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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
51 to 75 of 267 Research Studies DisplayedApplebury DE, Robinson EJ, Gold JA
Pilot testing of simulation in the evaluation of a novel, rapidly deployable electronic health record for use in disaster intensive care.
This purpose of this study was to present the application of simulation to assess a quickly scalable hub-and-spoke model for Electronic Health Record (EHR) system deployment and monitoring, utilizing asynchronous training. The researchers modified existing commercial EHR products to function as the entry point from a simulated hospital and a separate system for tele-ICU support and data monitoring. A modular video-based curriculum was developed for asynchronous training of users. The curriculum's effectiveness was evaluated through the completion of standard ICU documentation tasks in a high-fidelity simulation. Additional endpoints included EHR navigation assessment, user satisfaction (Net Promoter), system usability (System Usability Scale-SUS), and cognitive load (NASA-TLX). The study found that 5 participants achieved a 100% task completion rate in all domains, except for ventilator data (91%). The systems demonstrated high satisfaction, satisfactory usability, and acceptable cognitive load, with higher cognitive loads correlating to the number of screens used.
AHRQ-funded; HS023793.
Citation: Applebury DE, Robinson EJ, Gold JA .
Pilot testing of simulation in the evaluation of a novel, rapidly deployable electronic health record for use in disaster intensive care.
Disaster Med Public Health Prep 2021 Oct 22; 17:e51. doi: 10.1017/dmp.2021.302..
Keywords: COVID-19, Emergency Preparedness, Electronic Health Records (EHRs), Health Information Technology (HIT), Public Health, Intensive Care Unit (ICU), Critical Care
Holding EZ, Turner EM, Hall TA
The association between functional status and health-related quality of life following discharge from the pediatric intensive care unit.
This study investigated the association between new functional impairments, measured by the Functional Status Scale (FSS), and health-related quality of life (HRQOL) in pediatric patients with acquired brain injury (ABI) after critical care. This secondary analysis was conducted using children aged 2 months to 18 years with ABI. Complete data were analyzed for 195 children, including 127 with traumatic brain injury. New functional impairment was common with 32 patients experiencing FSS ≥ 3, 50 (26%) patients with FSS increases of 1-2 points, and 113 (58%) patients with no change from prehospital baseline. The majority of children (63%) demonstrated HRQOL ratings ≥ 1 standard deviation below healthy age-based standards.
AHRQ-funded; HS022981.
Citation: Holding EZ, Turner EM, Hall TA .
The association between functional status and health-related quality of life following discharge from the pediatric intensive care unit.
Neurocrit Care 2021 Oct;35(2):347-57. doi: 10.1007/s12028-021-01271-8..
Keywords: Children/Adolescents, Quality of Life, Brain Injury, Intensive Care Unit (ICU)
Anesi GL, Kerlin MP
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Researchers discuss the impact of resource limitations on care delivery and outcomes. They conclude that the interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. Further, the COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and non-pandemic times.
AHRQ-funded; HS026372.
Citation: Anesi GL, Kerlin MP .
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Curr Opin Crit Care 2021 Oct 1;27(5):513-19. doi: 10.1097/mcc.0000000000000859..
Keywords: COVID-19, Public Health, Healthcare Delivery, Intensive Care Unit (ICU), Outcomes
Jeffery AD, Werthman JA, Danesh V
Assess, prevent, and manage pain; both spontaneous awakening and breathing trials; choice of analgesia/sedation; delirium: assess, prevent, and manage; early mobility; family engagement and empowerment bundle implementation: quantifying the association of
This paper discusses a multicenter, exploratory, cross-sectional study to describe the physical environment factors of bundle-enhancing items and the association of physical environment with bundle adherence. The study included 10 medical and surgical ICUs in 6 academic medical centers. The cohort included adults with qualifying respiratory failure and/or septic shock. The interventions used were the Awakening, and Breathing trial Coordination, Delirium assessment/management, and Early mobility bundle as the recommended standard of care for randomized controlled trial patients. Primary outcome was adherence to the full bundle and the early mobility bundle component as identified from daily adherence documentation of 751 patient observations. Both unit- and patient-level factors such as unit size, a standard walker, and age were associated with increased or decreased adherence. Mechanical ventilation was always associated with decreased bundle adherence.
AHRQ-funded; HS026395.
Citation: Jeffery AD, Werthman JA, Danesh V .
Assess, prevent, and manage pain; both spontaneous awakening and breathing trials; choice of analgesia/sedation; delirium: assess, prevent, and manage; early mobility; family engagement and empowerment bundle implementation: quantifying the association of
Crit Care Explor 2021 Sep 14;3(9):e0525. doi: 10.1097/cce.0000000000000525..
Keywords: Critical Care, Intensive Care Unit (ICU), Care Management, Evidence-Based Practice
Parker MG, Garg A, Brochier A
Approaches to addressing social determinants of health in the NICU: a mixed methods study.
The objective of this study was to examine current approaches to addressing social determinants of health (SDOH) in the NICU and perceived appropriateness of a standardized screening and referral process. The investigators performed a mixed methods study in two Massachusetts safety-net NICUs. They concluded that current NICU assessment of SDOH was limited and use of a standardized screening and referral process could be useful.
AHRQ-funded; HS026370.
Citation: Parker MG, Garg A, Brochier A .
Approaches to addressing social determinants of health in the NICU: a mixed methods study.
J Perinatol 2021 Aug;41(8):1983-91. doi: 10.1038/s41372-020-00867-w..
Keywords: Social Determinants of Health, Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Cifra CL, Custer JW, Singh H
Diagnostic errors in pediatric critical care: a systematic review.
This study is a systematic review on the prevalence, impact, and contributing factors related to diagnostic errors in the PICU. A database search was done for literature up through December 2019. Using specific criteria, 396 abstracts were screened, and 17 studies were included. Fifteen of 17 studies had an observational research design. Autopsy studies showed a 10-23% rate of missed major diagnosis with 5-16% of the errors having a potential adverse impact on survival and would have changed care management. Retrospective record review studies reported varying rates of diagnostic error from 8% in a general PICU population to 12% among unexpected critical admissions. About a quarter of those patients were discussed at PICU morbidity and mortality conferences. Most misdiagnosed conditions were cardiovascular, infectious, congenital, or neurologic. System, cognitive, and both system and cognitive factors were associated with diagnostic error but there is limited information on the impact of misdiagnosis.
AHRQ-funded; HS026965.
Citation: Cifra CL, Custer JW, Singh H .
Diagnostic errors in pediatric critical care: a systematic review.
Pediatr Crit Care Med 2021 Aug;22(8):701-12. doi: 10.1097/pcc.0000000000002735..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Intensive Care Unit (ICU), Critical Care
Brei BK, Sawyer T, Umoren R
Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS.
This study looked at whether the presence of family members had an impact on neonatal tracheal intubation (TI) outcomes. This retrospective analysis looked at TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS) at 13 academic NICUS from October 2014 to December 2017. Family members were present in less than 10% of TIs, but this varied by site. Success rates were not significantly different, with the first attempt success rate at 55% with family present versus 49% and success within 2 attempts was 74% versus 66%. Adverse TI-associated events (TIAEs) were 17% versus 20% and severe oxygen desaturation was 49% versus 52%. No independent association between any of these outcomes was found with family presence.
AHRQ-funded; HS027259; HS024511.
Citation: Brei BK, Sawyer T, Umoren R .
Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS.
Arch Dis Child Fetal Neonatal Ed 2021 Jul;106(4):392-97. doi: 10.1136/archdischild-2020-319709..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Registries, Patient Safety
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, Decision Making, Intensive Care Unit (ICU), Simulation, Provider Performance, Patient Safety, Quality of Care
Carayon P, Thuemling T, Parmasad V
Implementation of an antibiotic stewardship intervention to reduce prescription of fluoroquinolones: a human factors analysis in two intensive care units.
In this study, researchers conducted an in-depth analysis of an intervention aimed at limiting ICU prescriber access to fluoroquinolones (FQ) in the ICUs of two hospitals. Their results showed some differences in the implementation of the FQ intervention between the two studied ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped quickly to identify problems with the intervention and to ensure that changes were made in a just-in-time manner. Despite their organizational differences, both sites developed strategies to implement the FQ intervention successfully.
AHRQ-funded; HS026226.
Citation: Carayon P, Thuemling T, Parmasad V .
Implementation of an antibiotic stewardship intervention to reduce prescription of fluoroquinolones: a human factors analysis in two intensive care units.
J Patient Saf Risk Manag 2021 Jul;26(4):161-71..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Safdar N, Parmasad V, Brown R
Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a study protocol.
Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the USA, having high incidence in intensive care units (ICU). Antibiotic use increases risk of CDI, with fluoroquinolones (FQs) particularly implicated. In healthcare settings, antibiotic stewardship (AS) and infection control interventions are effective in CDI control, but there is little evidence regarding the most effective AS interventions. In this paper the investigators describe their multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial.
AHRQ-funded; R01 HS026226.
Citation: Safdar N, Parmasad V, Brown R .
Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a study protocol.
BMJ Open 2021 Jun 29;11(6):e046480. doi: 10.1136/bmjopen-2020-046480..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Antimicrobial Stewardship, Antibiotics, Medication, Prevention
Ma AL, Loughland MED, Lapcharoensap W
California and Oregon NICU wildfire disaster preparedness tools.
In a follow-up to their previous study, the authors asked, "what tools/strategies do medical professionals deem as important and most helpful as they are preparing for wildfire disaster response?" They conducted surveys in 11 Oregon and Southwest Washington NICUs about their wildfire evacuation preparedness and interviewed two neonatologists about their wildfire disaster evacuation and preparation experiences. Their findings suggested that there is more work needed to fully prepare NICUs for wildfire disasters, and they hope that their work helps to educate and support future NICU disaster preparedness responses.
AHRQ-funded; HS023506.
Citation: Ma AL, Loughland MED, Lapcharoensap W .
California and Oregon NICU wildfire disaster preparedness tools.
Children 2021 Jun;8(6). doi: 10.3390/children8060465..
Keywords: Emergency Preparedness, Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Riley AR, Williams CN, Moyer D
Parental posttraumatic stress symptoms in the context of pediatric post intensive care syndrome: impact on the family and opportunities for intervention.
Pediatric intensive care unit (PICU) survivors and their families experience ongoing impacts on physical, cognitive, and psychosocial functioning, described as Post-Intensive Care Syndrome (PICS). The objective of this study was to determine whether the posttraumatic stress symptoms (PTSS) of parents predict the impact of critical illness on families following PICU admission beyond other factors (e.g., sex, race/ethnicity, age, insurance status, illness severity, family involvement or death).
AHRQ-funded; HS022981.
Citation: Riley AR, Williams CN, Moyer D .
Parental posttraumatic stress symptoms in the context of pediatric post intensive care syndrome: impact on the family and opportunities for intervention.
Clin Pract Pediatr Psychol 2021 Jun;9(2):156-66. doi: 10.1037/cpp0000399..
Keywords: Children/Adolescents, Caregiving, Intensive Care Unit (ICU), Family Health and History, Stress
Cifra Cifra, CL Dukes, KC Ayres, et al.
Referral communication for pediatric intensive care unit admission and the diagnosis of critically ill children: a pilot ethnography.
This pilot study’s goal was to determine the feasibility of using focused ethnography to understand the relationship between referral communication and the diagnostic process for critically ill children. Findings showed that focused ethnography in the pediatric intensive care unit is feasible to investigate relationships between clinician referral communication and the diagnostic process for critically ill children.
AHRQ-funded; HS026965.
Citation: Cifra Cifra, CL Dukes, KC Ayres, et al..
Referral communication for pediatric intensive care unit admission and the diagnosis of critically ill children: a pilot ethnography.
J Crit Care 2021 Jun;63:246-49. doi: 10.1016/j.jcrc.2020.09.011..
Keywords: Children/Adolescents, Communication, Critical Care, Intensive Care Unit (ICU), Diagnostic Safety and Quality
Anesi GL, Jablonski J, Harhay MO
Characteristics, outcomes, and trends of patients with COVID-19-related critical illness at a learning health system in the United States.
This study’s objective is to describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery, using five hospitals within the University of Pennsylvania Health System as a setting. Findings showed that, among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Recommendations included further studies to confirm this result and to investigate causal mechanisms.
AHRQ-funded; HS026372.
Citation: Anesi GL, Jablonski J, Harhay MO .
Characteristics, outcomes, and trends of patients with COVID-19-related critical illness at a learning health system in the United States.
Ann Intern Med 2021 May;174(5):613-21. doi: 10.7326/m20-5327..
Keywords: COVID-19, Critical Care, Intensive Care Unit (ICU), Mortality, Hospitals, Outcomes, Infectious Diseases
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), Decision Making, Healthcare-Associated Infections (HAIs), Diagnostic Safety and Quality
Colman N, Newman JW, Nishisaki A
Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU.
This single-center retrospective review discusses a translational simulation conducted to improve compliance with the National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) bundle to improve the safety of tracheal intubations. The simulation was implemented between March and December 2018. Bundle adherence was assessed 12 months before simulation and 9 months after. Primary outcomes measures were compliance with the bundle and utilization of apneic oxygenation and secondary outcomes was the occurrence of adverse tracheal intubation-associated events. Preintervention bundle compliance was 66%, which increased to 93.7% after the simulation intervention. Adherence to apneic oxygenation was 27.9% before the intervention and increased to 77.9% after. There was no difference in the occurrence of tracheal intubation events.
AHRQ-funded; HS024511.
Citation: Colman N, Newman JW, Nishisaki A .
Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU.
Pediatr Qual Saf 2021 May-Jun;6(3):e409. doi: 10.1097/pq9.0000000000000409..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Registries, Simulation, Patient Safety, Quality Improvement, Quality of Care
Krupp A, Di Martino M, Chung W
Communication and role clarity inform TeleICU use: a qualitative analysis of opportunities and barriers in an established program using AACN framework.
This study is a qualitative analysis of opportunities and barriers to tele-intensive care unit (teleICU) use. The authors sought to explore if novel ways to utilize teleICU services can emerge within an established, consulting-style teleICU model considering the program’s flexible, provider-driven operation. This study used semi-structured interviews from a convenience sample of ICU (n = 19) and teleICU (n = 13) nurses. Interviews were analyzed to identify themes that describe their experiences with teleICU using a deductive codebook developed from the American Association of Critical Care Nurses (AACN) statement on teleICU nursing. Three themes identified by the nurses were: 1) unique teleICU knowledge, including systems thinking and technological skills, 2) the teleICU partnership supported quality improvement initiatives, and 3) elements of the work environment influenced perceptions of teleICU and its use. When effective communication and role clarity were not present, teleICU was variable.
AHRQ-funded; HS026372.
Citation: Krupp A, Di Martino M, Chung W .
Communication and role clarity inform TeleICU use: a qualitative analysis of opportunities and barriers in an established program using AACN framework.
BMC Health Serv Res 2021 Mar 25;21(1):277. doi: 10.1186/s12913-021-06287-6..
Keywords: Communication, Intensive Care Unit (ICU), Telehealth, Health Information Technology (HIT)
Woods-Hill CZ, Papili K, Nelson E
Harnessing implementation science to optimize harm prevention in critically ill children: a pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit.
Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. In this study, the investigators explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses. The investigators concluded that PICU nurses were knowledgeable and motivated to prevent CLABSI, but faced challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Papili K, Nelson E .
Harnessing implementation science to optimize harm prevention in critically ill children: a pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit.
Am J Infect Control 2021 Mar;49(3):345-51. doi: 10.1016/j.ajic.2020.08.019..
Keywords: Children/Adolescents, Central Line-Associated Bloodstream Infections (CLABSI), Patient Safety, Intensive Care Unit (ICU), Nursing, Patient Safety
Haidari ES, Lee HC, Illuzzi JL
Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category.
The objective of this study was to examine interhospital variation in admissions to neonatal intensive care units (NICU) and reasons for the variation. 2010-2012 linked birth certificate and hospital discharge data from 35 hospitals in California on live births at 35-42 weeks gestation and ≥1500 g birth weight were used. The authors concluded that interhospital variation in NICU admissions is mostly driven by admissions for mild diagnoses.
AHRQ-funded; HS023801.
Citation: Haidari ES, Lee HC, Illuzzi JL .
Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category.
J Perinatol 2021 Mar;41(3):468-77. doi: 10.1038/s41372-020-00775-z..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Hospitalization, Hospitals
Flannery DD, Akinboyo IC, Mukhopadhyay S
Antibiotic susceptibility of Escherichia coli among infants admitted to neonatal intensive care units across the US From 2009 to 2017.
Investigators assessed the epidemiologic characteristics and antibiotic susceptibility patterns of E coli in infants admitted to neonatal intensive care units in the US over time. Using the Premier Health Database, they found nonsusceptibility to commonly administered antibiotics in substantial proportions of neonatal E coli isolates, with no significant change from 2009 to 2017. They suggested that their findings may inform empirical antibiotic choices for newborn infants.
AHRQ-funded; HS027468.
Citation: Flannery DD, Akinboyo IC, Mukhopadhyay S .
Antibiotic susceptibility of Escherichia coli among infants admitted to neonatal intensive care units across the US From 2009 to 2017.
JAMA Pediatr 2021 Feb;175(2):168-75. doi: 10.1001/jamapediatrics.2020.4719..
Keywords: Newborns/Infants, Antibiotics, Medication, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Infectious Diseases
Nishisaki A, Lee A, Li S
Sustained improvement in tracheal intubation safety across a 15-center quality-improvement collaborative: an interventional study from the national emergency airway registry for children investigators.
The authors sought to evaluate the effect of a tracheal intubation safety bundle on adverse tracheal intubation-associated events across 15 PICUs. The safety bundle included a quarterly site benchmark performance reports and an airway safety checklist consisting of preprocedure risk factor, approach, and role planning, preprocedure bedside "time-out," and immediate postprocedure debriefing. The authors found that effective implementation of a quality-improvement bundle was associated with a decrease in the adverse tracheal intubation-associated event that was sustained for 24 months.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Nishisaki A, Lee A, Li S .
Sustained improvement in tracheal intubation safety across a 15-center quality-improvement collaborative: an interventional study from the national emergency airway registry for children investigators.
Crit Care Med 2021 Feb;49(2):250-60. doi: 10.1097/ccm.0000000000004725..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Patient Safety, Quality Improvement, Quality of Care
Balikai SC, Badheka A, Casey A
Simulation to train pediatric ICU teams in endotracheal intubation of patients with COVID-19.
This paper describes the outcomes of pediatric intensive care unit (PICU) simulation training to safely perform endotracheal intubations in children with suspected or confirmed COVID-19. Confidence levels before and after training was measured using the Simulation Effectiveness Tool-Modified (SET-M, Likert scale 0-2). Fifty unique PICU staff members participated in 9 simulation sessions and mean confidences scores increased from 0.9 to 2.
AHRQ-funded; HS026965.
Citation: Balikai SC, Badheka A, Casey A .
Simulation to train pediatric ICU teams in endotracheal intubation of patients with COVID-19.
Pediatr Qual Saf 2021 Jan-Feb;6(1):e373. doi: 10.1097/pq9.0000000000000373..
Keywords: Children/Adolescents, COVID-19, Intensive Care Unit (ICU), Critical Care, Simulation, Training, Public Health, Infectious Diseases
Groetzinger LM, Rivosecchi RM, McVerry BJ
A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults.
This study assessed outcomes of using a light-sedation protocol as needed compared to the more usual continuous infusion sedation in mechanically ventilated adults in medical intensive care units (ICUs). This retrospective review compared patients who received the as needed sedation protocol to similar patients treated initially with continuous infusion sedation at a 32-bed medical ICU in a large academic center. Over a 2-year period, 254 total mechanically ventilated patients were evaluated. Of the evaluable patients, 114 received the prioritizing as-needed sedation protocol, and 140 received the continuous infusion approach. In the as-needed group, 42% of patients never received continuous infusion sedation. The group also received significantly less opioid, propofol, and benzodiazepine; and experienced less delirium, shorter duration of mechanical ventilation, and shorter ICU length of stay compared to the continuous infusion sedation group.
AHRQ-funded; HS025455.
Citation: Groetzinger LM, Rivosecchi RM, McVerry BJ .
A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults.
Crit Care Explor 2020 Dec;2(12):e0264. doi: 10.1097/cce.0000000000000264..
Keywords: Quality Improvement, Quality of Care, Intensive Care Unit (ICU), Critical Care, Implementation
Anesi GL, Chelluri J, Qasim ZA
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
The purpose of this study was to evaluate the potential impact of an emergency department-embedded critical care unit (CCU) at the Hospital of the University of Pennsylvania among patients with sepsis and acute respiratory failure (ARF) admitted from the emergency department to a medical ward or ICU from January 2016 to December 2017. Findings showed that the emergency department-embedded CCU was not associated with clinical outcomes among patients admitted with sepsis or ARF. Among less sick patients with sepsis, the emergency department-embedded CCU was initially associated with reduced rates of direct ICU admission from the emergency department. Further research was recommended to further evaluate the impact and utility of the emergency department-embedded CCU model.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chelluri J, Qasim ZA .
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
Ann Am Thorac Soc 2020 Dec;17(12):1599-609. doi: 10.1513/AnnalsATS.201912-912OC..
Keywords: Emergency Department, Critical Care, Intensive Care Unit (ICU), Hospitals, Sepsis, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Healthcare Delivery
Wang S, Hanneman P, Xu C
Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors.
As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). In this study, the investigators described how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI).
AHRQ-funded; HS024384.
Citation: Wang S, Hanneman P, Xu C .
Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors.
Int Psychogeriatr 2020 Dec;32(12):1409-18. doi: 10.1017/s1041610219000553..
Keywords: Intensive Care Unit (ICU), Critical Care, Health Status, Caregiving