National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (7)
- Adverse Events (36)
- Alcohol Use (1)
- Ambulatory Care and Surgery (1)
- Antibiotics (14)
- Antimicrobial Stewardship (9)
- Behavioral Health (4)
- Blood Clots (1)
- Blood Pressure (1)
- Brain Injury (3)
- Burnout (1)
- Cancer (1)
- Cardiovascular Conditions (6)
- Care Coordination (2)
- Caregiving (6)
- Care Management (8)
- Catheter-Associated Urinary Tract Infection (CAUTI) (7)
- Central Line-Associated Bloodstream Infections (CLABSI) (12)
- Children/Adolescents (74)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (2)
- Clinician-Patient Communication (4)
- Clostridium difficile Infections (1)
- Communication (16)
- Comparative Effectiveness (4)
- Complementary and Alternative Medicine (1)
- Comprehensive Unit-based Safety Program (CUSP) (2)
- COVID-19 (11)
- Critical Care (114)
- Data (1)
- Decision Making (13)
- Depression (1)
- Diagnostic Safety and Quality (18)
- Digestive Disease and Health (1)
- Education: Academic (1)
- Education: Continuing Medical Education (7)
- Elderly (12)
- Electronic Health Records (EHRs) (18)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (7)
- Emergency Medical Services (EMS) (1)
- Emergency Preparedness (4)
- Evidence-Based Practice (9)
- Family Health and History (2)
- Guidelines (4)
- Healthcare-Associated Infections (HAIs) (33)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Costs (7)
- Healthcare Delivery (14)
- Healthcare Utilization (4)
- Health Information Technology (HIT) (20)
- Health Insurance (2)
- Health Services Research (HSR) (1)
- Health Status (2)
- Heart Disease and Health (7)
- Hospital Discharge (3)
- Hospitalization (15)
- Hospital Readmissions (5)
- Hospitals (28)
- Implementation (3)
- Infectious Diseases (9)
- Injuries and Wounds (4)
- Inpatient Care (12)
- (-) Intensive Care Unit (ICU) (267)
- Kidney Disease and Health (1)
- Maternal Care (1)
- Medicaid (1)
- Medical Errors (6)
- Medicare (3)
- Medication (25)
- Medication: Safety (7)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (8)
- Mortality (13)
- Neonatal Intensive Care Unit (NICU) (16)
- Neurological Disorders (9)
- Newborns/Infants (40)
- Nursing (9)
- Nutrition (1)
- Organizational Change (1)
- Outcomes (28)
- Palliative Care (5)
- Patient-Centered Healthcare (5)
- Patient-Centered Outcomes Research (16)
- Patient and Family Engagement (8)
- Patient Experience (4)
- Patient Safety (73)
- Payment (1)
- Policy (3)
- Practice Patterns (3)
- Prevention (20)
- Provider (4)
- Provider: Clinician (1)
- Provider: Health Personnel (2)
- Provider: Nurse (1)
- Provider: Pharmacist (1)
- Provider Performance (3)
- Public Health (5)
- Public Reporting (1)
- Quality Improvement (16)
- Quality Indicators (QIs) (2)
- Quality Measures (1)
- Quality of Care (27)
- Quality of Life (3)
- Racial and Ethnic Minorities (3)
- Registries (8)
- Respiratory Conditions (24)
- Risk (11)
- Screening (1)
- Sepsis (10)
- Simulation (6)
- Sleep Problems (1)
- Social Determinants of Health (2)
- Stress (2)
- Substance Abuse (1)
- Surgery (5)
- Teams (14)
- Telehealth (4)
- Training (10)
- Transitions of Care (3)
- Trauma (2)
- Urinary Tract Infection (UTI) (6)
- Workflow (2)
- Workforce (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
126 to 150 of 267 Research Studies DisplayedCosta 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.
.
.
Keywords: Teams, Critical Care, Intensive Care Unit (ICU), Training
Kizzier-Carnahan V, Artis KA, Mohan V
Frequency of passive EHR alerts in the ICU: another form of alert fatigue?
The authors researched the impact of passive data alerts in the intensive care unit (ICU) on patient safety. They found that the average ICU patient generates a large number of passive alerts daily, many of which may be clinically irrelevant. Issues with Electronic Health Record design and use likely further magnified this problem. They concluded that their results established the need for additional studies to understand how a high burden of passive alerts impact clinical decision making and how to design passive alerts to optimize their clinical utility.
AHRQ-funded; HS023793; HS021637.
Citation: Kizzier-Carnahan V, Artis KA, Mohan V .
Frequency of passive EHR alerts in the ICU: another form of alert fatigue?
J Patient Saf 2019 Sep;15(3):246-50. doi: 10.1097/pts.0000000000000270..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient Safety
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)
Adelman JS, Applebaum JR, Southern WN
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
Researchers assessed the risk of wrong-patient orders among multiple-birth infants and singletons receiving care in the NICU and examined the proportion of wrong-patient orders between multiple-birth infants and siblings (intrafamilial errors) and between multiple-birth infants and nonsiblings (extrafamilial errors). They found that multiple-birth status in the NICU is associated with significantly increased risk of wrong-patient orders compared with singleton-birth status. Strategies to reduce this risk include using given names at birth, changing from temporary to given names when available, and encouraging parents to select names for multiple births before they are born when acceptable to families.
AHRQ-funded; HS024538.
Citation: Adelman JS, Applebaum JR, Southern WN .
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
JAMA Pediatr 2019 Oct 10;173(10):979-85. doi: 10.1001/jamapediatrics.2019.2733..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Anandaiah AM, Stevens JP, Sullivan AM
Implementation of a bundled consent process in the ICU: a single-center experience.
This study examined perceptions of internal medicine residents in the ICU of an urban academic medical center about using a bundled consent process with patients and their families. The bundled consent provides consent for all commonly performed procedures on a single form. It has been advocated as an efficient method, but there is little published literature about its use. Out of 164 internal residents surveyed, 102 completed the survey. The majority (78%) felt it scared or stressed families, and only 26% felt confident that they would obtain valid informed consent.
AHRQ-funded; HS024288.
Citation: Anandaiah AM, Stevens JP, Sullivan AM .
Implementation of a bundled consent process in the ICU: a single-center experience.
Crit Care Med 2019 Oct;47(10):1332-36. doi: 10.1097/ccm.0000000000003905..
Keywords: Implementation, Intensive Care Unit (ICU), Hospitals, Clinician-Patient Communication, Communication
Klawetter S, Neu M, Roybal KL S, Neu M, Roybal KL
Mothering in the NICU: a qualitative exploration of maternal engagement.
This qualitative study reflected a transdisciplinary research partnership between social work, nursing, and neonatology. Maternal experiences in the NICU, from the perspectives of mothers of preterm infants hospitalized in two NICUs, are collected. Results support an ecological systems framework to understanding barriers and facilitators to maternal engagement in the NICU and the utilization of a trauma-informed health care approach in NICU settings.
AHRQ-funded; HS026370.
Citation: Klawetter S, Neu M, Roybal KL S, Neu M, Roybal KL .
Mothering in the NICU: a qualitative exploration of maternal engagement.
Soc Work Health Care 2019 Sep;58(8):746-63. doi: 10.1080/00981389.2019.1629152..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Patient and Family Engagement
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
Gephart SM, Quinn MC
Relationship of necrotizing enterocolitis rates to adoption of prevention practices in US neonatal intensive care units.
Applying quality improvement methods has reduced necrotizing enterocolitis (NEC) in some neonatal intensive care units (NICUs) by 40% to 90%. This study was conducted to (1) examine relationships between adoption of prevention practices using the NEC-Zero adherence score and NEC rates, and (2) describe implementation strategies NICUs use to prevent NEC. The investigators concluded that broader use of evidence-based implementation strategies could bolster delivery of NEC prevention practices. The indicated that maternal lactation support is paramount.
AHRQ-funded; HS022908.
Citation: Gephart SM, Quinn MC .
Relationship of necrotizing enterocolitis rates to adoption of prevention practices in US neonatal intensive care units.
Adv Neonatal Care 2019 Aug;19(4):321-32. doi: 10.1097/anc.0000000000000592..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Prevention
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
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
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
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, Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient and Family Engagement
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
Asan O, Scanlan MC, Crotty B
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
The objective of this study was to explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms. The investigators suggest that a new health information technology system providing continuous access to open electronic health record data may be an effective way to empower and engage parents in the PICU, but also note potential drawbacks.
AHRQ-funded; HS023626.
Citation: Asan O, Scanlan MC, Crotty B .
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
Pediatr Crit Care Med 2019 May;20(5):435-41. doi: 10.1097/pcc.0000000000001895..
Keywords: Caregiving, Children/Adolescents, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Intensive Care Unit (ICU), Patient and Family Engagement
Myers LC, Faridi MK, Currier P
ICU utilization for patients with acute exacerbation of chronic obstructive pulmonary disease receiving noninvasive ventilation.
This retrospective cohort study investigated whether patients with chronic obstructive pulmonary disease (COPD) could safely receive noninvasive ventilation outside of ICU. Researchers examined 5,081 hospitalizations from 424 hospitals, using data from the State Inpatient Database. Researchers concluded that COPD patients who receive noninvasive ventilation had similar in-hospital mortality rates across the ICU utilization spectrum, but a lower rate of receiving invasive monitors. The results suggest that noninvasive ventilation can be delivered safely outside of ICU, but the researchers advocate that hospital-specific risk assessment be used if a hospital is considering changing its noninvasive ventilation policy.
AHRQ-funded; HS23305.
Citation: Myers LC, Faridi MK, Currier P .
ICU utilization for patients with acute exacerbation of chronic obstructive pulmonary disease receiving noninvasive ventilation.
Crit Care Med 2019 May;47(5):677-884. doi: 10.1097/ccm.0000000000003660..
Keywords: Respiratory Conditions, Healthcare Cost and Utilization Project (HCUP), Intensive Care Unit (ICU)
Roche SD, Reichheld AM, Demosthenes N
Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication.
The purpose of this study was to document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacted their overall perceptions of the quality of specialty care. The investigators found that most ICU families and nurses had no interaction with specialist providers. They concluded that nurses' frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists.
AHRQ-funded; K08 HS024288.
Citation: Roche SD, Reichheld AM, Demosthenes N .
Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication.
PLoS One 2019 Apr 11;14(4):e0214918. doi: 10.1371/journal.pone.0214918..
Keywords: Clinician-Patient Communication, Communication, Quality of Care, Intensive Care Unit (ICU), Patient Experience, Inpatient Care
Farra S, Hodgson E, Miller ET
Effects of virtual reality simulation on worker emergency evacuation of neonates.
This study compared differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent emergency evacuation training either with virtual reality simulation (VRS) or web-based clinical updates (CU). The workers were evaluated based on knowledge gained, confidence with evacuation, and performance in a live evacuation exercise. Workers were randomly assigned to VRS or CU. The groups did not statistically differ based on Cognitive Assessment scores or self-evaluations. However, the VRS group performed statistically better than the CU group in the live exercise. This study points to the effectiveness of virtual reality training.
AHRQ-funded; HS023149.
Citation: Farra S, Hodgson E, Miller ET .
Effects of virtual reality simulation on worker emergency evacuation of neonates.
Disaster Med Public Health Prep 2019 Apr;13(2):301-08. doi: 10.1017/dmp.2018.58..
Keywords: Emergency Preparedness, Newborns/Infants, Intensive Care Unit (ICU), Simulation, Training, Education: Continuing Medical Education
Law AC, Roche S, Reichheld A
Failures in the respectful care of critically ill patients.
The emotional toll of critical illness on patients and their families can be profound and is emerging as an important target for value improvement. One source of emotional harm to patients and families may be care perceived as inadequately respectful. The prevalence and risk factors for types of emotional harms is under-studied. This prospective cohort study was conducted in nine ICUs at a tertiary care academic medical center in the United States.
AHRQ-funded; HS024288.
Citation: Law AC, Roche S, Reichheld A .
Failures in the respectful care of critically ill patients.
Jt Comm J Qual Patient Saf 2019 Apr;45(4):276-84. doi: 10.1016/j.jcjq.2018.05.008..
Keywords: Critical Care, Intensive Care Unit (ICU), Patient Experience, Clinician-Patient Communication, Communication
Sick-Samuels AC, Woods-Hill CZ, Fackler JC
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
The goal of this study was to evaluate whether the use of antibiotics at the Johns Hopkins pediatric intensive care unit (PICU) changed in relation to a reduction in utilization of blood culture. Antibiotic usage is used as a balancing measure, because a reduction in blood cultures could lead to an increase in antibiotic treatment if clinicians continued treatment in scenarios when blood culture results were not available. The authors examined the administration of antibiotics over 12 months while a locally developed blood-culture guideline was being implemented. The distribution of antibiotics remained similar over the pre- and post-implementation periods.
AHRQ-funded; HS025642.
Citation: Sick-Samuels AC, Woods-Hill CZ, Fackler JC .
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
Infect Control Hosp Epidemiol 2019 Apr;40(4):482-84. doi: 10.1017/ice.2019.10..
Keywords: Antibiotics, Children/Adolescents, Intensive Care Unit (ICU), Medication, Practice Patterns
Artis KA, Bordley J, Mohan V
Data omission by physician trainees on ICU rounds.
This observational study measured how frequently physician trainees omitted data from prerounding notes ("artifacts") and verbal presentations during daily rounds. The authors concluded that in an academic rounding model reliant on trainees to preview and select data for presentation during ICU rounds, verbal appraisal of patient data was highly incomplete. They assert that additional trainee oversight and education, improved electronic health record tools, and novel academic rounding paradigms are needed to address this potential source of medical error.
AHRQ-funded; HS023793.
Citation: Artis KA, Bordley J, Mohan V .
Data omission by physician trainees on ICU rounds.
Crit Care Med 2019 Mar;47(3):403-09. doi: 10.1097/ccm.0000000000003557..
Keywords: Education: Continuing Medical Education, Intensive Care Unit (ICU), Medical Errors, Patient Safety, Quality of Care
Lindell RB, Nishisaki A, Weiss SL
Comparison of methods for identification of pediatric severe sepsis and septic shock in the Virtual Pediatric Systems Database.
This study compared the use of Virtual Pediatric Systems with traditional use of International Classification of Diseases, 9th edition (ICD) to identify children with severe sepsis or septic shock in PICU settings. Two different systems were compared “Martin” and “Angus”. Both showed good agreement, but ICD9 identified a smaller more accurate cohort of children. Additional analysis of discrepancies between the reference standard the two virtual systems showed that prospective screening missed 66 patients who were diagnosed with severe sepsis or severe shock. Once they were included in the standard cohort, agreement improved with a positive predictive value of 70%.
AHRQ-funded; HS024511; HS022464.
Citation: Lindell RB, Nishisaki A, Weiss SL .
Comparison of methods for identification of pediatric severe sepsis and septic shock in the Virtual Pediatric Systems Database.
Crit Care Med 2019 Feb;47(2):e129-e35. doi: 10.1097/ccm.0000000000003541..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Data, Sepsis
Foglia EE, Ades A, Sawyer T
Neonatal intubation practice and outcomes: an international registry study.
Neonatal tracheal intubation is a critical but potentially dangerous procedure. In this study, the investigators sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety. They developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. They suggest that their results will inform future interventional studies to improve neonatal intubation safety.
AHRQ-funded; HS024511.
Citation: Foglia EE, Ades A, Sawyer T .
Neonatal intubation practice and outcomes: an international registry study.
Pediatrics 2019 Jan;143(1). doi: 10.1542/peds.2018-0902..
Keywords: Emergency Department, Health Services Research (HSR), Intensive Care Unit (ICU), Newborns/Infants, Outcomes, Patient Safety, Registries