postoperative group, only 6 (3.9 %) out of 155 were ventilated, but a total of 38 (24.5 %) were under continuous medication. 111 patients were accompanied by nurses only during MRI. Only one severe adverse event (0.3 %) was noted and was attributed to study preparation (n = 385). In 8 MRI examinations (2.1 %), the examination was interrupted or cancelled due to the patients' condition. While all MRI examinations in the planned group were completed (n = 170, 100 %) (e. g., postoperative controls), only 207 out of 215 (96.3 %) could be performed for emergency diagnostic reasons. MRI influenced the clinical course with a change in diagnosis or therapy in 74 (19.2 %) of all 385 MRI examinations performed, and in the emergency diagnostic group it was 31.2 % (n = 67/215). CONCLUSION Nearly 20 % of MRI examinations of ICU patients resulted in a change of therapy. With only one potentially life-threatening adverse event (0.3 %) during transport and the MRI examination, the risk seems to be outweighed by the diagnostic benefit. KEY POINTS · The risk of adverse events associated with MRI scans in ICU patients is low.. · The rate of premature termination of ICU patients' MRI scans is low.. · Almost 20 % of ICU patients' MRI scans lead to a change of therapy..
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Affiliation(s)
- Michael T Pawlik
- Anaesthesiology and Intensive Care Medicine, Caritas-Krankenhaus Sankt Josef Regensburg, Germany
| | - Lena M Dendl
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
| | - Lom-Ali Achajew
- Anaesthesiology and Intensive Care Medicine, Caritas-Krankenhaus Sankt Josef Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University of Regensburg, Germany
| | | | - Michael Jung
- Radiology, University Hospital Regensburg, Germany
| | - Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Barmherzige Brüder Klinikum Sankt Elisabeth Straubing GmbH, Straubing, Germany
| | - Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a.d. Havel, Germany
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Soares LGB, Holanda VM, Lages GV, Soares AGB, Catarino MM, Ahumada-Vizcaíno JC, Pereira FS, Teixeira MLOL, Jiménez LÁC, Neto MR, Chaddad-Neto F. The Technique for Transorbital Ventricular Puncture: An Anatomic Approach. Oper Neurosurg (Hagerstown) 2024; 26:64-70. [PMID: 37811923 DOI: 10.1227/ons.0000000000000920] [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: 05/01/2023] [Accepted: 07/26/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Transorbital ventricular puncture is a minimally invasive described procedure with poor landmarks and anatomic references. This approach can be easily performed to save patients with intracranial hypertension, especially when it is secondary to an acute decompensated hydrocephalus. This study aims to describe anatomic structures and landmarks to facilitate the execution of transorbital puncture in emergency cases. METHODS We analyzed 120 head computed tomographies to show the best area to perform the procedure in the orbital roof. Two adult cadavers (4 sides) were punctured in the predetermined area. Angles, distances, landmarks, and anatomic structures were registered. This approach to the ventricular system may be performed at bedside to relieve intracranial hypertension only in specific cases. RESULTS The perforation point is 2.5 cm (female) or 3.0 cm (male) lateral to the midline and immediately inferior to the superciliary arch. A vertical line, parallel to midline, was drawn on the outer edge of the patient's forehead, the needle was 45° inferiorly and 20° medially and then progressed 2.0 cm backwards to reach the bone perforation point. After that, it was advanced another 4.5cm approximately until it reached the anterior horn of the lateral ventricle. CONCLUSION Based on statistical and experimental evidences, we were able to establish reliable anatomic reference points to access the anterior horn of the lateral ventricle through transorbital puncture.
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Affiliation(s)
- Luís Gustavo Biondi Soares
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , Brazil
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
| | | | - Gustavo Veloso Lages
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
| | | | - Marcilio Monteiro Catarino
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
| | | | | | | | | | - Mateus Reghin Neto
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo , Brazil
| | - Feres Chaddad-Neto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , Brazil
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
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Karamchandani K, Evers M, Smith T, Bonavia A, Deshpande R, Klick JC, Abdelmalak BB. Pro-Con Debate: Should Critically Ill Patients Undergo Procedures at Bedside or in the Operating Room? Anesth Analg 2023; 137:1149-1153. [PMID: 37973129 DOI: 10.1213/ane.0000000000006387] [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: 11/19/2023]
Abstract
Nonoperating room anesthesia (NORA) is a fast-growing field in anesthesiology, wherein anesthesia care is provided for surgical procedures performed outside the main operating room (OR) pavilion. Advances in medical science and technology have led to an increasing number of procedures being moved out of the operating room to procedural suites. One such NORA location is the intensive care unit (ICU), where a growing number of urgent and emergent procedures are being performed on medically unstable patients. ICU-NORA allows medical care to be provided to patients who are too sick to tolerate transport between the ICU and the OR. However, offering the same, high-quality, and safe care in this setting may be challenging. It requires special planning and a thorough consideration of the presence of life-threatening comorbidities and location-specific and ergonomic barriers. In this Pro-Con commentary article, we discuss these special considerations and argue in favor of and against routinely performing procedures at the bedside in the ICU versus in the OR.
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Affiliation(s)
- Kunal Karamchandani
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew Evers
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Travis Smith
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Anthony Bonavia
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - John C Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, Burlington, Vermont
| | - Basem B Abdelmalak
- Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
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4
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McLean B, Thompson D. MRI and the Critical Care Patient: Clinical, Operational, and Financial Challenges. Crit Care Res Pract 2023; 2023:2772181. [PMID: 37325272 PMCID: PMC10264715 DOI: 10.1155/2023/2772181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/03/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Neuroimaging in conjunction with a neurologic examination has become a valuable resource for today's intensive care unit (ICU) physicians. Imaging provides critical information during the assessment and ongoing neuromonitoring of patients for toxic-metabolic or structural injury of the brain. A patient's condition can change rapidly, and interventions may require imaging. When making this determination, the benefit must be weighed against possible risks associated with intrahospital transport. The patient's condition is assessed to decide if they are stable enough to leave the ICU for an extended period. Intrahospital transport risks include adverse events related to the physical nature of the transport, the change in the environment, or relocating equipment used to monitor the patient. Adverse events can be categorized as minor (e.g., clinical decompensation) or major (e.g., requiring immediate intervention) and may occur in preparation or during transport. Regardless of the type of event experienced, any intervention during transport impacts the patient and may lead to delayed treatment and disruption of critical care. This review summarizes the commentary on the current literature on the associated risks and provides insight into the costs as well as provider experiences. Approximately, one-third of patients who are transported from the ICU to an imaging suite may experience an adverse event. This creates an additional risk for extending a patient's stay in the ICU. The delay in obtaining imaging can negatively impact the patient's treatment plan and affect long-term outcomes as increased disability or mortality. Disruption of ICU therapy can decrease respiratory function after the patient returns from transport. Because of the complex care team needed for patient transport, the staff time alone can cost $200 or more. New technologies and advancements are needed to reduce patient risk and improve safety.
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Affiliation(s)
- Barbara McLean
- Division of Emergency Services and Critical Care, Grady Health System, Atlanta, GA, USA
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Slave M, Scribante J, Perrie H, Lambat F. Carbon dioxide levels of ventilated adult critically ill post-operative patients on arrival at the intensive care unit. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:10.7196/SAJCC.2023.v39i1.655. [PMID: 37521962 PMCID: PMC10378180 DOI: 10.7196/sajcc.2023.v39i1.655] [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: 08/24/2022] [Accepted: 01/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background The transportation of critically ill patients presents a precarious situation in which adverse events may occur. At Chris Hani Baragwanath Academic Hospital (CHBAH) patients were manually ventilated using a manual resuscitator bag during transportation from theatre to the intensive care unit (ICU). Objectives To evaluate the arterial partial pressure of carbon dioxide (PaCO2 ) levels of ventilated adult critically ill post-operative patients on arrival at the ICU at CHBAH. Methods This was a cross-sectional study using convenience sampling. Pre- and post-transportation arterial blood gases were obtained from 47 patients. Results There was a statistically significant difference in the pre- and post-transport PaCO2 level (p=0.03), with a mean difference of 3.3 mmHg. The pre- and post-transport arterial partial pressure of oxygen (PaO2 ) level (p≤0.001) and the week and weekend pre-transport (p≤0.001) and post-transport (p=0.01) PaCO2 were statistically significantly different. No statistically significant difference was found in the other arterial blood gas parameters or in the post-transport PaCO2 of those patients (26 (55.3%)), who received a neuromuscular blocking drug compared with those that did not. Adverse events were noted during 12 (25.6%) of the transports, 5 (41.7%) of which were patient-related, and 7 (58.3%) of which were infrastructure-related. Conclusion There was a statistically but not clinically significant difference in the pre- and post-transport PaCO2 level and between week and weekend transportations. Hypercarbia was the most common derangement in all transports. Adverse events occurred during one-quarter of transportations. Contributions of the study This study evaluated the PaCO2 levels of critically ill patients at CHBAH during transportation from theatre to the ICU. The findings indicate that manual ventilation was not injurious. The authors recommend reproducing the study in patients with severe ARDS and pulmonary hypertension to ascertain if manual ventilation is safe in this population; and also with healthcare practitioners other than anaesthesiologists, who may not be as experienced in manual ventilation.
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Affiliation(s)
- M Slave
- Department of Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Scribante
- Surgeons for Little Lives, Department of Paediatric Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa
| | - H Perrie
- Department of Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Lambat
- Private Practice, Johannesburg, South Africa
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6
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Cammarota G, Vetrugno L, Longhini F. Lung ultrasound monitoring: impact on economics and outcomes. Curr Opin Anaesthesiol 2023; 36:234-239. [PMID: 36728722 DOI: 10.1097/aco.0000000000001231] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the impact of lung ultrasonography (LUS) on economics and possible impact on patients' outcomes, proven its diagnostic accuracy in patients with acute respiratory failure. RECENT FINDINGS Despite some previous ethical concerns on LUS examination, today this technique has showed several advantages. First, it is now clear that the daily use of LUS can provide a relevant cost reduction in healthcare of patients with acute respiratory failure, while reducing the risk of transport of patients to radiological departments for chest CT scan. In addition, LUS reduces the exposition to x-rays since can replace the bedside chest X-ray examination in many cases. Indeed, LUS is characterized by a diagnostic accuracy that is even superior to portable chest X-ray when performed by well trained personnel. Finally, LUS examination is a useful tool to predict the course of patients with pneumonia, including the need for hospitalization and ICU admission, noninvasive ventilation failure and orotracheal intubation, weaning success, and mortality. SUMMARY LUS should be implemented not only in Intensive Care Units, but also in other setting like emergency departments. Since most data comes from the recent coronavirus disease 2019 pandemic, further investigations are required in Acute Respiratory Failure of different etiologies.
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Affiliation(s)
- Gianmaria Cammarota
- Anesthesia and Intensive Care Unit 2, Department of Medicine and Surgery, University of Perugia
| | - Luigi Vetrugno
- Anesthesiology, Critical Care Medicine, and Emergency, 'S.S. Annunziata' Hospital, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Gabriele d'Annunzio University of Chieti and Pescara
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, 'Mater Domini' University Hospital, Magna Graecia University, Catanzaro, Italy
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Lasselin P, Grousson S, Souza Netto EP, Balanca B, Terrier A, Dailler F, Haesbaert J, Boublay N, Gory B, Berhouma M, Lukaszewicz AC. Accuracy of bedside bidimensional transcranial ultrasound versus tomodensitometric measurement of the third ventricle. J Neuroimaging 2022; 32:629-637. [PMID: 35083801 PMCID: PMC9540242 DOI: 10.1111/jon.12970] [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: 11/26/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the accuracy of transcranial duplex sonography (TCS) for measuring the diameter of the third ventricle (DTV) and the brain midline shift (MLS), as compared to cerebral CT. METHODS Single-center retrospective study including 177 patients admitted to the neurological intensive care unit (NICU). We studied the correlation between TCS and CT measurements of DTV and MLS using a Bland-Altman analysis. The best threshold of DTV to diagnose acute hydrocephalus was evaluated with a receiver operating characteristic (ROC) analysis. RESULTS We analyzed 177 pairs of CT-TCS measurements for DTV and 165 for MLS. The mean time interval between CT and TCS was 87 ± 73 minutes. Median DTV measurement on CT was 4 ± 3 mm, and 5 ± 3 mm by TCS. Median MLS on CT was 2 ± 3 mm, and 2 ± 4 mm by TCS. The Pearson correlation coefficient (r2 ) was .96 between TCS and CT measurements (p < .001). The Bland-Altman analysis found a proportional bias of 0.69 mm for the DTV with a limit of agreement ranging between -3.04 and 2.53 mm. For the MLS, the proportional bias was 0.23 mm with limits of agreements between -3.5 and 3.95. The area under the ROC curve was .97 for the detection of hydrocephalus by DTV on TCS, with a best threshold of 5.72 mm (Sensitivity [Se] = 92% Specificity [Sp] = 92.1%). CONCLUSIONS TCS seems to be a reliable and accurate bedside technique for measuring both DTV and MLS, which might allow detection of acute hydrocephalus among NICU patients.
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Affiliation(s)
- Philippe Lasselin
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Sebastien Grousson
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Anesthesia and Intensive Care, Paris Sud University, Le Kremlin-Bicêtre, France
| | | | - Baptiste Balanca
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Anne Terrier
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Frederic Dailler
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France
| | - Julie Haesbaert
- Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Lyon, France
| | - Nawele Boublay
- Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Lyon, France
| | - Benjamin Gory
- Department of Interventional Neuroradiology, Lyon University Hospital, Bron, France
| | - Moncef Berhouma
- Hospices Civils de Lyon, Department of Neurosurgery, Lyon University Hospital, Bron, France
| | - Anne-Claire Lukaszewicz
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon University Hospital, Bron, France.,Université de Lyon EA 7426 Pathophysiology of Injury-Induced Immunosuppression (PI3), Lyon, France
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8
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Delacrétaz R, Fischer Fumeaux CJ, Stadelmann C, Rodriguez Trejo A, Destaillats A, Giannoni E. Adverse Events and Associated Factors During Intrahospital Transport of Newborn Infants. J Pediatr 2022; 240:44-50. [PMID: 34480917 DOI: 10.1016/j.jpeds.2021.08.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the frequency, type, and severity of adverse events (AEs) during intrahospital transport of newborn infants and to identify associated factors. STUDY DESIGN We conducted a prospective observational study in a tertiary care academic neonatal unit. All patients hospitalized in the neonatal unit and undergoing intrahospital transport between June 1, 2015, and May 31, 2017 were included. Transports from other hospitals and the delivery room were not included. RESULTS Data from 990 intrahospital transports performed in 293 newborn infants were analyzed. The median postnatal age at transport was 13 days (Q1-Q3, 5-44). Adverse events occurred in 25% of transports (248/990) and were mainly related to instability of cardiovascular and respiratory systems, agitation, and temperature control. Adverse events were associated with no harm in 207 transports (207/990, 21%), mild harm in 37 transports (37/990, 4%), and moderate harm in 4 transports (4/990, 0.4%). There was no severe or lethal adverse event. Hemodynamic support with catecholamines, the presence of a central venous catheter, and a longer duration of transport were independent predictors for the occurrence of adverse events during transport. CONCLUSIONS Intrahospital transports of newborns are associated with a substantial proportion of adverse events of low-to-moderate severity. Our data have implications to inform clinical practice, for benchmarking and quality improvement initiatives, and for the development of specific guidelines.
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Affiliation(s)
- Romaine Delacrétaz
- Department of Pediatrics, eHnv Yverdon-les-Bains, Yverdon-les-Bains, Switzerland; Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline J Fischer Fumeaux
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Corinne Stadelmann
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Adriana Rodriguez Trejo
- Mother-Child Research Unit, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alice Destaillats
- Mother-Child Research Unit, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Giannoni
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2021; 46:14-22. [PMID: 34802990 DOI: 10.1016/j.medine.2021.11.002] [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: 01/25/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Madrid, Spain.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Medicina, Universidad de Vic-Central de Cataluña, Spain
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10
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Lost in Transition: A Call to Arms for Better Transition From ICU to Hospital Ward. Crit Care Med 2021; 48:1075-1076. [PMID: 32568901 DOI: 10.1097/ccm.0000000000004381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Lin SJ, Tsan CY, Su MY, Wu CL, Chen LC, Hsieh HJ, Hsiao WL, Cheng JC, Kuo YW, Jerng JS, Wu HD, Sun JS. Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness. BMJ Open Qual 2021; 9:bmjoq-2019-000698. [PMID: 32317274 PMCID: PMC7202726 DOI: 10.1136/bmjoq-2019-000698] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
Aim Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation. Design and implementation We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme. Results The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001). Conclusion The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.
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Affiliation(s)
- Shwu-Jen Lin
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Yuan Tsan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Jung Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Chen Cheng
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wen Kuo
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Rana S, Hughes LA, Rana S, Adam LA. The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic. Crit Care Explor 2021; 3:e0333. [PMID: 33490958 PMCID: PMC7808566 DOI: 10.1097/cce.0000000000000333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019. DESIGN This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group). SETTING High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri. PATIENTS All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001). CONCLUSIONS Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.
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Affiliation(s)
- Sameer Rana
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
| | - Laura A. Hughes
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
| | - Siddharth Rana
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
| | - Laura A. Adam
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2020; 46:S0210-5691(20)30215-1. [PMID: 32682510 DOI: 10.1016/j.medin.2020.05.022] [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] [Received: 01/25/2020] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), MadridEspaña.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Medicina, Universidad de Vic-Central de Cataluña, España
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Bergman L, Pettersson M, Chaboyer W, Carlström E, Ringdal M. In safe hands: Patients' experiences of intrahospital transport during intensive care. Intensive Crit Care Nurs 2020; 59:102853. [PMID: 32223920 DOI: 10.1016/j.iccn.2020.102853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intrahospital transports are associated with complications and adverse events in intensive care patients. Yet, little is known about how patients' percive these tranfers. Thus, this study aimed to explore patients' experiences of the intrahospital transport process. RESEARCH DESIGN An exploratory qualitative study compromising interviews with twelve patients. Data were analysed using thematic analysis. SETTING Two intensive care units in a university hospital setting. MAIN OUTCOME An understanding of patients' experiences of the intrahospital transport process. FINDINGS The main finding was patients' description of "being in safe hands" during the transport. Patients' experience of transports as feasible and safe was reflected in the first main theme, "feeling prepared and safeguarded". The second theme, "being on the move", described patients' perceptions of the transport; although they were aware of movement, the transport was viewed as a minor event during their stay. The third theme, "entrusting myself to others", revealed how patients handed over control and decision making to the staff, confident that they would look after their best interest. CONCLUSIONS Patients perceived intrahospital transports as an acceptable and safe process. Findings suggest that patients' experience could be improved by being provided with accurate and timely information and preparedness for transport-related events.
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Affiliation(s)
- Lina Bergman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Monica Pettersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Wendy Chaboyer
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
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Abstract
PURPOSE OF REVIEW To outline key points for perioperative ICU optimization of nutrition, airway management, blood product preparation and transfusion, antibiotic prophylaxis and transport. RECENT FINDINGS Optimization entails glycemic control for all, with specific attention to type-1 diabetic patients. Transport-related adverse events may be averted with surgery in the ICU. If moving the patient is unavoidable, transport guidelines should be followed and hemodynamic optimization, airway control, and stabilization of mechanical ventilation ensured before transport. Preinduction preparation includes assessment of the airway and the provision of high-flow oxygen to prolong apneic oxygenation. Postintubation, a protective positive ventilation strategy should be employed. Ideal transfusion thresholds are 7 g/dl for hemodynamically stable adult patients, 8 g/dl in orthopedic or cardiac surgery patients as well as those with underlying cardiovascular disease. Higher transfusions thresholds may be required in specific disease states. Antimicrobial prophylaxis within 120 min of incision prevents most surgical site infections. Antibiotic therapy depends on the antibiotics being received in the ICU, the time elapsed since ICU admission, local epidemiology and the type of surgery. Tailored antimicrobial regimens may be continued periprocedurally. If more than 70% of the nutritional requirement cannot be met enterally, parenteral nutrition should be initiated within 5-7 days of surgery or earlier if the patient is malnourished. SUMMARY ICU patients who require surgery may benefit from appropriate perioperative management.
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Vulcu S, Wagner F, Santos AF, Reitmeir R, Söll N, Schöni D, Fung C, Wiest R, Raabe A, Beck J, Z’Graggen WJ. Repetitive Computed Tomography Perfusion for Detection of Cerebral Vasospasm–Related Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 121:e739-e746. [DOI: 10.1016/j.wneu.2018.09.208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/27/2022]
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Yang SH, Jerng JS, Chen LC, Li YT, Huang HF, Wu CL, Chan JY, Huang SF, Liang HW, Sun JS. Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system. BMJ Open 2017; 7:e017932. [PMID: 29101141 PMCID: PMC5695373 DOI: 10.1136/bmjopen-2017-017932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. OBJECTIVE To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. SETTING A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. PARTICIPANTS All eligible IHT-related patient safety events between January 2010 to December 2015 were included. MAIN OUTCOME MEASURES Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. RESULTS There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (p<0.001). Of the events with human failures (n=186), the most common related process step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, p<0.001) was associated with increased patient harm, whereas the presence of omission (OR 0.12, p<0.001) was associated with less patient harm. CONCLUSIONS This study shows a need to reduce human failures to prevent patient harm during intra-hospital transportation. We suggest that the transportation team pay specific attention to the sub-process at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted.
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Affiliation(s)
- Shu-Hui Yang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tsu Li
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Fang Huang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Yuan Chan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
OBJECTIVE To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. DESIGN A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. SETTING The study was undertaken at two ICUs in one university hospital. PATIENTS Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4-10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. CONCLUSIONS Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
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Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan. Dimens Crit Care Nurs 2017; 35:133-46. [PMID: 27043399 DOI: 10.1097/dcc.0000000000000176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intrahospital transport of the critically ill adult carries inherent risks that can be manifested as unexpected events. OBJECTIVE The aim of this study is to evaluate the implementation of a standardized evaluation plan for intrahospital transports to/from adult intensive care units. METHODS Nurses at a level I trauma/academic center captured clinical data throughout transport. Outcome measures included compliance with the organization's transport policy and unexpected events. RESULTS There were 502 transports audited. Most nurses were compliant with the policy, except for the stabilization process (n = 174, 34.7%). Forty-one transports (8.2%) had an unexpected event, and 11 of these transports (26.8%) were aborted. Most of the events were hemodynamic (12), sedation (11), respiratory (10), and gastrointestinal (5). Fewer events occurred with the transport team (P = .036) and among nurses with a bachelor of science in nursing or higher degree (P = .002). Events were higher among transporting nurses with only 0 to 2 years of intensive care unit experience (P = .002), "stabilized" transports (P = .022), and patients with higher Acute Physiology and Chronic Health Evaluation scores (P = .009). CONCLUSIONS Health care organizations should have a policy that includes both transport and evaluation plans for intrahospital transport. Guidelines should be revised with specific criteria for the stabilization process and unexpected events. Revision should also have a standardized evaluation plan that includes an audit tool to measure incidence of unexpected events and a rapid change quality improvement method.
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Comeau OY, Armendariz-Batiste J, Woodby SA. Safety First! Using a Checklist for Intrafacility Transport of Adult Intensive Care Patients. Crit Care Nurse 2017; 35:16-25. [PMID: 26427972 DOI: 10.4037/ccn2015991] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adult critical care patients in an academic medical center experienced adverse events during intrafacility transport resulting from lack of preparation. An intervention was needed to help keep patients safe during intrafacility transport. OBJECTIVE To develop a checklist for transport that is easy to use and effective in preparing patients for transport. METHOD A checklist was developed and implemented. Elements of the checklist include preparation of the patient before transport, screening of patients for criteria that may place them at higher risk during transport, and a checklist for the procedural site. RESULTS From May 2011 through July 2014, 2506 transports were conducted. Of these, 97.6% (n = 2445) involved no reported complications. CONCLUSION This tool is suitable for bedside clinicians to use when preparing patients for transport.
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Affiliation(s)
- Odette Y Comeau
- Odette Y. Comeau is an adult critical care clinical nurse specialist at University of Texas Medical Branch (UTMB) in Galveston, Texas.Josette Armendariz-Batiste is the director of patient care and assistant chief nursing officer for adult medical-surgical and critical care units at UTMB Galveston.Scott A. Woodby is a nurse clinician in the medical intensive care unit/cardiac care unit at UTMB Galveston.
| | - Josette Armendariz-Batiste
- Odette Y. Comeau is an adult critical care clinical nurse specialist at University of Texas Medical Branch (UTMB) in Galveston, Texas.Josette Armendariz-Batiste is the director of patient care and assistant chief nursing officer for adult medical-surgical and critical care units at UTMB Galveston.Scott A. Woodby is a nurse clinician in the medical intensive care unit/cardiac care unit at UTMB Galveston
| | - Scott A Woodby
- Odette Y. Comeau is an adult critical care clinical nurse specialist at University of Texas Medical Branch (UTMB) in Galveston, Texas.Josette Armendariz-Batiste is the director of patient care and assistant chief nursing officer for adult medical-surgical and critical care units at UTMB Galveston.Scott A. Woodby is a nurse clinician in the medical intensive care unit/cardiac care unit at UTMB Galveston
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Brouard F, Muller G, Michel P, Ehrmann S, da Silva D, Kimmoun A, Hamzaoui O, Lacherade JC, Audoin C, Boissier F, Hraiech S, Grimaldi D, Aissaoui N. Étude du Transport INTrA-Hospitalier du MAlade de Réanimation (TINTAHMAR). MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Paschoal Jr FM, Nogueira RC, Ronconi KDAL, de Lima Oliveira M, Teixeira MJ, Bor-Seng-Shu E. Multimodal brain monitoring in fulminant hepatic failure. World J Hepatol 2016; 8:915-923. [PMID: 27574545 PMCID: PMC4976210 DOI: 10.4254/wjh.v8.i22.915] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/22/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.
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Jia L, Wang H, Gao Y, Liu H, Yu K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Crit Care 2016; 20:12. [PMID: 26781179 PMCID: PMC4717618 DOI: 10.1186/s13054-016-1183-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/06/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the incidence of adverse events (AEs) during intra-hospital transport (IHT) of critically ill patients and evaluate the risk factors associated with these events. METHODS This prospective multicenter observational study was performed in 34 intensive care units in China during 20 consecutive days from 5 November to 25 November 2012. All consecutive patients who required IHT for diagnostic testing or therapeutic procedures during the study period were included. All AEs that occurred during IHT were recorded. The incidence of AEs was defined as the rate of transports with at least one AE. The statistical analysis included a description of demographic and clinical characteristics of the cohort as well as identification of risk factors for AEs during IHT by univariate and multivariate logistic regression analyses. RESULTS In total, 441 IHTs of 369 critically ill patients were analyzed. The overall incidence of AEs was 79.8% (352 IHTs). The proportion of equipment- and staff-related adverse events was 7.9% (35 IHTs). The rate of patient-related adverse events (P-AEs) was 79.4% (349 IHTs). The rates of vital sign-related P-AEs and arterial blood gas analysis-related P-AEs were 57.1% (252 IHTs) and 46.9% (207 IHTs), respectively. The incidence of critical P-AEs was 33.1% (146 IHTs). The rates of vital sign-related critical P-AEs and arterial blood gas analysis-related critical P-AEs were 22.9% (101 IHTs) and 15.0% (66 IHTs), respectively. All data collected in our study were considered potential risk factors. In the multivariate analysis, predictive factors for P-AEs were pH, partial pressure of carbon dioxide in arterial blood, lactate level, glucose level, and heart rate before IHT. Furthermore, the Acute Physiology and Chronic Health Evaluation II score, partial pressure of oxygen in arterial blood, lactate level, glucose level, heart rate, respiratory rate, pulse oximetry, and sedation before transport were independent influential factors for critical P-AEs during IHT. CONCLUSIONS The incidence of P-AEs during IHT of critically ill patients was high. Risk factors for P-AEs during IHT were identified. Strategies are needed to reduce their frequency. TRIAL REGISTRATION Chinese Clinical Trial Register identifier ChiCTR-OCS-12002661. Registered 5 November 2012.
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Affiliation(s)
- Liu Jia
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yang Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Haitao Liu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Kaijiang Yu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Kumar P. Improving timely medical reviews for patients discharged from intensive care. BMJ QUALITY IMPROVEMENT REPORTS 2016; 4:bmjquality_uu207871.w3816. [PMID: 26734417 PMCID: PMC4693071 DOI: 10.1136/bmjquality.u207871.w3816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/24/2015] [Indexed: 11/04/2022]
Abstract
Transferring patients from the intensive care unit (ICU) to a general ward is commonly associated with error and adverse events, and is one of the most challenging and high-risk transitions of care. Patients discharged from ICUs often require sustained intensive multi-disciplinary team input, part of which can be provided by nurse or clinician-led outreach teams. Unfortunately, due to a lack of resources many institutions do not have such programmes. We work in one such hospital with no ICU outreach service for recently discharged patients. We noted that a disproportionate number of patients recently discharged from the ICU needed acute medical reviews by on-call evening and overnight junior doctors. Furthermore we noted that many of these patients had not been reviewed by their medical team after having arrived onto the general ward from the ICU. We aimed to foster a fundamental culture change within junior doctors to review patients within six hours of arrival onto a ward from the ICU. We introduced simple and low-cost interventions that included educational sessions for junior doctors and ward-based nurses, as well as posters that acted as visual reminders in relevant departments. Overall, the number of patients discharged from the ICU to general wards that were reviewed within six hours improved from 22% to 70% in the space of six months. In the same period, the number of patients requiring an acute medical review by the evening or overnight on-call junior doctor dropped from 14% to 0%. Whilst our project is not necessarily appropriate for many larger institutions that already have outreach teams in place, it is certainly applicable to other similar sized smaller hospitals. We hope that others who face the same inherent barriers are inspired to implement similar projects, to bring about positive change, and ultimately improve the safety of their patients.
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Park SH, Weaver L, Mejia-Johnson L, Vukas R, Zimmerman J. An Integrative Literature Review of Patient Turnover in Inpatient Hospital Settings. West J Nurs Res 2015; 38:629-55. [DOI: 10.1177/0193945915616811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High patient turnover can result in fragmentation of nursing care. It can also increase nursing workload and thus impede the ability of nurses to provide safe and high-quality care. We reviewed 20 studies that examined patient turnover in relation to nursing workload, staffing, and patient outcomes as well as interventions in inpatient hospital settings. The studies consistently addressed the importance of accounting for patient turnover when estimating nurse staffing needs. They also showed that patient turnover varied by time, day, and unit type. Researchers found that higher patient turnover was associated with adverse events; however, further research on this topic is needed because evidence on the effect of patient turnover on patient outcomes is not yet strong and conclusive. We suggest that researchers and administrators need to pay more attention to patterns and levels of patient turnover and implement managerial strategies to reduce nursing workload and improve patient outcomes.
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Affiliation(s)
- Shin Hye Park
- University of Kansas Medical Center, Kansas City, USA
| | | | | | - Rachel Vukas
- University of Kansas Medical Center, Kansas City, USA
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Heselmans A, van Krieken J, Cootjans S, Nagels K, Filliers D, Dillen K, De Broe S, Ramaekers D. Medication review by a clinical pharmacist at the transfer point from ICU to ward: a randomized controlled trial. J Clin Pharm Ther 2015; 40:578-583. [PMID: 29188903 DOI: 10.1111/jcpt.12314] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/02/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug-related problems (DRPs) occur frequently in hospitalized patients. Patient discharge from the intensive care unit (ICU) to a non-ICU ward is one of the most challenging and high-risk transitions of care due to the number of medications, and the complexity and acuity of the medical conditions that characterize this patient group. Pharmacists could play an important role in preventing DRPs. This study was undertaken to evaluate the impact on the number and severity of drug-related problems by assigning a clinical pharmacist to the transfer process from ICU to wards. METHODS The study was a randomized controlled multicentre trial conducted at the Hospital Network of Antwerp between December 2010 and January 2012. The clinical pharmacist performed a medical review in both the intervention and control group. Recommendations for drug therapy changes were immediately communicated in the intervention group but were kept blinded in the control group. The primary outcome was expressed as the number of implemented recommendations for drug therapy changes. Differences between groups were calculated using mixed effects binary logistic regression. RESULTS Drug-related problems were found in the medical records of 360 of the 600 participants (60%). A total of 743 recommendations could be made, 375 in the intervention group and 368 in the control group. 54·1% of these problems were adjusted on time in the intervention group vs. 12·8% in the control group. Of 743 recommendations, 24·8% were judged by the expert group as major, 13·1% as moderate, 53.4% as minor and 8·9% as having no clinical impact. The odds of implementing recommendations of drug therapy changes in the intervention group were 10 times the odds of implementing recommendations of drug therapy changes in the control group (odds ratio = 10·1; 95%CI [6·3-16·1]; P < 0·001), even after accounting for differences in types of DRP between the groups (odds ratio = 15·6; 95%CI [9·4-25·9]; P < 0·001). WHAT IS NEW AND CONCLUSION The integration of a clinical pharmacist at the transfer point from ICU to ward led to a significant reduction in DRPs.
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Affiliation(s)
- A Heselmans
- School of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Belgium
| | - J van Krieken
- AZ Sint Maarten General Hospital, Hospital Pharmacy, Mechelen, Belgium
| | - S Cootjans
- ZNA Antwerp Hospital Network, Hospital Pharmacy, Antwerp, Belgium
| | - K Nagels
- ZNA Antwerp Hospital Network, Hospital Pharmacy, Antwerp, Belgium
| | - D Filliers
- ZNA Antwerp Hospital Network, Hospital Pharmacy, Antwerp, Belgium
| | - K Dillen
- ZNA Antwerp Hospital Network, Hospital Pharmacy, Antwerp, Belgium
| | - S De Broe
- ZNA Antwerp Hospital Network, Hospital Pharmacy, Antwerp, Belgium
| | - D Ramaekers
- School of Public Health and Primary Care, Centre for Health Services and Nursing Research, KU Leuven, Belgium
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Shields J, Overstreet M, Krau SD. Nurse Knowledge of Intrahospital Transport. Nurs Clin North Am 2015; 50:293-314. [DOI: 10.1016/j.cnur.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Oks M, Cleven KL, Cardenas-Garcia J, Schaub JA, Koenig S, Cohen RI, Mayo PH, Narasimhan M. The effect of point-of-care ultrasonography on imaging studies in the medical ICU: a comparative study. Chest 2015; 146:1574-1577. [PMID: 25144593 DOI: 10.1378/chest.14-0728] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Point-of-care ultrasonography performed by frontline intensivists offers the possibility of reducing the use of traditional imaging in the medical ICU (MICU). We compared the use of traditional radiographic studies between two MICUs: one where point-of-care ultrasonography is used as a primary imaging modality, the other where it is used only for procedure guidance. METHODS This study was a retrospective 3-month chart review comparing the use of chest radiographs, CT scans (chest and abdomen/pelvis), transthoracic echocardiography performed by the cardiology service, and DVT ultrasonography studies performed by the radiology service between two MICUs of similar size and acuity and staffing levels. RESULTS Total number of admissions, patient demographics, and disease acuity were similar between MICUs. Comparing the non-point-of-care ultrasonography MICU with the point-of-care ultrasonography MICU, there were 3.75 ± 4.6 vs 0.82 ± 1.85 (P < .0001) chest radiographs per patient, 0.10 ± 0.31 vs 0.04 ± 0.20 (P = .0007) chest CT scans per patient, 0.17 ± 0.44 vs 0.05 ± 0.24 (P < .0001) abdomen/pelvis CT scans per patient, 0.20 ± 0.47 vs 0.02 ± 0.14 (P < .0001) radiology service-performed DVT studies per patient, and 0.18 ± 0.40 vs 0.07 ± 0.26 (P < .0001) cardiology service-performed transthoracic echocardiography studies per patient, respectively. CONCLUSIONS The use of point-of-care ultrasonography in an MICU is associated with a significant reduction in the number of imaging studies performed by the radiology and cardiology services.
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Affiliation(s)
- Margarita Oks
- Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY.
| | - Krystal L Cleven
- Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY
| | | | | | - Seth Koenig
- Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY
| | - Rubin I Cohen
- Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY
| | - Paul H Mayo
- Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY
| | - Mangala Narasimhan
- Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY
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Zieleskiewicz L, Cornesse A, Hammad E, Haddam M, Brun C, Vigne C, Meyssignac B, Remacle A, Chaumoitre K, Antonini F, Martin C, Leone M. Implementation of lung ultrasound in polyvalent intensive care unit: Impact on irradiation and medical cost. Anaesth Crit Care Pain Med 2015; 34:41-4. [PMID: 25829314 DOI: 10.1016/j.accpm.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of implementing a daily lung ultrasound round on the number of chest radiographs and chest computed tomography (CT) scans in a polyvalent intensive care unit (ICU). STUDY DESIGN Retrospective study comparing two consecutive periods. PATIENTS All patients hospitalized for longer than 48 hours in a polyvalent ICU. METHODS Implementation of a daily lung ultrasound round after a short educational program. The number of chest radiographs and chest CT scans and the patient outcome were measured before (group PRE) and after (group POST) the implementation of a daily lung ultrasound round. RESULTS No demographic difference was found between the two groups, with the exception of a higher severity score in the group POST. For each ICU stay, the number of chest radiographs was 10.3 ± 12.4 in the group PRE and 7.7 ± 10.3 in the group POST, respectively (P<0.005) The number of chest CT scans was not reduced in the group POST, as compared with the group PRE (0.5 ± 0.7 CT scan/patient/ICU stay versus 0.4 ± 0.6 CT scan/patient/ICU stay, P=0.01). The ICU mortality was similar in both groups (21% versus 22%, P=0.75) CONCLUSION: The implementation of a daily lung ultrasound round was associated with a reduction in radiation exposure and medical cost without altering patient outcome.
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Affiliation(s)
- L Zieleskiewicz
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - A Cornesse
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - E Hammad
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - M Haddam
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Brun
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Vigne
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - B Meyssignac
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - A Remacle
- Department of medical informatics, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - K Chaumoitre
- Department of radiology, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - F Antonini
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - C Martin
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
| | - M Leone
- Department of anesthesiology and critical care medicine, Nord hospital, AP-HM, Aix Marseille university, Marseille, France.
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Ott LK, Pinsky MR, Hoffman LA, Clarke SP, Clark S, Ren D, Hravnak M. Patients in the radiology department may be at increased risk of developing critical instability. ACTA ACUST UNITED AC 2015; 34:29-34. [PMID: 25821413 DOI: 10.1016/j.jradnu.2014.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to calculate the event rate for in-patients in the Radiology Department (RD) developing instability leading to calls for Medical Emergency Team assistance (MET-RD) compared to general ward (MET-W) patients. A retrospective comparison was done of MET-RD and MET-W calls in 2009 in a U.S. tertiary hospital with a well-established MET system. MET-RD and MET-W event rates represented as MET calls/hour/1000 admissions, adjusted for length of stay (LOS); rates also calculated for RD modalities. There were 31,320 hospital ward admissions had 1,230 MET-W, and among 149,569 radiology admissions there were 56 MET-RD. When adjusted for LOS, the MET-RD event rate was 2 times higher than the MET-W rate (0.48 vs. 0.24 events/hour/1000 admissions). Event rates differed by procedure: computed tomography (CT) had 38% of MET-RDs (event rate 0.89); magnetic resonance imaging (MRI) accounted for 27% (event rate 1.56). Nuclear medicine had 1% of RD admissions but these patients accounted for 5% of MET-RD (event rate 1.53). Interventional radiology (IR) had 6% of RD admissions but 16% of MET-RD (event rate 0.61). While general x-ray comprised 63% of RD admissions, only 11% of MET-RD involved their care (event rate 0.09). In conclusion, the overall MET-RD event rate was twice the MET-W event rate; CT, MRI and IR rates were 3.7-6.5 times higher than on wards. RD patients are at increased risk for a MET call compared to ward patients when the time at risk is considered. Increased surveillance of RD patients is warranted.
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Affiliation(s)
- Lora K Ott
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
| | | | - Leslie A Hoffman
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
| | | | - Sunday Clark
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh
| | - Dianxu Ren
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
| | - Marilyn Hravnak
- Department of Tertiary Care, School of Nursing, University of Pittsburgh
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Øyri K, Chávez-Santiago R, Støa S, Martinsen ØG, Balasingham I, Fosse E. Wireless vital signs from a life-supporting medical device exposed to electromagnetic disturbance. MINIM INVASIV THER 2014; 23:341-9. [PMID: 24976270 DOI: 10.3109/13645706.2014.931869] [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: 11/13/2022]
Abstract
OBJECTIVES To evaluate the level of agreement of simulated wired and Wi-Fi vital signs output from an intra-aortic balloon pump during exposure to electromagnetic interference from frequency overlapping ZigBee sensors. MATERIAL AND METHODS A series of experiments with interference from single and multiple ZigBee sensors were benchmarked with wired and Wi-Fi output. Tests included single ZigBee sensor adjacent and co-channel interference, and multiple ZigBee interferences towards the Wi-Fi receiver and transmitter. RESULTS Interference-free differences between wired and wireless aortic blood pressure and electrocardiogram were very small, verified by time domain and Bland - Altman plots. Bland - Altman plots comparing level of agreement in wired and wireless aortic blood pressure and ECG output during interference experiments showed a difference from 0.2 to 0.3 mmHg for blood pressure, and from 0.001 to 0.004 mV for electrocardiogram. CONCLUSIONS Level of agreement in wired and wireless (Wi-Fi) arterial blood pressure and electrocardiogram during single or multiple sensor interference was high. No clinically relevant degradation of Wi-Fi transmission of aortic blood pressure or ECG signals was observed.
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Affiliation(s)
- Karl Øyri
- The Intervention Centre, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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Albrecht L, Busse R, Tepe H, Poschmann R, Teichgräber U, Hamm B, de Bucourt M. [Turnaround time for reporting results of radiological examinations in intensive care unit patients: an internal quality control]. Radiologe 2014; 53:810-6. [PMID: 23933637 DOI: 10.1007/s00117-013-2537-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS The radiological examinations performed in intensive care units (ICUs) were analyzed for the purpose of internal quality control. Data included the type of examination performed, the time of day the examination was performed and the differences in radiologist report turnaround times. MATERIAL AND METHODS A retrospective analysis of the radiology information system (RIS) database of all radiological examinations performed in the ICU of a large German hospital from 2009 through 2011 was carried out. The search retrieved 75,169 examinations performed in ICU patients which were included in the analysis. The records were analyzed for type of radiological examination performed, i.e. conventional X-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), angiography and nuclear medicine examinations, time of day the examination was performed and the interval between examination and time of reporting and release of the final report. RESULTS Cross-modality it took on average 52 min until a report was written and approximately 7 h before the final report was released. Turnaround times were shortest for ultrasound, conventional X-ray and CT. Over the 3-year observation period there was an overall tendency toward shorter turnaround times whereby improvement in time until reporting was most marked for conventional X-ray, MRI and ultrasound (reduction of 24, 17, and 15 min, respectively). The time until release of the final report improved most markedly for CT, conventional X-ray and angiography (improvement of approximately 6.67, 5.08 and 0.78 h, respectively). CONCLUSIONS During the 3-year observation period a reduction in turnaround times for reporting results and release of finalized reports could be observed, despite an increase in the total number of cases.
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Affiliation(s)
- L Albrecht
- Abteilung Radiologie, Charité-Universitätsmedizin Berlin, Charité-Platz 1, 10117, Berlin, Deutschland
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Radiotherapy for Intubated Patients with Malignant Airway Obstruction: Futile or Facilitating Extubation? J Thorac Oncol 2013; 8:1365-70. [DOI: 10.1097/jto.0b013e3182a47501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study*. Crit Care Med 2013; 41:1919-28. [PMID: 23863225 DOI: 10.1097/ccm.0b013e31828a3bbd] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To describe intrahospital transport complications in critically ill patients receiving invasive mechanical ventilation. DESIGN Prospective multicenter cohort study. SETTING Twelve French ICUs belonging to the OUTCOMEREA study group. PATIENTS Patients older than or equal to 18 years old admitted in the ICU and requiring invasive mechanical ventilation between April 2000 and November 2010 were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Six thousand two hundred forty-two patients on invasive mechanical ventilation were identified in the OUTCOMEREA database. The statistical analysis included a description of demographic and clinical characteristics of the cohort, identification of risk factors for intrahospital transport and construction of an intrahospital transport propensity score, and an exposed/unexposed study to compare complication of intrahospital transport (excluding transport to the operating room) after adjustment on the propensity score, length of stay, and confounding factors on the day before intrahospital transport. Three thousand and six intrahospital transports occurred in 1,782 patients (28.6%) (1-17 intrahospital transports/patient). Transported patients had higher admission Simplified Acute Physiology Score II values (median [interquartile range], 51 [39-65] vs 46 [33-62], p < 10) and longer ICU stay lengths (12 [6-23] vs 5 [3-11] d, p < 10). Post-intrahospital transport complications were recorded in 621 patients (37.4%). We matched 1,659 intrahospital transport patients to 3,344 nonintrahospital transport patients according to the intrahospital transport propensity score and previous ICU stay length. After adjustment, intrahospital transport patients were at higher risk for various complications (odds ratio = 1.9; 95% CI, 1.7-2.2; p < 10), including pneumothorax, atelectasis, ventilator-associated pneumonia, hypoglycemia, hyperglycemia, and hypernatremia. Intrahospital transport was associated with a longer ICU length of stay but had no significant impact on mortality. CONCLUSIONS Intrahospital transport increases the risk of complications in ventilated critically ill patients. Continuous quality improvement programs should include specific procedures to minimize intrahospital transport-related risks.
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Ultrasound imaging and use of B-lines for functional lung evaluation in neurocritical care. Eur J Anaesthesiol 2013; 30:464-8. [DOI: 10.1097/eja.0b013e32835fe4a4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Parmentier-Decrucq E, Poissy J, Favory R, Nseir S, Onimus T, Guerry MJ, Durocher A, Mathieu D. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care 2013; 3:10. [PMID: 23587445 PMCID: PMC3639083 DOI: 10.1186/2110-5820-3-10] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/07/2013] [Indexed: 01/03/2023] Open
Abstract
Background Transport of critically ill patients for diagnostic or therapeutic procedures is at risk of complications. Adverse events during transport are common and may have significant consequences for the patient. The objective of the study was to collect prospectively adverse events that occurred during intrahospital transports of critically ill patients and to determine their risk factors. Methods This prospective, observational study of intrahospital transport of consecutively admitted patients with mechanical ventilation was conducted in a 38-bed intensive care unit in a university hospital from May 2009 to March 2010. Results Of 262 transports observed (184 patients), 120 (45.8%) were associated with adverse events. Risk factors were ventilation with positive end-expiratory pressure >6 cmH2O, sedation before transport, and fluid loading for intrahospital transports. Within these intrahospital transports with adverse events, 68 (26% of all intrahospital transports) were associated with an adverse event affecting the patient. Identified risk factors were: positive end-expiratory pressure >6 cmH2O, and treatment modification before transport. In 44 cases (16.8% of all intrahospital transports), adverse event was considered serious for the patient. In our study, adverse events did not statistically increase ventilator-associated pneumonia, time spent on mechanical ventilation, or length of stay in the intensive care unit. Conclusions This study confirms that the intrahospital transports of critically ill patients leads to a significant number of adverse events. Although in our study adverse events have not had major consequences on the patient stay, efforts should be made to decrease their incidence.
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Affiliation(s)
- Erika Parmentier-Decrucq
- Service d'Urgence Respiratoire, Réanimation Médicale et Medecine Hyperbare, Université de Lille II et Centre Hospitalier et Universitaire de Lille, Lille 59037, France.
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Stelfox HT, Perrier L, Straus SE, Ghali WA, Zygun D, Boiteau P, Zuege DJ. Identifying intensive care unit discharge planning tools: protocol for a scoping review. BMJ Open 2013; 3:e002653. [PMID: 23562817 PMCID: PMC3641498 DOI: 10.1136/bmjopen-2013-002653] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/07/2013] [Accepted: 03/11/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Transitions of care between providers are vulnerable periods in healthcare delivery that expose patients to preventable errors and adverse events. Patient discharge from the intensive care unit (ICU) to a medical or surgical hospital ward is one of the most challenging and high risk transitions of care. Approximately 1 in 12 patients discharged will be readmitted to ICU or die before leaving the hospital. Many more patients are exposed to unnecessary healthcare, adverse events and/or are disappointed with the quality of their care. Our objective is to conduct a scoping review by systematically searching the literature to identify ICU discharge planning tools and their supporting evidence-base including barriers and facilitators to their use. METHODS AND ANALYSIS Systematic searching of the published health literature will be conducted to identify the existing ICU discharge planning tools and supporting evidence. Literature (research and non-research) reporting on the tools used to facilitate decision making and/or communication at ICU discharge with patients of any age will be included. Outcomes will include adverse events and provider and patient/family-reported outcomes. Two investigators will independently review the abstracts (screen 1) to identify those meeting the inclusion criteria and then independently assess the full text articles (screen 2) to determine if they meet the inclusion criteria. Data collection will include information on citations and identified tools. A quality assessment will be performed on original research studies. A descriptive summary will be developed for each tool. ETHICS AND DISSEMINATION Our scoping review will synthesise the literature for ICU discharge planning tools and identify the opportunities for knowledge to action and gaps in evidence where primary evidence is necessary. This will serve as the foundational element in a multistep research programme to standardise and improve the quality of care provided to patients during ICU discharge. Ethics approval is not required for this study.
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Affiliation(s)
- Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada
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Met de patiënt op stap. Crit Care 2013. [DOI: 10.1007/s12426-012-0114-4] [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] Open
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Becker A, Kuhnt D, Bakowsky U, Nimsky C. Contrast-Enhanced Ultrasound Ventriculography. Oper Neurosurg (Hagerstown) 2012; 71:ons296-301; discussion ons301. [PMID: 22843135 DOI: 10.1227/neu.0b013e31826a8a97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andreas Becker
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, Marburg, Germany.
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Kiphuth IC, Huttner HB, Breuer L, Schwab S, Köhrmann M. Sonographic monitoring of midline shift predicts outcome after intracerebral hemorrhage. Cerebrovasc Dis 2012; 34:297-304. [PMID: 23146822 DOI: 10.1159/000343224] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/04/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) and the evolution of subsequent perihemorrhagic edema lead to midline shift (MLS), which can be assessed by transcranial duplex sonography (TDS). In this observational study, we monitored MLS with TDS in patients with supratentorial ICH up to day 14 after the ictus, and then correlated MLS with the outcome 6 months after hospital discharge. METHODS Sixty-eight patients with spontaneous ICH (volume >20 cm(3)) were admitted during a 1-year period between April 2009 and April 2010. Sixty-one patients fulfilled the inclusion criteria and were eligible for analysis. TDS to measure MLS was performed upon admission and then subsequently, using serial examinations in 24-hour intervals up to day 14. Statistical tests were used to determine cut-off values for functional outcome and mortality after 6 months. RESULTS The median National Institutes of Health Stroke Scale (NIHSS) score upon admission was 21 and the mean hematoma volume was 52 cm(3). NIHSS score, functional outcome, hematoma volume and MLS were correlated in the examined patient cohort. ICH score upon admission, hematoma volume and the extent of MLS on days 1-14 were predictive of functional outcome and death. Values of MLS showed two peaks, the first between day 2 and day 5 and the second between day 12 and day 14, indicating that edema progresses not only during the acute but also during the subacute phase. Depending on the time point, an MLS of 4.5-7.5 mm or greater indicated an impending failure of conservative therapy. An MLS of 12 mm or greater at any time indicated mortality with a sensitivity of 69%, a specificity of 100% and positive and negative predictive values of 100 and 74%, respectively. CONCLUSIONS MLS seems to be a crucial factor for outcome after ICH. Apart from the hematoma volume itself, edema adds to the intracranial pressure. To monitor MLS in early patient management after ICH, TDS is a useful noninvasive bedside alternative, avoiding increased radiation exposure and repeated transportation of critically ill patients. Cut-off values may help to reliably predict functional outcome and treatment failure in patients undergoing maximal neurointensive therapy.
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Affiliation(s)
- Ines C Kiphuth
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany. ines-christine.kiphuth@uk-erlangen
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Ott LK, Pinsky MR, Hoffman LA, Clarke SP, Clark S, Ren D, Hravnak M. Medical emergency team calls in the radiology department: patient characteristics and outcomes. BMJ Qual Saf 2012; 21:509-18. [PMID: 22389020 PMCID: PMC3630458 DOI: 10.1136/bmjqs-2011-000423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to identify the characteristics of patients who experience medical emergency team calls in the radiology department (MET-RD) and the relationship between these characteristics and patient outcomes. DESIGN/PARTICIPANTS Retrospective review of 111 inpatient MET-RD calls (May 2008-April 2010). SETTING Academic medical centre with a well established MET system. MEASUREMENTS The characteristics of patients before, during and after transport to radiology were extracted from medical records and administrative databases. These characteristics were compared between patients with good and poor outcomes. MAIN RESULTS The majority of patients who experience MET-RD calls had a Charlson Comorbidity Index ≥4 and were from non-intensive care units (60%). Almost half (43%) of MET-RD calls occurred during patients' first day in hospital. Patients commonly arrived with nasal cannula oxygen (38%), recent tachypnoea (28%) and tachycardia (34%). A minority (16%) fulfilled MET call criteria in the 12 h before the MET-RD. MET-RD etiologies were cardiac (41%), respiratory (29%) or neurological (25%), and occurred most frequently during CT (44%) and MRI (22%) testing. Post MET-RD, the majority of patients (70%) required a higher level of care. Death before discharge (25%) was associated with need for cardiovascular support prior to RD transport (p=0.02), need for RD monitoring (p=0.02) and need for heightened RD surveillance (p=0.04). CONCLUSIONS The majority of patients who experienced MET-RD calls came from non-intensive care units, with comorbidities and vital sign alterations prior to arrival at the RD. Risk appeared to be increased for those requiring CT and MRI. These findings suggest that prior identification of a subset of patients at risk of instability in the RD may be possible.
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Affiliation(s)
- Lora K Ott
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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An outcome analysis of two different procedures of burr-hole trephine and external ventricular drainage in acute hydrocephalus. J Clin Neurosci 2012; 19:267-70. [DOI: 10.1016/j.jocn.2011.04.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 03/31/2011] [Accepted: 04/02/2011] [Indexed: 11/17/2022]
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Nakayama DK, Lester SS, Rich DR, Weidner BC, Glenn JB, Shaker IJ. Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients. J Pediatr Surg 2012; 47:112-8. [PMID: 22244402 DOI: 10.1016/j.jpedsurg.2011.10.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/06/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intrahospital transfers are necessary but hazardous aspects of pediatric surgical care. Plan-Do-Study-Act processes identify risks during hospitalization and improve care systems and patient safety. METHODS A multidisciplinary team developed a checklist that documented patient data and handoffs for all intrahospital transfers involving pediatric surgical inpatients. The checklist summarized major clinical events and provided concurrent summaries by 3-month quarters (Q) over 1 year. RESULTS There were 903 intrahospital transfers involving 583 inpatients undergoing surgery. Total handoffs were documented in 436 (75% of 583), with greater than 1 handoff in 202 (46% of 436). Documented problems occurred in 31 transfers (3.4%), the most during Q1 (19/191; 9.9%). Incidence fell to 3.5% (9/260) in Q2, 0.4% (1/243) in Q3, and 1.0% (2/209) in Q4 (P < .001). Patient care issues (14/31; 45%) were most common, followed by documentation (10, 32%) and process problems (7, 23%). The quality improvement team was able to resolve patient instability during transport (5 in Q1, none in Q3, Q4) and poor pain control (3 in Q2, 1 in Q3, Q4). Of the patients, 3.2% had identified problems with patient care during intrahospital transfer. CONCLUSIONS Plan-Do-Study-Act review emphasizes ongoing process analysis by multidisciplinary teams. Checklists reinforce communication and provide feedback on whether system goals are being achieved.
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Affiliation(s)
- Don K Nakayama
- Department of Surgery, Mercer University School of Medicine and Medical Center of Central Georgia, Macon, GA 31201, USA.
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Abstract
Although nurses perform the majority of the clinical tasks in an intensive care unit, current patient monitors were not designed to support a nurse's workflow. Nurses constantly triage patients, deciding which patient is currently in the most need of care. To make this decision, nurses must observe the patient's vital signs and therapeutic device information from multiple sources. To obtain this information, they often have to enter the patient's room. This study addresses 3 hypotheses. Information provided by far-view monitoring displays (1) reduces the amount of time to determine which patient needs care first, (2) increases the accuracy of assigning priority to the right patient, and (3) reduces nurses mental workload. We developed 2 far-view displays to be read from a distance of 3 to 5 m without entering the patient's room. Both display vital signs, trends, alarms, infusion pump status, and therapy support indicators. To evaluate the displays, nurses were asked to use the displays to decide which of 2 patients required their attention first. They made 60 decisions: 20 with each far-view display and 20 decisions with a standard patient monitor next to an infusion pump. Sixteen nurses (median age of 27.5 years with 2.75 years of experience) participated in the study. Using the 2 far-view displays, nurses more accurately and rapidly identified stable patients and syringe pumps that were nearly empty. Median decision times were 11.3 and 12.4 seconds for the 2 far-view displays and 17.2 seconds for the control display. The 2 far-view displays reduced median decision-making times by 4.8 to 5.9 seconds, increased accuracy in assignment of priority in 2 of 7 patient conditions, and reduced nurses' frustration with the triaging task. In a clinical setting, the proposed far-view display might reduce nurses' mental workload and thereby increase patient safety.
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Schödel P, Proescholdt M, Brawanski A, Bele S, Schebesch KM. Ventriculostomy for acute hydrocephalus in critically ill patients on the ICU--outcome analysis of two different procedures. Br J Neurosurg 2011; 26:227-30. [PMID: 21970781 DOI: 10.3109/02688697.2011.603853] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Burr-hole trephine and insertion of an external ventricular drainage (EVD) is a common procedure in neurosurgical practice. In critically ill patients, the transport to the operating room, OR represents a major risk. Thus, the burr-hole trephine and implantation of an EVD is frequently performed on the Intensive Care Unit (ICU). Since 2004, we have applied two different procedures: the conventional method with a mechanical compressed air or an electric drill, and an alternative method with a manual twist drill, including fixation of the EVD in a skull screw (Bolt Kit, Raumedic AG, Germany). This study was designed to evaluate the outcome of both surgical procedures. PATIENTS AND METHOD In this retrospective analysis we included 166 consecutive patients with acute hydrocephalus due to intracranial hemorrhage that had been operated at our neurosurgical ICU in a six years interval. We reviewed the charts for gender and age, kind of surgical procedure, cerebrospinal fluid (CSF)-infections, duration of drainage, attempts of insertions, wound infections, misplacement rate, post-surgical hemorrhages, revisions, comorbidities and shunt-dependency. RESULTS In 122 patients we applied the Bolt Kit System, in 44 patients the conventional method was performed. We found a significantly lower rate of CSF-infections and significantly fewer attempts of insertions in the Bolt Kit group (p = 0.002 and p = 0.001, respectively). The rate of wound infections, misplacement, revisions, shunt-dependency and the post-surgical hemorrhages did not differ significantly. DISCUSSION Our data indicate that the manual drill and the skull screw are safe and feasible tools in the treatment of acute hydrocephalus. Presumably, the direct skin contact is causative for the higher rate of CSF-infections when the conventional method is performed. The skull screw guides the EVD into the ventricle without skin contact. The lower number of insertions needed may be due to the fact that the skull screw allows just one trajectory for the insertion of the EVD.
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Affiliation(s)
- Petra Schödel
- Department of Neurosurgery, Medical Center University of Regensburg, Germany
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Li P, Stelfox HT, Ghali WA. A prospective observational study of physician handoff for intensive-care-unit-to-ward patient transfers. Am J Med 2011; 124:860-7. [PMID: 21854894 DOI: 10.1016/j.amjmed.2011.04.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/23/2011] [Accepted: 04/07/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Poor physician handoff can be a major contributor to suboptimal care and medical errors occurring in the hospital. Physician handoffs for intensive care unit (ICU)-to-ward patient transfer may face more communication hurdles. However, few studies have focused on physician handoffs in patient transfers from the ICU to the inpatient ward. METHODS We performed a hospitalized patient-based observational study in an urban, university-affiliated tertiary care center to assess physician handoff practices for ICU-to-ward patient transfer. One hundred twelve adult patients were enrolled. The stakeholders (sending physicians, receiving physicians, and patients/families) were interviewed to evaluate the quality of communication during these transfers. Data collected included the presence and effectiveness of communication, continuity of care, and overall satisfaction. RESULTS During the initial stage of patient transfers, 15.6% of the consulted receiving physicians verbally communicated with sending physicians; 26% of receiving physicians received verbal communication from sending physicians when patient transfers occurred. Poor communication during patient transfer resulted in 13 medical errors and 2 patients being transiently "lost" to medical care. Overall, the levels of satisfaction with communication (scored on a 10-point scale) for sending physicians, receiving physicians, and patients were 7.9±1.1, 8.1±1.0, and 7.9±1.7, respectively. CONCLUSION The overall levels of satisfaction with communication during ICU-to-ward patient transfer were reasonably high among the stakeholders. However, clear opportunities to improve the quality of physician communication exist in several areas, with potential benefits to quality of care and patient safety.
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Affiliation(s)
- Pin Li
- Department of Medicine, University of Calgary, Alberta, Canada.
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Ott LK, Hoffman LA, Hravnak M. Intrahospital Transport to the Radiology Department: Risk for Adverse Events, Nursing Surveillance, Utilization of a MET and Practice Implications. ACTA ACUST UNITED AC 2011; 30:49-52. [PMID: 21666851 DOI: 10.1016/j.jradnu.2011.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nurses providing care in the Radiology Department (RD) are challenged by the broad scope of conditions and varied acuity of patients served by this unit. Nurses must facilitate the required diagnostic testing and simultaneously provide the surveillance necessary to detect physiologic changes signaling the need for rescue interventions. When instability occurs, one method of rescue involves activation of a Medical Emergency Team (MET) to bring an experienced cadre of critical care providers to the unstable patient. Despite recognition that the RD can be a high risk area, there is little in the literature specific to the surveillance of RD patients, risk for and prevention of adverse events, MET activation or the management of patient instability specific to the RD. The purpose of this paper is to examine what is known regarding risk for adverse events during intrahospital transport, utilization of a MET as a rescue intervention, and practice implications.
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Affiliation(s)
- Lora K Ott
- School of Nursing University of Pittsburgh 3500 Victoria St. Pittsburgh, PA 15261
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Cianchi G, Bonizzoli M, Pasquini A, Bonacchi M, Zagli G, Ciapetti M, Sani G, Batacchi S, Biondi S, Bernardo P, Lazzeri C, Giovannini V, Azzi A, Abbate R, Gensini G, Peris A. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med 2011; 11:2. [PMID: 21223541 PMCID: PMC3022902 DOI: 10.1186/1471-2466-11-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 01/11/2011] [Indexed: 11/10/2022] Open
Abstract
Background Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance. Methods Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination. Results A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%. Conclusions In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.
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Affiliation(s)
- Giovanni Cianchi
- Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, 50139, Florence, Italy
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Évaluation (5). MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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