National Healthcare Quality and Disparities Report
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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 73 Research Studies DisplayedFlannery DD, Zevallos Barboza A, Mukhopadhyay S
Antibiotic use among infants admitted to neonatal intensive care units.
The purpose of this cross-sectional study was to examine antibiotic exposure, days of therapy, types of antibiotics, and changes in use patterns among newborns in neonatal intensive care units (NICUs) across the U.S. Data for almost 1.4 million infants were taken from the Premier Healthcare Database. The most common antibiotics prescribed during the study period were ampicillin, gentamicin, vancomycin, and cefotaxime. Antibiotic use declined substantially over time, primarily because of reductions in ampicillin and gentamicin. The authors noted that these findings probably reflect the penetration of national calls for neonatal antibiotic stewardship efforts and refined early-onset infection risk-assessment strategies; shortage and subsequent discontinuation of cefotaxime may have played a role in the sharp decline in its use and the related increase in ceftazidime use.
AHRQ-funded; HS027468.
Citation: Flannery DD, Zevallos Barboza A, Mukhopadhyay S .
Antibiotic use among infants admitted to neonatal intensive care units.
JAMA Pediatr 2023 Dec; 177(12):1354-56. doi: 10.1001/jamapediatrics.2023.3664..
Keywords: Newborns/Infants, Antibiotics, Medication, Intensive Care Unit (ICU), Critical Care
Eaton TL, Lincoln TE, Lewis A
Palliative care in survivors of critical illness: a qualitative study of post-intensive care unit program clinicians.
This paper’s goal was to understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and to explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. The authors conducted semistructured interviews with 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. All clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. These clinician-level facilitators promoted palliative care strategies including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers discussed included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers mentioned were time constraints, cost, and lack of specialty palliative care services.
AHRQ-funded; HS027210.
Citation: Eaton TL, Lincoln TE, Lewis A .
Palliative care in survivors of critical illness: a qualitative study of post-intensive care unit program clinicians.
J Palliat Med 2023 Dec; 26(12):1644-53. doi: 10.1089/jpm.2023.0034..
Keywords: Palliative Care, Critical Care
Cifra CL, Custer JW, Smith CM
Prevalence and characteristics of diagnostic error in pediatric critical care: a multicenter study.
This study’s objective was to determine the prevalence and characteristics of diagnostic errors and identify factors associated with error in patients admitted to the PICU. This multicenter cohort study used structured medical record review by trained clinicians using the Revised Safer Dx instrument to identify diagnostic error (defined as missed opportunities in diagnosis). The cohort included 882 randomly selected patients 0-18 years old who were nonelectively admitted to participating PICUs. Of these admissions, 13 (1.5%) had a diagnostic error up to 7 days after PICU admission, with infections (46%) and respiratory conditions (23%) being the most missed diagnoses. One diagnostic error caused a prolonged hospital stay. Common missed diagnostic opportunities included failure to consider the diagnosis despite a suggestive history and failure to broaden diagnostic testing, both at 69%. Unadjusted analysis identified more diagnostic errors in patients with atypical presentations (23.1% vs 3.6%), neurologic chief complaints (46.2% vs 18.8%), admitting intensivists greater than or equal to 45 years old (92.3% vs 65.1%), admitting intensivists with more service weeks/year (mean 12.8 vs 10.9 weeks), and diagnostic uncertainty on admission (77% vs 25.1%). Generalized linear mixed models determined that atypical presentation (odds ratio [OR] 4.58) and diagnostic uncertainty on admission (OR 9.67) were significantly associated with diagnostic error.
AHRQ-funded; HS026965.
Citation: Cifra CL, Custer JW, Smith CM .
Prevalence and characteristics of diagnostic error in pediatric critical care: a multicenter study.
Crit Care Med 2023 Nov; 51(11):1492-501. doi: 10.1097/ccm.0000000000005942..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Critical Care, Intensive Care Unit (ICU), Medical Errors, Patient Safety
Woods-Hill CZ, Koontz DW, Colantuoni EA
Sustainability of the Bright STAR diagnostic stewardship program to reduce blood culture rates among critically ill children.
From 2017 to2020, 14 pediatric intensive care units (PICUs) participated in the Bright STAR (Testing Stewardship for Antibiotic Reduction) QI collaborative to reduce unnecessary blood cultures for PICU patients. The collaborative project found that 4 sites demonstrated a 33% decrease in blood culture rates and a 13% decrease in broad spectrum antibiotic use. The purpose of this current study was to assess whether sites sustained reduced blood culture rates after completion of the formal project. The study found that all sites had lower blood culture rates during the sustainability period when compared with the pre-implementation period. The blood culture rate increased 8% during the sustainability period compared with the postimplementation period but was 27% lower than during the pre-implementation period.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Koontz DW, Colantuoni EA .
Sustainability of the Bright STAR diagnostic stewardship program to reduce blood culture rates among critically ill children.
JAMA Pediatr 2023 Nov; 177(11):1234-37. doi: 10.1001/jamapediatrics.2023.3229..
Keywords: Children/Adolescents, Critical Care, Quality Improvement, Diagnostic Safety and Quality, Quality of Care
Sikora A, Jeong H, Yu M
Cluster analysis driven by unsupervised latent feature learning of medications to identify novel pharmacophenotypes of critically ill patients.
This study used a machine learning approach (Restricted Boltzmann Machine) to perform an unsupervised analysis of 991 medication profiles of patients managed in the intensive care unit (ICU) to explore pharmacophenotypes that correlated with ICU complications (e.g., mechanical ventilation) and patient-centered outcomes (e.g., length of stay, mortality). The authors observed six unique pharmacophenotypes, with unique medication profiles and clinically relevant differences in ICU complications and patient-centered outcomes. While pharmacophenotypes 2 and 4 had no statistically significant difference in ICU length of stay, duration of mechanical ventilation, or duration of vasopressor use, their mortality differed significantly (9.0% vs. 21.9%). All but pharmacophenotype 4 had a mortality rate ranging from 2.5 to 9%. This approach has shown promise in classifying the heterogenous syndromes of critical illness to predict treatment response and guide clinical decision support systems but have never included comprehensive medication information.
AHRQ-funded; HS028485.
Citation: Sikora A, Jeong H, Yu M .
Cluster analysis driven by unsupervised latent feature learning of medications to identify novel pharmacophenotypes of critically ill patients.
Sci Rep 2023 Sep 20; 13(1):15562. doi: 10.1038/s41598-023-42657-2..
Keywords: Medication, Critical Care
Karvonen KL, Anunwah E, Chambers Butcher BD
Structural racism operationalized via adverse social events in a single-center neonatal intensive care unit.
The purpose of this retrospective cohort study was to assess structural racism in the neonatal intensive care unit (NICU) by establishing whether variations in adverse social events occur by racialized groups. The study included 3,290 infants hospitalized in a single center NICU in the Racial and Ethnic Justice in Outcomes in Neonatal Intensive Care (REJOICE) study, and researchers included demographics and adverse social events including infant urine toxicology screening, child protective services (CPS) referrals, behavioral contracts, and security emergency response calls were collected from electronic medical records. The study found that 6.2% of families experienced an adverse social event. Black families had a greater likelihood of having experienced a CPS referral and a urine toxicology screen. American Indian and Alaskan Native families also had a greater likelihood of experiencing CPS referrals and urine toxicology screens. Black families had a greater likelihood of experiencing behavioral contracts and security emergency response calls. Latinx families had a similar risk of adverse events, and Asian families were less likely to experience adverse events.
AHRQ-funded; HS028473; HS026383.
Citation: Karvonen KL, Anunwah E, Chambers Butcher BD .
Structural racism operationalized via adverse social events in a single-center neonatal intensive care unit.
J Pediatr 2023 Sep; 260:113499. doi: 10.1016/j.jpeds.2023.113499..
Keywords: Racial and Ethnic Minorities, Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Lenz KB, Nishisaki A, Lindell RB
Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant.
The goal of this study was to investigate whether adverse peri-intubation associated events occur at increased frequency in pediatric patients with hematopoietic cell transplant (HCT) compared with non-HCT oncologic or other pediatric ICU (PICU) patients and therefore might contribute to increased mortality. This retrospective cohort study of critically ill children who underwent tracheal intubation (TI) was conducted between 2014 and 2019. Data was merged from local airway management quality databases and Virtual Pediatric Systems. Data was supplemented with a retrospective chart review for HCT-related data, including HCT indication, transplant-related comorbidity status, and patient condition at the time of TI procedure. There was a total of 1,931 children identified who underwent TI, of which 92 (4.8%) were post-HCT, while 319 (16.5%) had history of malignancy without HCT, and 1,520 (78.7%) had neither HCT nor malignancy. Children post-HCT were older, more often had respiratory failure, use of catecholamine infusions peri-intubation, and use of noninvasive ventilation prior to intubation. There was no difference in hemodynamic tracheal intubation-associated adverse events (TIAEs) or peri-intubation hypoxemia across three groups (HCT 16%, non-HCT with malignancy 10%, other 15%). The authors did not find an association between HCT status and the adverse TI outcome after adjusting for age, difficulty airway feature, provider type, device, apneic oxygenation use, and indication for intubation.
AHRQ-funded; HS024511.
Citation: Lenz KB, Nishisaki A, Lindell RB .
Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant.
Pediatr Crit Care Med 2023 Jul; 24(7):584-93. doi: 10.1097/pcc.0000000000003243..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Adverse Events
Herrick HM, O'Reilly M, Lee S
Providing Oxygen during Intubation in the NICU Trial (POINT): study protocol for a randomised controlled trial in the neonatal intensive care unit in the USA.
This article is a study protocol describing a pilot randomized controlled trial called Providing Oxygen during Intubation in the NICU Trial or POINT. This study’s objective will be to determine among infants ≥28 weeks' corrected gestational age (cGA) who undergo intubation in the neonatal intensive care unit (NICU) whether apnoeic oxygenation with a regular low-flow nasal cannula (NC), compared with standard of care (no additional respiratory support), reduces the magnitude of SpO(2) decline during intubation. This severe desaturation occurs in nearly half of neonatal intubations. This multicenter, prospective, unblinded, pilot randomized controlled trial recruited 120 infants, 10 in the run-in phase, and 110 in the randomization phase at two tertiary care hospitals in Pennsylvania. Patients will be randomized to 6 L NC 100% oxygen versus standard of care (no respiratory support) at time of intubation, with primary outcome the magnitude of oxygen desaturation during intubation. Secondary outcomes will include additional efficacy, safety, and feasibility outcomes.
AHRQ-funded; HS029029.
Citation: Herrick HM, O'Reilly M, Lee S .
Providing Oxygen during Intubation in the NICU Trial (POINT): study protocol for a randomised controlled trial in the neonatal intensive care unit in the USA.
BMJ Open 2023 Apr 13; 13(4):e073400. doi: 10.1136/bmjopen-2023-073400..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Kempker JA, Stearns E, Peterson EN
U.S. adult critical care beds per capita: a 2021 county-level cross-sectional study.
This study used November 2021 hospital data from the Department of Health and Human Services' Protect Public Data Hub to describe the per capita distribution of staffed adult critical care beds across the US. There was a high percentage of hospitals reporting (98.6%). A total of 4,846 adult hospitals accounted for 79,876 adult critical care beds in the US and its’ territories. The authors crudely aggregated the data at the national-level to 0.31 adult critical care beds per 1,000 adults. The median crude per capita density of adult critical care beds per 1,000 adults across U.S. counties was 0.00 per 1,000 adults. Spatially smoothed county-level estimates were obtained using Empirical Bayes and Spatial Empirical Bayes approaches, resulting in an estimated 0.18 adult critical care beds per 1,000 adults. Counties in the upper quartile had higher average adult population counts (mean 159,000 vs 32,000 adults per county) compared to counties in the lower quartile of adult critical care bed density.
AHRQ-funded; HS025240.
Citation: Kempker JA, Stearns E, Peterson EN .
U.S. adult critical care beds per capita: a 2021 county-level cross-sectional study.
Crit Care Explor 2023 Mar;5(3):e0868. doi: 10.1097/cce.0000000000000868.
Keywords: Critical Care, Public Health
Napolitano N, Polikoff L, Edwards L
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
This study’s goal was to determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI) reduces adverse TI-associated events (TIAEs) in children. AO was implemented at 14 pediatric intensive care units as a quality improvement intervention from 2016 through 2020. Implementation consisted of an intubation safety checklist, leadership endorsement, use of a local champion, and data feedback to frontline clinicians. Of 6549 TIs during the study period, 2554 occurred during the pre-implementation phase and 3995 during post-implementation phase. AO utilization increased from 23 to 68%. It was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patients intubated due to respiratory or neurological failure or shock. Conversely, it was used more often in TIs done for procedures or those associated by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs, and the occurrence of hypoxemia was not different (AO 14.2% versus without AO 15.2%).
AHRQ-funded; HS024511.
Citation: Napolitano N, Polikoff L, Edwards L .
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
Crit Care 2023 Jan 17; 27(1):26. doi: 10.1186/s13054-023-04304-0..
Keywords: Children/Adolescents, Critical Care, Adverse Events, Respiratory Conditions
Doherty JR, Schaefer A, Goodman DC
Texas hospital's perspectives about NICU performance measures: a mixed-methods study.
This exploratory mixed-methods study was conducted to determine Texas hospital leaders’ perspectives about neonatal intensive care (NICU) performance measures. First a survey was sent along with a copy of the Dartmouth Atlas of Neonatal Intensive Care to clinical and administrative leaders of 150 NICUs in Texas. The authors asked respondents to review the chapter that reported Texas-specific results and respond to a variety of open and closed-ended questions about the overall usefulness of the report. Secondly, they conducted semistructured qualitative interviews with a subset of survey respondents to better understand their perspectives. There was a 50% survey response rate. Respondents generally found the report to be interesting and useful, and 87.7% of all respondents reported being in favor of receiving future reports with their own hospital's data benchmarked against other anonymous NICU peers. All measures in the Atlas were considered favorably. The respondents also felt that a report with performance data would serve as a mechanism to drive change by identifying opportunities for improvement.
AHRQ-funded; HS024075.
Citation: Doherty JR, Schaefer A, Goodman DC .
Texas hospital's perspectives about NICU performance measures: a mixed-methods study.
Qual Manag Health Care 2023 Jan-Mar;32(1):8-15. doi: 10.1097/qmh.0000000000000347..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Provider Performance, Hospitals
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