National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Antibiotics (4)
- Antimicrobial Stewardship (3)
- (-) Children/Adolescents (9)
- Critical Care (2)
- Diagnostic Safety and Quality (1)
- (-) Intensive Care Unit (ICU) (9)
- (-) Medication (9)
- Medication: Safety (2)
- Patient Safety (2)
- Practice Patterns (1)
- Sepsis (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 9 of 9 Research Studies DisplayedChiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis
Chiotos K, Marshall D, Kellom K
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
The purpose of this study was to perform an evaluation of a diagnostic stewardship initiative for respiratory culture in the healthcare setting within a pediatric intensive care unit (PICU) in a tertiary-care center. The study found that the frequency of culture collection per day of service differed among attending physicians, ranging from 2.2 to 27 cultures per 100 days. A total of 14 interviews were conducted, and 87 clinicians (response rate: 47%) along with 77 nurses or respiratory therapists (response rate: 17%) participated in the survey. There was a variation in clinicians' stated practices concerning culture ordering, which was influenced by both their specialty and their perception of the respiratory culture's usefulness. Additionally, group "default" practices, fear, and hierarchy affected the decision to order cultures. Obstacles to standardization encompassed concerns about missing a diagnosis and the conflict between standardized practices and individual judgment.
AHRQ-funded; HS026393.
Citation: Chiotos K, Marshall D, Kellom K .
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):191-99. doi: 10.1017/ice.2022.299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Antibiotics, Medication, Antimicrobial Stewardship, Intensive Care Unit (ICU)
Ramsden SC, Pergjika A, Janssen AC
A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings.
This systematic review evaluated the effectiveness and safety of droperidol for the management of acute, severe agitation in children in acute care settings. The authors conclude that existing data indicate that droperidol is both effective and safe; however, data are limited by study designs that may introduce bias.
AHRQ-funded; HS026385.
Citation: Ramsden SC, Pergjika A, Janssen AC .
A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings.
Acad Emerg Med 2022 Dec;29(12):1466-74. doi: 10.1111/acem.14515..
Keywords: Children/Adolescents, Medication, Medication: Safety, Intensive Care Unit (ICU), Patient Safety
Chiotos K, Fitzgerald JC, Hayes M
Improving vancomycin stewardship in critically ill children.
The purpose of this study was to describe a quality improvement intervention to reduce the use of vancomycin in a tertiary care Pediatric Intensive Care Unit. Over a period of 3 years, the researchers conducted 3 quality improvement (QI) interventions including 1) stakeholder education, 2) development of a consensus-based guideline for empiric vancomycin use, and 3) implementation of the guideline through clinical decision support. The study found that of 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias. Over the 3-year period of the QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). The study concluded that the intervention reduced overall vancomycin use in the Pediatric Intensive Care Unit without evidence of harm.
AHRQ-funded; HS026393.
Citation: Chiotos K, Fitzgerald JC, Hayes M .
Improving vancomycin stewardship in critically ill children.
Pediatrics 2022 Apr;149(4):e2021052165. doi: 10.1542/peds.2021-052165..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Conway JA, Kharayat P, Sanders RC
Ketamine use for tracheal intubation in critically ill children is associated with a lower occurrence of adverse hemodynamic events.
Tracheal intubation in critically ill children with shock poses a risk of hemodynamic compromise. Ketamine has been considered the drug of choice for induction in these patients, but limited data exist. In this study, the authors investigated whether the administration of ketamine for tracheal intubation in critically ill children with or without shock was associated with fewer adverse hemodynamic events compared with other induction agents. They also investigated if there was a dose dependence for any association between ketamine use and adverse hemodynamic events.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Conway JA, Kharayat P, Sanders RC .
Ketamine use for tracheal intubation in critically ill children is associated with a lower occurrence of adverse hemodynamic events.
Crit Care Med 2020 Jun;48(6):e489-e97. doi: 10.1097/ccm.0000000000004314..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Medication
Sick-Samuels AC, Woods-Hill CZ, Fackler JC
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
The goal of this study was to evaluate whether the use of antibiotics at the Johns Hopkins pediatric intensive care unit (PICU) changed in relation to a reduction in utilization of blood culture. Antibiotic usage is used as a balancing measure, because a reduction in blood cultures could lead to an increase in antibiotic treatment if clinicians continued treatment in scenarios when blood culture results were not available. The authors examined the administration of antibiotics over 12 months while a locally developed blood-culture guideline was being implemented. The distribution of antibiotics remained similar over the pre- and post-implementation periods.
AHRQ-funded; HS025642.
Citation: Sick-Samuels AC, Woods-Hill CZ, Fackler JC .
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
Infect Control Hosp Epidemiol 2019 Apr;40(4):482-84. doi: 10.1017/ice.2019.10..
Keywords: Antibiotics, Children/Adolescents, Intensive Care Unit (ICU), Medication, Practice Patterns
Dai D, Feinstein JA, Morrison W
Epidemiology of polypharmacy and potential drug-drug interactions among pediatric patients in ICUs of U.S. children's hospitals.
The authors studied the characteristics and prevalence of exposure of pediatric patients to polypharmacy and potential drug-drug interactions in pediatric intensive care units (PICUs). They found that many PICU patients are exposed to substantial polypharmacy and potential drug-drug interactions. Future research should identify the risk of adverse drug events following specific potential drug-drug interaction exposures.
AHRQ-funded; HS018425.
Citation: Dai D, Feinstein JA, Morrison W .
Epidemiology of polypharmacy and potential drug-drug interactions among pediatric patients in ICUs of U.S. children's hospitals.
Pediatr Crit Care Med 2016 May;17(5):e218-28. doi: 10.1097/pcc.0000000000000684.
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Keywords: Adverse Drug Events (ADE), Children/Adolescents, Intensive Care Unit (ICU), Medication, Medication: Safety
Costarino AT, Dai D, Feng R
Gastric acid suppressant prophylaxis in pediatric intensive care: current practice as reflected in a large administrative database.
The researchers described the use of histamine 2 receptor blockers and proton pump inhibitors and associated factors among a national sample of pediatric intensivecare unit (PICU) patients with stress-related gatrointestinal bleeding. Histamine 2 receptor blocker and proton pump inhibitor are prescribed in most PICU patients, but significant variation exists across health conditions and hospitals.
AHRQ-funded; HS018425.
Citation: Costarino AT, Dai D, Feng R .
Gastric acid suppressant prophylaxis in pediatric intensive care: current practice as reflected in a large administrative database.
Pediatr Crit Care Med 2015 Sep;16(7):605-12. doi: 10.1097/pcc.0000000000000427.
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Keywords: Children/Adolescents, Intensive Care Unit (ICU), Children/Adolescents, Medication
Tarquinio KM, Howell JD, Montgomery V
Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study.
The objective of this study was to evaluate the association of medication selection on specific tracheal intubation–associated events across pediatric intensive care units. It found that fentanyl, midazolam, and ketamine were the most commonly used induction agents, and the majority of tracheal intubations involved neuromuscular blockade. Ketamine use was not associated with lower prevalence of hypotension.
AHRQ-funded; HS022464; HS021583.
Citation: Tarquinio KM, Howell JD, Montgomery V .
Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study.
Pediatr Crit Care Med 2015 Mar;16(3):210-8. doi: 10.1097/pcc.0000000000000319..
Keywords: Children/Adolescents, Patient Safety, Intensive Care Unit (ICU), Adverse Events, Medication