National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (6)
- Antibiotics (3)
- Antimicrobial Stewardship (2)
- Cardiovascular Conditions (1)
- Care Coordination (1)
- Care Management (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
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- Communication (1)
- (-) Critical Care (29)
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- Electronic Health Records (EHRs) (3)
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- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
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- Healthcare Utilization (1)
- Health Information Technology (HIT) (6)
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- Health Services Research (HSR) (1)
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- Intensive Care Unit (ICU) (17)
- Kidney Disease and Health (1)
- Medicaid (1)
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- Medication: Safety (2)
- Mortality (2)
- Neurological Disorders (1)
- Newborns/Infants (3)
- Nursing (1)
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- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (8)
- Practice Patterns (1)
- Prevention (1)
- Quality Improvement (2)
- Quality of Care (3)
- Registries (1)
- Respiratory Conditions (2)
- Risk (1)
- Rural Health (1)
- Sepsis (1)
- Shared Decision Making (2)
- Simulation (1)
- Surgery (2)
- Teams (4)
- Telehealth (1)
- Training (1)
- Transitions of Care (1)
- Trauma (1)
- Urinary Tract Infection (UTI) (1)
- Young Adults (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 25 of 29 Research Studies DisplayedGladen KM, Tellez D, Napolitano N
Adverse tracheal intubation events in critically ill underweight and obese children: retrospective study of the National Emergency Airway for Children Registry (2013-2020).
This retrospective cohort study’s aim was to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. The National Emergency Airway for Children registry dataset of 2013-2020 was used to identify 24,342 critically ill children who underwent TI between 2013 and 2020. Underweight was most common in infants (34%); and obesity was most common in children older than 8 years old (15.1%). The underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients. TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; and obesity: aOR, 1.22).
AHRQ-funded; HS024511.
Citation: Gladen KM, Tellez D, Napolitano N .
Adverse tracheal intubation events in critically ill underweight and obese children: retrospective study of the National Emergency Airway for Children Registry (2013-2020).
Pediatr Crit Care Med 2024 Feb; 25(2):147-58. doi: 10.1097/pcc.0000000000003387..
Keywords: Children/Adolescents, Critical Care
Van Damme DM, McRae EM, Irving SY
Tracheal intubation by advanced practice registered nurses in pediatric critical care: retrospective study from the National Emergency Airway for Children Registry (2015-2019).
A study was conducted from 2015-2019 to compare the success rates of tracheal intubation (TI) administered by advanced practice registered nurses (APRNs), vs. more experienced clinicians. It also compared the rates of TI-associated events (TIAE). The study subjects were critically ill children in need of tracheal intubation. The findings indicated a lower TI success rate for APRNs when compared to more experienced clinicians. The study did not find significant differences in adverse events.
AHRQ-funded; HS024511.
Citation: Van Damme DM, McRae EM, Irving SY .
Tracheal intubation by advanced practice registered nurses in pediatric critical care: retrospective study from the National Emergency Airway for Children Registry (2015-2019).
Pediatr Crit Care Med 2024 Feb; 25(2):139-46. doi: 10.1097/pcc.0000000000003386..
Keywords: Children/Adolescents, Critical Care, Nursing
Loi MV, Lee JH, Huh JW
Ketamine use in the intubation of critically ill children with neurological indications: a multicenter retrospective analysis.
This study examined use of ketamine in children undergoing tubal intubation (TI) for a primary neurological indication. The authors conducted a retrospective observational cohort study of critically ill children undergoing TI for neurological indications in 53 international pediatric intensive care units and emergency departments. They screened all intubations from 2014 to 2020 entered into the multicenter National Emergency Airway Registry for Children (NEAR4KIDS) registry database. Of 21,562 TIs, 2,073 were performed for a primary neurological indication, including 190 for traumatic brain injury/trauma. Patients received ketamine in 495 TIs (23.9%), which increased from 10% in 2014 to 41% in 2020. Criteria for ketamine use includes a coindication of respiratory failure, difficult airway history, and use of vagolytic agents, apneic oxygenation, and video laryngoscopy. Composite adverse outcomes were reported in 289 (13.9%) TIs and were more common in the ketamine group (17.0% vs. 13.0%). After adjusting for location, patient age and co-diagnoses, the presence of respiratory failure and shock, difficult airway history, provider demographics, intubating device, and the use of apneic oxygenation, vagolytic agents, and neuromuscular blockade, ketamine use was not significantly associated with increased composite adverse outcomes. This paucity of association remained even when only neurotrauma intubations were considered (10.6% vs. 7.7%).
AHRQ-funded; HS022464, HS024511.
Citation: Loi MV, Lee JH, Huh JW .
Ketamine use in the intubation of critically ill children with neurological indications: a multicenter retrospective analysis.
Neurocrit Care 2024 Feb; 40(1):205-14. doi: 10.1007/s12028-023-01734-0.
Keywords: Children/Adolescents, Critical Care, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Sick-Samuels AC, Koontz DW, Xie A
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
A survey of medical professionals from 16 different academic pediatric hospitals was conducted from May 2021-January 2022. The goal of the survey was to examine respiratory culture practices, drivers, and barriers in mechanically ventilated patients. The study concluded that respiratory culture practices were inconsistent.
AHRQ-funded; HS028634.
Citation: Sick-Samuels AC, Koontz DW, Xie A .
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
Pediatr Crit Care Med 2024 Jan; 25(1):e20-e30. doi: 10.1097/pcc.0000000000003379..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Healthcare-Associated Infections (HAIs)
Qureshi N, Kroger J, Zangwill KM
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
The purpose of this study was to assess clinician perceptions towards the value and implementation of antibiotic stewardship (AS) in neonatal intensive care units (NICU). The researchers conducted a mixed-methods study of AS perceptions utilizing surveys and interviews in 30 California NICUs before and after a multicenter collaborative (Optimizing Antibiotic Use in California NICUs [OASCN]). The study found that pre-OASCN, 24% of respondents believed there was "a lot of" or "some" inappropriate prescribing, often driven by fear of a bad outcome or hesitation to change existing practices. Clinicians reported statistically significant increases in AS importance, perceived AS activity, and more openness to change after OASCN.
AHRQ-funded; HS026168.
Citation: Qureshi N, Kroger J, Zangwill KM .
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
J Perinatol 2024 Jan; 44(1):62-70. doi: 10.1038/s41372-023-01823-0..
Keywords: Antibiotics, Antimicrobial Stewardship, Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Napolitano N, Laverriere EK, Craig N
Apneic oxygenation as a quality improvement intervention in an academic PICU.
The objective of this prospective pre/post observational study was to evaluate if the use of apneic oxygenation during tracheal intubation in children is feasible and would decrease the occurrence of oxygen desaturation. The investigators concluded that implementation of apneic oxygenation in PICU was feasible, and was associated with significant reduction in moderate and severe oxygen desaturation. They suggest that use of apneic oxygenation should be considered when intubating critically ill children.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Napolitano N, Laverriere EK, Craig N .
Apneic oxygenation as a quality improvement intervention in an academic PICU.
Pediatr Crit Care Med 2019 Dec;20(12):e531-e37. doi: 10.1097/pcc.0000000000002123..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Patient Safety, Adverse Events
Stoops C, Stone S, Evans E
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
The purpose of this study was to test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting. The authors concluded that a systematic surveillance program to identify high-risk infants can prevent nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.
AHRQ-funded; HS023763.
Citation: Stoops C, Stone S, Evans E .
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
J Pediatr 2019 Dec;215:223-28.e6. doi: 10.1016/j.jpeds.2019.08.046..
Keywords: Newborns/Infants, Medication, Medication: Safety, Patient Safety, Kidney Disease and Health, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Prevention, Adverse Drug Events (ADE), Adverse Events
Williams CN, Eriksson CO, Kirby A
Hospital mortality and functional outcomes in pediatric neurocritical care.
Pediatric neurocritical care (PNCC) outcomes research is scarce. In this study, the investigators aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. The investigators concluded that PNCC patients had high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability were affected, underscoring the ongoing multidisciplinary health care needs of survivors.
AHRQ-funded; HS022981.
Citation: Williams CN, Eriksson CO, Kirby A .
Hospital mortality and functional outcomes in pediatric neurocritical care.
Hosp Pediatr 2019 Dec;9(12):958-66. doi: 10.1542/hpeds.2019-0173..
Keywords: Children/Adolescents, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Neurological Disorders, Mortality, Hospitals, Inpatient Care, Outcomes, Patient-Centered Outcomes Research
Kitsios GD, Yang L, Manatakis DV
Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome.
This study examined whether certain plasma biomarkers can be used to help classify mechanically ventilated ICU patients with acute respiratory distress syndrome into hyper- and hypoinflammatory subphenotypes to facilitate more effective targeted therapy. The researchers performed longitudinal measures of 10 plasma biomarkers of host injury and inflammation. They were able to demonstrate that two-class models (hyper- vs hypoinflammatory subphenotypes) fit better than one-class models in patients with acute respiratory distress syndrome or patients at risk for acute respiratory distress (ARFA). Hyperinflammatory classification was associated higher severity of illness, worse clinical outcomes, and persistently elevated biomarkers of host injury and inflammation compared with hypoinflammatory patients.
AHRQ-funded; HS025455.
Citation: Kitsios GD, Yang L, Manatakis DV .
Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome.
Crit Care Med 2019 Dec;47(12):1724-34. doi: 10.1097/ccm.0000000000004018..
Keywords: Respiratory Conditions, Critical Care, Intensive Care Unit (ICU), Risk
Costa DK
The team, the team, the team: what critical care research can learn from football teams.
This article compares critical care ICUs to football teams and discusses how ICU teams can learn from the science of football teams. The author suggests that ICU teams should discuss team composition and their roles, and have individual and team training on team dynamics. She also suggests applying processes from football like huddles and time-outs that may be useful.
AHRQ-funded; HS024552.
Citation: Costa DK .
The team, the team, the team: what critical care research can learn from football teams.
Ann Am Thorac Soc 2019 Dec;16(12):1492-94. doi: 10.1513/AnnalsATS.201903-202IP.
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Keywords: Teams, Critical Care, Intensive Care Unit (ICU), Training
Bahr N, Meckler G, Hansen M
Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.
This study used simulation to evaluate Pediatric Advanced Life Support (PALS) guideline performance in pediatric emergency medical service (EMS) care and to introduce this easy-to-use tool to score guideline compliance and patient safety. Standard pediatric resuscitation simulations with a child manikin were created. The manikin was presented as a choking 6-year-old with a complex medical history who is unconscious and apneic, with bradycardic pulse. Teams were expected to monitor vitals, initiate airway management and CPR, and establish vascular access and administer epinephrine based on PALS guidelines. The authors observed 34 EMS teams providing care in P-OHCA simulations. Teams were found to be proficient in assessing vitals, using correct-sized equipment, intubation, and confirmation of tube placement. The teams were delayed in initiating positive pressure ventilation (PPV) and chest compressions, with many teams (53%) deviating from guidelines in chest compression. Half the teams performed continuous compressions before establishing an advanced airway and one team did not perform compressions. Twenty teams also deviated from medication guidelines with 12 teams failing to administer epinephrine, six teams underdosing, and two teams overdosing by more than 20%.
AHRQ-funded; HS025590.
Citation: Bahr N, Meckler G, Hansen M .
Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.
Am J Emerg Med 2021 Oct;48:301-06. doi: 10.1016/j.ajem.2021.06.061.
AHRQ-funded; HS025590..
AHRQ-funded; HS025590..
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Critical Care, Cardiovascular Conditions
Rafiei A, Ghiasi Rad M, Sikora A
Improving mixed-integer temporal modeling by generating synthetic data using conditional generative adversarial networks: a case study of fluid overload prediction in the intensive care unit.
The aim of this study was to pilot test integrating synthetic data within an existing dataset of complex medication data to improve machine learning model prediction of fluid overload. The study found that training machine learning algorithms on the combined synthetic and original dataset overall increased the performance of the predictive models compared to training on the original dataset. The best-performing model was the meta-model trained on the combined dataset with 0.83 AUROC while it enhanced the sensitivity across different training scenarios.
AHRQ-funded; HS028485, HS029009.
Citation: Rafiei A, Ghiasi Rad M, Sikora A .
Improving mixed-integer temporal modeling by generating synthetic data using conditional generative adversarial networks: a case study of fluid overload prediction in the intensive care unit.
Comput Biol Med 2024 Jan; 168:107749. doi: 10.1016/j.compbiomed.2023.107749..
Keywords: Critical Care, Intensive Care Unit (ICU), Health Information Technology (HIT)
Carayon P, Wetterneck TB, Cartmill R
Medication safety in two intensive care units of a community teaching hospital after electronic health record implementation: sociotechnical and human factors engineering considerations.
This study examined the impact of electronic health record (EHR) implementation in two intensive care units (ICUs). The authors assessed 1254 consecutive admissions before and after an EHR implementation. They identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). The overall potential for harm due to medication errors decreased post-implementation, but only 2 of the 3 error rates were significantly lower post-implementation. They observed reductions in rates of medication errors per admission at the stages of transcription, dispensing, and administration. In the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information).
AHRQ-funded; HS015274; HS000083.
Citation: Carayon P, Wetterneck TB, Cartmill R .
Medication safety in two intensive care units of a community teaching hospital after electronic health record implementation: sociotechnical and human factors engineering considerations.
J Patient Saf 2021 Aug 1;17(5):e429-e39. doi: 10.1097/pts.0000000000000358.
AHRQ-funded; HS015274; HS000083..
AHRQ-funded; HS015274; HS000083..
Keywords: Medication: Safety, Medication, Intensive Care Unit (ICU), Critical Care, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Law AC, Stevens JP, Walkey AJ
Hospital variation in gastrostomy tube use among the critically ill.
This article describes an analysis of hospital variation in gastrostomy tube use among critically ill patients in hospitals. The investigators used the AHRQ National Inpatient Sample Database from 2014. They identified hospitalized patients using ICD-9, Clinical Modification codes consistent with critical illness who received gastrostomy tubes. Overall, the median rate was 2.0 per 100 critically ill patients with no variation between hospital size.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Walkey AJ .
Hospital variation in gastrostomy tube use among the critically ill.
Ann Am Thorac Soc 2019 Sep;16(9):1201-03. doi: 10.1513/AnnalsATS.201903-250RL..
Keywords: Surgery, Critical Care, Practice Patterns, Hospitals
Wooldridge A, Carayon P, Hoonakker P
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, the investigators combined interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity.
AHRQ-funded; HS023837.
Citation: Wooldridge A, Carayon P, Hoonakker P .
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Cogn Technol Work 2019 Aug;21(3):397-416. doi: 10.1007/s10111-018-0520-0..
Keywords: Care Coordination, Children/Adolescents, Critical Care, Health Services Research (HSR), Healthcare Delivery, Inpatient Care, Patient Safety, Teams, Trauma, Young Adults
Hussain FS, Sosa T, Ambroggio L
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
This case-control study aimed to determine the predictive validity of an emergency transfer (ET) for outcomes in a free-standing children's hospital. Controls were matched in terms of age, hospital unit, and time of year. Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality (22% vs 9%), longer ICU length of stay (4.9 vs 2.2 days), and longer posttransfer length of stay (26.4 vs 14.7 days) compared with controls (P < .03 for each).
AHRQ-funded; HS023827.
Citation: Hussain FS, Sosa T, Ambroggio L .
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
J Hosp Med 2019 Aug;14(8):482-85. doi: 10.12788/jhm.3219..
Keywords: Transitions of Care, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Outcomes, Patient-Centered Outcomes Research, Inpatient Care, Hospitalization, Hospitals, Healthcare Delivery
Barbash IJ, Wallace DJ, Kahn JM
Effects of changes in ICU bed supply on ICU utilization.
The purpose of this study was to determine the relationship between intensive care unit (ICU) bed supply and ICU admission in US hospitals. Using a difference-in-differences approach, researchers compared the risk-adjusted probability of ICU admission at hospitals that increased their ICU bed supply over time with matched hospitals that did not. Subjects were three patient groups with a low likelihood of benefiting from ICU admission: low-severity patients with acute myocardial infarction and pulmonary embolism, and high-severity patients with metastatic cancer at the end of life. Results showed that increases in ICU bed supply were associated with inconsistent changes in the probability of ICU admission that varied across patient subgroups.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Wallace DJ, Kahn JM .
Effects of changes in ICU bed supply on ICU utilization.
Med Care 2019 Jul;57(7):544-50. doi: 10.1097/mlr.0000000000001137..
Keywords: Intensive Care Unit (ICU), Critical Care, Healthcare Utilization, Hospitalization, Healthcare Delivery, Hospitals
Hinson JS, Martinez DA, Cabral S
Triage performance in emergency medicine: a systematic review.
The authors synthesized existing emergency department (ED) triage literature by using a framework that enables performance comparisons and benchmarking across triage systems, with respect to clinical outcomes and reliability. They found that a substantial proportion of ED patients who die post-encounter or who are critically ill are not designated as high acuity at triage. They suggested that the opportunity exists to improve interrater reliability and triage performance in identifying patients at risk of adverse outcome.
AHRQ-funded; HS023641.
Citation: Hinson JS, Martinez DA, Cabral S .
Triage performance in emergency medicine: a systematic review.
Ann Emerg Med 2019 Jul;74(1):140-52. doi: 10.1016/j.annemergmed.2018.09.022..
Keywords: Emergency Department, Shared Decision Making, Critical Care, Outcomes, Health Information Technology (HIT)
Chiotos K, Tamma PD, Gerber JS
Antibiotic stewardship in the intensive care unit: challenges and opportunities.
This study examined unique considerations and knowledge gaps in antibiotic stewardship intervention in the intensive care unit (ICU). There is limited data available, but the available data was summarized and included the impact of prospective audit and feedback, diagnostic test stewardship, rapid molecular diagnostic tests, and procalcitonin-guided algorithms for antibiotic discontinuation.
AHRQ-funded; HS026393.
Citation: Chiotos K, Tamma PD, Gerber JS .
Antibiotic stewardship in the intensive care unit: challenges and opportunities.
Infect Control Hosp Epidemiol 2019 Jun;40(6):693-98. doi: 10.1017/ice.2019.74..
Keywords: Antimicrobial Stewardship, Antibiotics, Intensive Care Unit (ICU), Critical Care, Antibiotics
Boltey EM, Iwashyna TJ, Hyzy RC
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
In order to support coordination among ICU team members, researchers developed a shared mental model (SMM). After administering a survey at the 2016 MHA Keystone Center ICU workshop, different components of SMMs were measured using five items from a validated survey, each on a 5-point Likert scale. Self-reported routine ABCDE implementation was measured using a single item 4-point Likert scale, and the relationship between SMMs and routine ABCDE implementation measured using logistic regression. The majority of survey respondents reported using the ABCDE bundle routinely. Odds of reporting routine ABCDE implementation significantly decreased when clinicians agreed it was difficult to predict team members' behaviors. The researchers conclude that increased awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles such as ABCDE.
AHRQ-funded; HS024552.
Citation: Boltey EM, Iwashyna TJ, Hyzy RC .
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
J Crit Care 2019 Jun;51:192-97. doi: 10.1016/j.jcrc.2019.02.028..
Keywords: Care Management, Critical Care, Hospitals, Intensive Care Unit (ICU), Healthcare Delivery, Teams
Law AC, Stevens JP, Walkey AJ
Gastrostomy tube use in the critically ill, 1994-2014.
This study used AHRQ’s Healthcare Cost and Utilization Project’s (HCUP’s) National Inpatient Sample to evaluate trends in gastrostomy tube use among critically ill adults from 1994 to 2014. Patients with dementia were excluded from the study. It was found that tube use more than doubled during that time period. Most patients were discharged to long-term care facilities after tube placement. Population-based rates went from 11.9 to 28.8 gastrostomies per 100,000 adults which is an increase of 142%.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Walkey AJ .
Gastrostomy tube use in the critically ill, 1994-2014.
Ann Am Thorac Soc 2019 Jun;16(6):724-30. doi: 10.1513/AnnalsATS.201809-638OC..
Keywords: Critical Care, Digestive Disease and Health, Healthcare Cost and Utilization Project (HCUP), Outcomes, Patient-Centered Outcomes Research, Surgery
Khandelwal N, White L, Curtis JR
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
The objective of this study was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and to examine how these costs vary by insurance coverage. Results showed that, across all categories of insurance coverage, out-of-pocket spending in the last 12 months of life was high and represented a significant portion of assets for many patients requiring intensive care and their families. Medicare fee-for-service alone did not insulate individuals from the financial burden of high-intensity care. Medicaid was found to provide the most complete hospital coverage of all the insurance groups, as well as significantly financing long-term care.
AHRQ-funded; HS022982.
Citation: Khandelwal N, White L, Curtis JR .
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
Crit Care Med 2019 Jun;47(6):749-56. doi: 10.1097/ccm.0000000000003723..
Keywords: Critical Care, Elderly, Health Insurance, Healthcare Costs, Intensive Care Unit (ICU), Medicaid, Medicare
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
Pepper DJ, Sun J, Rhee C
Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis.
This study is a systematic review and meta-analysis on survival outcomes of using procalcitonin (PCT)-guided antibiotic discontinuation on critically ill adults. The study quality was assessing with the Cochrane risk of bias tool, and GRADEpro was used to grade evidence. PCT-guided discontinuation was associated with decreased mortality, but there was a high risk of bias in many of the studies reviewed with a low certainty of evidence. The authors suggest properly designed studies with mortality as the primary outcome is needed to further answer this question.
AHRQ-funded; HS025008.
Citation: Pepper DJ, Sun J, Rhee C .
Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis.
Chest 2019 Jun;155(6):1109-18. doi: 10.1016/j.chest.2018.12.029..
Keywords: Antibiotics, Critical Care, Evidence-Based Practice, Medication, Mortality, Outcomes, Sepsis
Sanders R, Edwards L, Nishisaki A
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
This editorial discusses a research study on outcomes of performing pediatric trachael intubations (TIs) and how the results can be applied to performing intubations on critically ill children in the United Kingdom outside of specialized centers. One of the authors is from a U.S. site that submits its airway management data to the National Emergency Airway Registry for Children (NEAR4KIDS). The results from the registry were compared to the results from the study. A total of 1,051 patients out of 1,237 eligible patients were analyzed. The results came from 47 nonspecialized local hospitals in the North Thames and East Anglia region of the UK. Adverse TI-associated events (TIAEs) occurred in 22.7% of the patients, which is higher than those in PICUs and cardiac ICUs. The majority of intubations were performed by the anesthesiologist in the team. The results were similar to those in the NEAR4KIDS registry. There were more complications with children with a higher grade of airway difficulties and comorbidities. The authors believe that pediatric airway management for acutely ill children would benefit from new strategies. They recommend a system change using Plan, Do, Study, Act (PDSA) cycles.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Sanders R, Edwards L, Nishisaki A .
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
Pediatr Crit Care Med 2019 Jun;20(6):572-73. doi: 10.1097/pcc.0000000000001946..
Keywords: Adverse Events, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Outcomes, Patient Safety, Registries, Respiratory Conditions