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Jakobson DJ, Bashkin O, Kalatskaya V, Veinberg H, Chernoguz E, Nesi V, Levy C, Sherer Y. Challenging Organizational Factors Associated With Admission Delay to Intensive Care Unit-A Novel Quality Indicator. J Intensive Care Med 2023; 38:1121-1126. [PMID: 37403372 DOI: 10.1177/08850666231183899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Delays in admitting patients to the intensive care unit (ICU) can defer the timely initiation of life-sustaining therapies and invasive monitoring, jeopardizing the success of the treatment. Nevertheless, the availability of research on interventions that reduce or minimize admission delays is limited. OBJECTIVES The current study aimed to assess the factors related to delays in admission times of critically ill patients transferred to the ICU. METHODS A software was designed to follow-up, compare and measure the defined intervals of the time to admission, implemented at the ICU for 6 months. Measurements included 5 time intervals, referral department, and work shift at admission. Data from 1004 patients admitted to the ICU between July 2017 and January 2020 were analyzed in a retrospective observational study. RESULTS Precisely, 53.9% of total patients were referred from the hospital emergency department, and 44% were admitted during the evening shift. Significant differences were found in time intervals between shifts, showing the morning round had the longer total admission time (median: 67.8 min). Analysis showed that admission time was longer at times of full capacity compared to times of available bed (mean: 56.4 and 40.2 min, respectively; U = 68,722, p < .05). Findings demonstrated a significant shortening of time to admission after implementing a new time monitoring software by the Institutional Quality Control Commission (U = 5072, p < .001). CONCLUSIONS Our study opens doors for potential studies on applying effective initiatives in critical care settings to improve patient care and outcomes. Additionally, it generates new insights regarding how clinicians and nursing teams can jointly develop and promote multidisciplinary interventions in intensive care work environments.
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Affiliation(s)
- Daniel J Jakobson
- Intensive Care Department, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | | | - Halel Veinberg
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - Evgeny Chernoguz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Quality Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Vicky Nesi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Quality Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Chezy Levy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Hospital Direction Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Yaniv Sherer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Hospital Direction Department, Barzilai University Medical Center, Ashkelon, Israel
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J. Jakobson D, Cohen O, Cherniavsky E, Batumsky M, Fuchs L, Yellin A. Ultrasonography can replace chest X-rays in the postoperative care of thoracic surgical patients. PLoS One 2022; 17:e0276502. [PMID: 36264957 PMCID: PMC9584362 DOI: 10.1371/journal.pone.0276502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives Lung ultrasound accurately identifies pulmonary and pleural pathologies. Presently it has not been accepted as a routine examination in the postoperative follow-up of thoracic surgical patients. The present study aimed to compare thoracic ultrasonography with chest X-ray for detecting and clinical relevance of pneumothorax, pleural effusion, and lung consolidation and determine whether ultrasonography could replace chest X-ray as the standard examination after surgery. Methods In this blinded, prospective, single-center study, lung ultrasound images were obtained within 2 hours of post-operative routine chest X-ray. A severity score was given to each examination in each technique. Lung ultrasound and chest X-ray results were compared by three methods: absolute comparison of normal to abnormal, the degree of pathology, and the clinical findings’ relevance. Results Eighty patients were enrolled from 2013 to 2017, and 215 ultrasonography images were obtained. For pneumothorax, the precise overlap was found in 129/180 (72%) images. In 24% of examinations, X-ray missed ultrasonography findings. There was an agreement between studies in 80/212 (38%) images for pleural effusion. 60% of pleural effusions were missed by chest X-ray and detected by ultrasonography, and only 2.4% were missed by ultrasound, all very small. Clinically relevant fluid accumulation found a precise match in 80%, and 20% were found only by lung ultrasound. For lung consolidation, a 100% overlap was found with both methods. Conclusions Our results suggest that lung ultrasound may replace chest X-ray as the standard examination in the postoperative care of patients undergoing thoracic surgical procedures.
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Affiliation(s)
- Daniel J. Jakobson
- Intensive Care Department, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Ornit Cohen
- Faculty of Public Health Ben-Gurion University, Beer-Sheba, Israel
| | - Evgenia Cherniavsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Radiology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Moris Batumsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- General Surgery Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Lior Fuchs
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Intensive Care Department, Soroka University Medical Center, Beer Sheba, Israel
- * E-mail:
| | - Alon Yellin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Thoracic Surgery Department, Barzilai University Medical Center, Ashkelon, Israel
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Jakobson DJ, Yellin A, Yagil Y, Bar-Shai A. Bellows sign: A novel sonographic sign for the detection of segmental atelectasis. Am J Emerg Med 2018; 37:156-158. [PMID: 29779680 DOI: 10.1016/j.ajem.2018.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/12/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Daniel J Jakobson
- Intensive Care Unit, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | - Alon Yellin
- Department of Thoracic Surgery, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Yoram Yagil
- Department of Nephrology and Hypertension, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Amir Bar-Shai
- Department of Pulmonology, Barzilai University Medical Center, Ashkelon, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
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Jakobson DJ, Shemesh I. [Seeing the sounds--chest and lung ultrasonography]. Harefuah 2014; 153:600-624. [PMID: 25518079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chest ultrasonography was considered hampered and deficient but it is now taking a prominent role as a bedside tool for the diagnosis of lung ailments. Technological development has made it accurate, fast and reliable to the extent that it is gradually replacing the traditional chest X-ray and sometimes also the computed tomography scan. In this article we review and display in a few images the diagnostic possibilities of the thoracic ultrasound examination in a diverse range of maladies such as pneumonia, pulmonary congestion, pleural effusion and other conditions.
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Jakobson DJ, Shemesh I. Merging ultrasound in the intensive care routine. Isr Med Assoc J 2013; 15:688-692. [PMID: 24511649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Goal-oriented ultrasound examination is gaining a place in the intensive care unit. Some protocols have been proposed but the applicability of ultrasound as part of a routine has not been studied. OBJECTIVES To assess the influence of ultrasound performed by intensive care physicians. METHODS This retrospective descriptive clinical study was performed in a medical-surgical intensive care unit of a university-affiliated general hospital. Data were collected from patients undergoing ultrasound examinations performed by a critical care physician during the period 2010 to June 2011. RESULTS A total of 299 ultrasound exams were performed in 113 mechanically ventilated patients (70 males, mean age 65 years). Exams included trans-cranial Doppler (n = 24), neck evaluation before tracheostomy (n = 15), chest exam (n = 83), focuse cardiac echocardiography (n = 60), abdominal exam (n = 41), and comprehensive screening at patient admission (n = 30). Ultrasound was used to guide invasive procedures for vascular catheter insertion (n = 42), pleural fluid drainage (n = 24), and peritoneal fluid drainage (n = 7). One pneumothorax was seen during central venous line insertion but no complications were observed after pleural or abdominal drainage. The ultrasound study provided good quality visualization in 86% (258 of 299 exams) and was a diagnostic tool that induced a change in treatment in 58% (132 of 226 exams). CONCLUSIONS Bedside ultrasound examinations performed by critical care physicians provide an important adjunct to diagnostic and therapeutic performance, improving quality of care and patient safety.
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Affiliation(s)
- Daniel J Jakobson
- Intensive Care Unit, Barzilai Medical Center, Ashkelon, affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Iftach Shemesh
- Intensive Care Unit, Barzilai Medical Center, Ashkelon, affiliated with Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Jakobson DJ, Eidelman LA, Worner TM, Oppenheim AE, Pizov R, Sprung CL. Evaluation of Changes in Forgoing Life-Sustaining Treatment in Israeli ICU Patients. Chest 2004; 126:1969-73. [PMID: 15596700 DOI: 10.1378/chest.126.6.1969] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Over the last several years, there have been legal decisions and changes in medical directives concerning end-of-life decisions in Israel. METHODS The data were compared to evaluate the changes in the frequency and types of forgoing of life-sustaining treatment (FLST) in patients who were admitted to the ICU during period I (November 1994 to July 1995) and period II (January 1998 to January 1999). RESULTS During period I, there were 385 ICU admissions, and during period II there were 627 ICU admissions. In period I, FLST or death occurred in 13.5% of patients, and in 12% in period II. There was no significant difference in cardiopulmonary resuscitation (9% vs 13%, respectively), withholding therapy (90% vs 91%, respectively), or withdrawing therapy (0% vs 0%, respectively) between the two study periods. CONCLUSIONS There was no significant change in the frequency or types of FLST in an Israeli ICU between 1994 and 1998, despite passage of a new Patients' Rights Law and the issuing of a Ministry of Health directive on the treatment of the terminally ill, both of which occurred in 1996, and recent district court decisions favoring the termination of life-sustaining therapies.
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Affiliation(s)
- Daniel J Jakobson
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, The Hebrew University of Jerusalem, PO Box 12000, Jerusalem, Israel 91120, USA
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Eidelman LA, Jakobson DJ, Worner TM, Pizov R, Geber D, Sprung CL. End-of-life intensive care unit decisions, communication, and documentation: an evaluation of physician training. J Crit Care 2003; 18:11-6. [PMID: 12640607 DOI: 10.1053/jcrc.2003.yjcrc3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The majority of patients dying in intensive care units (ICUs) do so after the forgoing of life-sustaining therapies (FLST). Communication between physicians, patients, and their families regarding the decision to FLST has not been evaluated in Israel. MATERIALS AND METHODS All patients who had FLST in a general ICU were enrolled in the study. We evaluated whether physicians communicated and documented the FLST decisions with patients or the patients' families. We also assessed the effect of the physician's geographic place of training on communication behavior. RESULTS Over a period of 8.5 months, 385 patients were admitted to a general ICU in Israel. Fifty-seven patients died or had FLST. Twelve of these 57 were excluded from the study. Thus, 45 (79%) patients had FLST and were enrolled in the study. All patients were deemed medically incompetent to make FLST decisions. In 24 (53%) patients, FLST was discussed with the family before the decision to forgo therapy. Discussion occurred later with 6 other families, who were unavailable at the time the FLST decision was made. In 15 patients, there were no discussions with families. American-trained physicians discussed FLST with 22 of 29 families initially and 5 other families later (93%), whereas the Eastern European-trained physicians discussed FLST with only 3 of 16 (19%) families (P <.001). Documentation of FLST was present in 26 (90%) patients of American-trained physicians and 8 (50%) patients of Eastern European-trained physicians (P <.001). CONCLUSIONS FLST is common in an Israeli ICU. Patients are not medically competent to make FLST decisions. American-trained physicians discuss and document FLST more often than Eastern European-trained physicians.
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Affiliation(s)
- Leonid A Eidelman
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Abstract
OBJECTIVE To describe the use of muscle relaxants and a bite raiser to avoid continued tongue trauma. DESIGN Case report. SETTING A tertiary general intensive care unit (ICU). INTERVENTIONS Muscle relaxation and bite raiser. MAIN RESULTS Muscle relaxation and a bite raiser were used in a 17-yr-old male with traumatic macroglossia, which allowed for rapid resolution of edema and prevented additional trauma to the tongue. CONCLUSION Early use of a bite raiser together with muscle relaxants allows for more rapid solution of edema and prevention of additional trauma to the tongue in patients with traumatic macroglossia.
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Affiliation(s)
- D J Jakobson
- Department of Anesthesiology, Hadassah Hebrew University Medical Center, The Hebrew University of Jerusalem, Israel
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Abstract
OBJECTIVE To determine whether physicians in Israel withhold and/or withdraw life-sustaining treatments. DESIGN A prospective, descriptive study of consecutively admitted patients. Patients were prospectively evaluated for diagnoses, types and reasons for foregoing life-sustaining treatment, mortality and times from foregoing therapy until mortality. SETTING A general intensive care unit of a university hospital in Israel. RESULTS Foregoing life-sustaining treatment occurred in 52 (13.5%) of 385 patients admitted and 5 (1%) had cardiopulmonary resuscitation. Withholding therapy occurred in 48 patients. Four patients with brain death had all treatments withdrawn. No patient had antibiotics, nutrition or fluids withheld or withdrawn. Time from foregoing therapy until death was 2.9 +/- 0.6 days. Thirty-one of 48 (65%) patients who had therapy withheld died within 48 h. CONCLUSIONS Withholding life-prolonging treatments is common in an Israeli intensive care unit whereas withdrawing therapy is limited to brain dead patients. Terminal patients die soon after withholding, even if the therapy is not withdrawn. Withholding treatments should be an option for patients and professionals who object to withdrawing therapies.
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Affiliation(s)
- L A Eidelman
- Department of Anesthesiology and Critical Care Medicine, Hadassah University Medical Center, Hebrew University of Jerusalem, Israel
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Jakobson DJ, Katz E, Kramer MR. Coated cyclosporine: a new method of lung targeting. Transplant Proc 1997; 29:2667-9. [PMID: 9290784 DOI: 10.1016/s0041-1345(97)00550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D J Jakobson
- Institute of Pulmonology, Hadassah University Hospital, Jerusalem, Israel
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Kramer MR, Jakobson DJ, Springer C, Donchin Y. The safety of air transportation of patients with advanced lung disease. Experience with 21 patients requiring lung transplantation or pulmonary thromboendarterectomy. Chest 1995; 108:1292-6. [PMID: 7587432 DOI: 10.1378/chest.108.5.1292] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Air travel can cause severe respiratory decompensation in a patient with advanced lung disease due to high altitude hypoxemia. We report our experience in flying 21 patients with advanced lung disease to a medical center remote from Israel for lung transplantation or pulmonary thromboendarterectomy (PTE). All patients had severe lung disease with marked hypoxemia (PaO2, 40 to 59) and 16 had significant pulmonary hypertension. Nine patients (with emphysema and pulmonary fibrosis) required single lung transplant, four (with cystic fibrosis and emphysema) required double-lung transplant, six (with primary or secondary pulmonary hypertension) required heart-lung transplant, and two (with major vessel pulmonary thrombosis) required PTE. All patients were flown by commercial aircraft to centers located 2,634 to 13,181 km away from Israel. Length of flight was between 4 and 21 h. Patients were given oxygen supplementation during the flight and were monitored by portable oximeters. All but three patients were hemodynamically stable and 19 of them were escorted by physicians. All but one hemodynamically unstable patient who died on board arrived safely at their destinations. We conclude that with careful preparation, sufficient oxygen supply, oximetric monitoring, and medical escort, almost any patient with severe lung disease can travel by air to any necessary destination.
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Affiliation(s)
- M R Kramer
- Institute of Pulmonology, Hadassah University Hospital, Jerusalem, Israel
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