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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Caregiving (1)
- Children/Adolescents (2)
- Clinical Decision Support (CDS) (1)
- Communication (1)
- Critical Care (6)
- Diagnostic Safety and Quality (1)
- Elderly (1)
- Electronic Health Records (EHRs) (4)
- Healthcare-Associated Infections (HAIs) (1)
- Health Information Technology (HIT) (1)
- Health Status (1)
- Hospitalization (1)
- Hospitals (1)
- (-) Intensive Care Unit (ICU) (13)
- Neonatal Intensive Care Unit (NICU) (1)
- Newborns/Infants (1)
- Palliative Care (1)
- Patient-Centered Healthcare (1)
- Patient and Family Engagement (2)
- Patient Experience (1)
- Patient Safety (6)
- Provider Performance (2)
- Quality of Care (1)
- Risk (1)
- (-) Shared Decision Making (13)
- Simulation (1)
- Teams (2)
- Training (2)
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 13 of 13 Research Studies DisplayedValley TS, Schutz A, Miller J
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
In order to understand factors influencing how intensive care unit (ICU) admission decisions are made, researchers conducted qualitative analysis of eight U.S. hospitals. Semi-structured, one-on-one interviews with 87 participants were supplemented by site visits and clinical observations. Four hospital-level factors were identified which influenced ICU admission decisionmaking. The researchers concluded that healthcare systems should evaluate use of ICU care and establish institutional patterns to ensure that ICU admission decisions are patient-centered as well as account for resources and hospital-specific constraints.
AHRQ-funded; HS028038.
Citation: Valley TS, Schutz A, Miller J .
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
Intensive Care Med 2023 May; 49(5):505-16. doi: 10.1007/s00134-023-07031-w..
Keywords: Intensive Care Unit (ICU), Hospitals, Shared Decision Making, Hospitalization
Viglianti EM, Ervin JN, Newton CA
Time-limited trials in the ICU: a mixed-methods sequential explanatory study of intensivists at two academic centres.
Investigators sought to understand intensivist perceptions of the appropriateness of time-limited trials (TLTs), a strategy to align life-sustaining care with patient goals and values in the midst of clinical uncertainty. They conducted semi-structured interviews with intensivists, revealing that having clarity about patient goals and clinical endpoints facilitated successful TLTs while lack of an evidenced-based framework was a barrier. More than half of the physicians who responded had conducted or participated in a TLT.
AHRQ-funded; HS028038.
Citation: Viglianti EM, Ervin JN, Newton CA .
Time-limited trials in the ICU: a mixed-methods sequential explanatory study of intensivists at two academic centres.
BMJ Open 2022 Apr 4;12(4):e059325. doi: 10.1136/bmjopen-2021-059325..
Keywords: Intensive Care Unit (ICU), Critical Care, Shared Decision Making
Murray DJ, Boulet JR, Boyle WA
Competence in decision making: setting performance standards for critical care.
Health care professionals must be able to make frequent and timely decisions that can alter the illness trajectory of intensive care patients. A competence standard for this ability is difficult to establish yet assuring practitioners can make appropriate judgments is an important step in advancing patient safety. In this study, the investigators hypothesized that simulation could be used effectively to assess decision-making competence.
AHRQ-funded; HS022265.
Citation: Murray DJ, Boulet JR, Boyle WA .
Competence in decision making: setting performance standards for critical care.
Anesth Analg 2021 Jul 1;133(1):142-50. doi: 10.1213/ane.0000000000005053..
Keywords: Critical Care, Shared Decision Making, Intensive Care Unit (ICU), Simulation, Provider Performance, Patient Safety, Quality of Care
Sick-Samuels AC, Linz M, Bergmann J
Diagnostic stewardship of endotracheal aspirate cultures in a PICU.
This study describes the development and impact of a clinical decision support algorithm to standardize the use of endotracheal aspirate cultures (EACs) from ventilated PICU patients in the evaluation of suspected ventilator-associated infections. Bacterial growth in EACs does not distinguish bacterial colonization from infection and may lead to overtreatment with antibiotics. The rate of EACs was compared pre- and postintervention. In the preintervention year there were 557 EACs over 5092 ventilator days. After introduction of the algorithm the rate went down to 234 EACs over 3654 ventilator days. There was a 41% decrease in the monthly rate of EACs. This intervention did not affect mortality, readmissions, or length of stay in ventilated PICU patients.
AHRQ-funded; HS025642.
Citation: Sick-Samuels AC, Linz M, Bergmann J .
Diagnostic stewardship of endotracheal aspirate cultures in a PICU.
Pediatrics 2021 May;147(5). doi: 10.1542/peds.2020-1634..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Clinical Decision Support (CDS), Shared Decision Making, Healthcare-Associated Infections (HAIs), Diagnostic Safety and Quality
Neu M, Klawetter S, Greenfield JC
Mothers' experiences in the NICU before family-centered care and in NICUs where it is the standard of care.
Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago.
AHRQ-funded; HS026370.
Citation: Neu M, Klawetter S, Greenfield JC .
Mothers' experiences in the NICU before family-centered care and in NICUs where it is the standard of care.
Adv Neonatal Care 2020 Feb;20(1):68-79. doi: 10.1097/anc.0000000000000671.
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Keywords: Newborns/Infants, Patient-Centered Healthcare, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Caregiving, Shared Decision Making, Patient Experience, Patient and Family Engagement
Woods-Hill CZ, Koontz DW, King AF
Practices, perceptions, and attitudes in the evaluation of critically ill children for bacteremia: a national survey.
Sending blood cultures in children at low risk of bacteremia can contribute to a cascade of unnecessary antibiotic exposure, adverse effects, and increased costs. In this study, the investigators aimed to describe practice variation, clinician beliefs, and attitudes about blood culture testing in critically ill children. They concluded that there is variation in blood culture practices in the pediatric ICU. Fear and reflexive habits are common drivers of cultures. These practices may contribute to over-testing for bacteremia.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Koontz DW, King AF .
Practices, perceptions, and attitudes in the evaluation of critically ill children for bacteremia: a national survey.
Pediatr Crit Care Med 2020 Jan;21(1):e23-e29. doi: 10.1097/pcc.0000000000002176..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Intensive Care Unit (ICU), Shared Decision Making
Kruser JM, Benjamin BT, Gordon EJ
Patient and family engagement during treatment decisions in an ICU: a discourse analysis of the electronic health record.
This study looked at patient and family engagement during treatment decisions with patients in a medical ICU. A total of 52 patients were included who had been admitted to a hospital ICU during 2016. Half of them met a consensus definition of chronic critical illness, and the other half either died or had transitioned to hospice care in the ICU. Clinical electronic health records (EHRs) were used to document decision points. The phrase “goals of care” was frequently found in the HER and was used to indicate poor prognosis.
AHRQ-funded; HS000078.
Citation: Kruser JM, Benjamin BT, Gordon EJ .
Patient and family engagement during treatment decisions in an ICU: a discourse analysis of the electronic health record.
Crit Care Med 2019 Jun;47(6):784-91. doi: 10.1097/ccm.0000000000003711..
Keywords: Critical Care, Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient and Family Engagement
Bordley J, Sakata KK, Bierman J
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
The electronic health record is a primary source of information for all professional groups participating in ICU rounds. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, the investigators created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
Crit Care Med 2018 Oct;46(10):1570-76. doi: 10.1097/ccm.0000000000003302..
Keywords: Shared Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Teams
Satchidanand N, Servoss TJ, Singh R
Development of a risk tool to support discussions of care for older adults admitted to the ICU with pneumonia.
The purpose of this study was to develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. The authors suggest that their risk tool can help care teams make more informed decisions among care options by identifying a patient group for whom a careful review of goals of care is indicated both during and after hospitalization.
AHRQ-funded; HS023656.
Citation: Satchidanand N, Servoss TJ, Singh R .
Development of a risk tool to support discussions of care for older adults admitted to the ICU with pneumonia.
Am J Hosp Palliat Care 2018 Sep;35(9):1201-06. doi: 10.1177/1049909118764093..
Keywords: Shared Decision Making, Elderly, Health Status, Intensive Care Unit (ICU), Palliative Care, Risk
Boyle WA, Murray DJ, Beyatte MB
Simulation-based assessment of critical care "front-line" providers.
The researchers developed a standardized simulation method to assess clinical skills of ICU providers. Their simulation assessments yielded reasonably reliable measures of Critical Care Medicine decision-making skills. Despite a wide range of performance, those with more ICU training and experience performed better, providing evidence to support the validity of the scores.
AHRQ-funded; HS018734; HS022265.
Citation: Boyle WA, Murray DJ, Beyatte MB .
Simulation-based assessment of critical care "front-line" providers.
Crit Care Med 2018 Jun;46(6):e516-e22. doi: 10.1097/ccm.0000000000003073.
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Keywords: Critical Care, Shared Decision Making, Intensive Care Unit (ICU), Provider Performance, Training
Bordley J, Sakata KK, Bierman J
Medication history versus point-of-care platelet activity testing in patients with intracerebral hemorrhage.
This study evaluated whether reduced platelet activity detected by point-of-care (POC) testing was a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure. A history of antiplatelet medication use better identified patients at risk for hematoma growth and poor functional outcomes than POC measures of platelet activity after spontaneous ICH.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Medication history versus point-of-care platelet activity testing in patients with intracerebral hemorrhage.
Crit Care Med 2018 Oct;46(10):1570-76. doi: 10.1097/ccm.0000000000003302..
Keywords: Shared Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Teams
Segall N, Bennett-Guerrero E
ICU rounds: "What we've got here is failure to communicate".
Many of the decisions regarding critical care patients are made during patient rounds—approximately nine per patient— based on the premise that the data that inform the decisions are accurate and complete. The study by Artis et al in this issue challenges this premise. The authors discuss the article, its context and implications.
AHRQ-funded; HS023387.
Citation: Segall N, Bennett-Guerrero E .
ICU rounds: "What we've got here is failure to communicate".
Crit Care Med 2017 Feb;45(2):366-67. doi: 10.1097/ccm.0000000000002125.
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Keywords: Communication, Critical Care, Shared Decision Making, Intensive Care Unit (ICU), Patient Safety
Gold JA, Tutsch AS, Gorsuch A
Integrating the electronic health record into high-fidelity interprofessional intensive care unit simulations.
The authors described the impact of integrating the electronic health record (EHR) into high-fidelity, interprofessional intensive care unit (ICU) simulations, and the errors induced. They found a number of safety issues directly related to the EHR, and they now have an infrastructure to focus educational initiative and deploy informatics solutions to mitigate these safety issues.
AHRQ-funded; HS021637.
Citation: Gold JA, Tutsch AS, Gorsuch A .
Integrating the electronic health record into high-fidelity interprofessional intensive care unit simulations.
J Interprof Care 2015;29(6):562-3. doi: 10.3109/13561820.2015.1063482.
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Keywords: Shared Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Training