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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 274 Research Studies DisplayedParikh NR, Francisco LS, Balikai SC
Development and evaluation of I-PASS-to-PICU: a standard electronic template to improve referral communication for interfacility transfers to the pediatric ICU.
The objective of this study was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers. I-PASS-to-PICU was developed in a single PICU, designed with an electronic health record-supported clinical note template by adapting elements from an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. Usability testing with receiving PICU physicians using simulated and actual calls revealed good usability on the System Usability Scale. The authors planned further evaluation of the template’s effectiveness in improving information exchange during real-time PICU practice.
AHRQ-funded; HS026965.
Citation: Parikh NR, Francisco LS, Balikai SC .
Development and evaluation of I-PASS-to-PICU: a standard electronic template to improve referral communication for interfacility transfers to the pediatric ICU.
Jt Comm J Qual Patient Saf 2024 May; 50(5):338-47. doi: 10.1016/j.jcjq.2024.01.010..
Keywords: Children/Adolescents, Transitions of Care, Intensive Care Unit (ICU), Electronic Health Records (EHRs), Health Information Technology (HIT), Communication, Critical Care
Harlan EA, Venkatesh S, Morrison J
Rural-urban differences in mortality among mechanically ventilated patients in intensive and intermediate care.
Antibiotic misuse in treating urinary tract infections (UTIs) in outpatients is widespread, contributing significantly to antibiotic overuse. While multifaceted interventions involving pre- or post-design strategies have shown promise in improving antibiotic use for UTIs, the long-term sustainability of audit and feedback, a common approach, remains uncertain. Future investigations into outpatient antibiotic stewardship for UTIs should focus on assessing both the effectiveness of interventions and the feasibility of their implementation.
AHRQ-funded; HS028038.
Citation: Harlan EA, Venkatesh S, Morrison J .
Rural-urban differences in mortality among mechanically ventilated patients in intensive and intermediate care.
Ann Am Thorac Soc 2024 May; 21(5):774-81. doi: 10.1513/AnnalsATS.202308-684OC..
Keywords: Rural/Inner-City Residents, Rural Health, Urban Health, Mortality, Critical Care, Intensive Care Unit (ICU), Hospitals
Ratliff HC, Yakusheva O, Boltey EM
Patterns of interactions among ICU interprofessional teams: a prospective patient-shift-level survey approach.
The objective of this study was to determine number and types of individuals who interact in the care of mechanically ventilated (MV) patients. Researchers conducted a prospective, patient-shift-level survey in two ICUs. They surveyed each patients’ assigned physician, nurse, and respiratory therapist each shift about who they interacted with when providing the Awakening, Breathing Coordination, Delirium monitoring and Early mobility bundle (ABCDE). The results indicated that clinicians interacted with 3-4 other clinicians each shift, fewer on nights; nurses interacted with the most clinicians and family members. The researchers concluded that interventions targeting shift-level teams, focusing on nurses and family members, may improve ABCDE delivery and ICU teamwork.
AHRQ-funded; HS024552.
Citation: Ratliff HC, Yakusheva O, Boltey EM .
Patterns of interactions among ICU interprofessional teams: a prospective patient-shift-level survey approach.
PLoS One 2024 Apr16; 19(4):e0298586. doi: 10.1371/journal.pone.0298586..
Keywords: Teams, Intensive Care Unit (ICU), Critical Care
Wilsterman EJ, Nellis ME, Panisello
Evaluating airway management in patients with trisomy 21 in the PICU and cardiac ICU: a retrospective cohort study.
This retrospective database study tested the hypothesis that in children with trisomy 21, tracheal intubation (TI) is associated with greater odds of adverse airway outcomes (AAOs), including TI-associated events, and peri-intubation hypoxemia. Data was taken from the National Emergency Airway Registry for Children (NEAR4KIDS). The participants were a cohort of children under 18 who underwent TI in the pediatric ICU or cardiac ICUs in a NEAR4KIDS center. The results suggested that, in spite of differences in airway risks and TI approaches, no association between the diagnosis of trisomy 21 and higher AAOs was identified.
AHRQ-funded; HS024511.
Citation: Wilsterman EJ, Nellis ME, Panisello .
Evaluating airway management in patients with trisomy 21 in the PICU and cardiac ICU: a retrospective cohort study.
Pediatr Crit Care Med 2024 Apr; 25(4):335-43. doi: 10.1097/pcc.0000000000003418..
Keywords: Critical Care, Intensive Care Unit (ICU), Children/Adolescents
Molloy MJ, Zackoff M, Gifford A
Usability testing of situation awareness clinical decision support in the intensive care unit.
Researchers conducted a mixed-methods usability evaluation of an automated clinical decision support (CDS) tool previously implemented in pediatric intensive care units (PICUs) to promote shared situation awareness among medical teams to prevent safety events within children's hospitals. The site for this study was a large, urban, quaternary, free-standing children's hospital in the Midwestern U.S. PICU staff, including physicians, advanced practice providers, nurses, and respiratory therapists, completed a system usability scale, while ten participants underwent think-aloud usability testing. The overall median usability score was 87.5; participant responses and observations from think-aloud testing highlighted positive aspects of learnability and clear display of complex, easily accessible information. The researchers concluded that the tool demonstrated good usability in the critical care setting.
AHRQ-funded; HS026975.
Citation: Molloy MJ, Zackoff M, Gifford A .
Usability testing of situation awareness clinical decision support in the intensive care unit.
Appl Clin Inform 2024 Mar; 15(2):327-34. doi: 10.1055/a-2272-6184..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Intensive Care Unit (ICU), Critical Care
Ducharme-Crevier L, Furlong-Dillard J, Jung P
Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU).
This study examined the safety of using primary nasal tracheal intubation (TI) in the pediatric intensive care unit (PICU), which is a minority of all TI procedures. The authors evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. A total of 22,741 TIs were reported from 60 PICUs, with the majority (96.2%) oral and 3.8% nasal. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%). Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI. With propensity score (PS) matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%). First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI. With PS matching, the overall success rate was not different between two groups (nasal 72.2% vs. oral 71.5%).
AHRQ-funded; HS024511.
Citation: Ducharme-Crevier L, Furlong-Dillard J, Jung P .
Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU).
Intensive Care Med Paediatr Neonatal 2024; 2(1):7. doi: 10.1007/s44253-024-00035-4..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Patient Safety, Critical Care
Sick-Samuels AC, Koontz DW, Xie A
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
A survey of medical professionals from 16 different academic pediatric hospitals was conducted from May 2021-January 2022. The goal of the survey was to examine respiratory culture practices, drivers, and barriers in mechanically ventilated patients. The study concluded that respiratory culture practices were inconsistent.
AHRQ-funded; HS028634.
Citation: Sick-Samuels AC, Koontz DW, Xie A .
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
Pediatr Crit Care Med 2024 Jan; 25(1):e20-e30. doi: 10.1097/pcc.0000000000003379..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Healthcare-Associated Infections (HAIs)
Qureshi N, Kroger J, Zangwill KM
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
The purpose of this study was to assess clinician perceptions towards the value and implementation of antibiotic stewardship (AS) in neonatal intensive care units (NICU). The researchers conducted a mixed-methods study of AS perceptions utilizing surveys and interviews in 30 California NICUs before and after a multicenter collaborative (Optimizing Antibiotic Use in California NICUs [OASCN]). The study found that pre-OASCN, 24% of respondents believed there was "a lot of" or "some" inappropriate prescribing, often driven by fear of a bad outcome or hesitation to change existing practices. Clinicians reported statistically significant increases in AS importance, perceived AS activity, and more openness to change after OASCN.
AHRQ-funded; HS026168.
Citation: Qureshi N, Kroger J, Zangwill KM .
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
J Perinatol 2024 Jan; 44(1):62-70. doi: 10.1038/s41372-023-01823-0..
Keywords: Antibiotics, Antimicrobial Stewardship, Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Azimi H, Johnson L, Loudermilk C
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
This study’s purpose was to assess if a patient’s medication regimen complexity-intensive care unit (MRC-ICU) score could predict in-hospital mortality in patients with COVID-19. This single-center, observational study was conducted from August 2020 to January 2021. The primary outcome was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. The authors assessed age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification. They included 149 patients who had a median SOFA score of 8 (IQR 5-11), and median MRC-ICU score at 48 hours of 15. The in-hospital mortality rate of 36%. The AUROC for MRC-ICU was 0.71 compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. Univariate analysis was used to compare the 4 characteristics. SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. All 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis.
AHRQ-funded; HS028485; HS029009.
Citation: Azimi H, Johnson L, Loudermilk C .
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
Hosp Pharm 2023 Dec; 58(6):564-68. doi: 10.1177/00185787231169460..
Keywords: COVID-19, Medication, Mortality, Intensive Care Unit (ICU)
Flannery 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
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
Xie A, Koontz DW, Colantuoni EA
Application of participatory ergonomics to the dissemination of a quality improvement program for optimizing blood culture use.
The overuse of blood cultures in pediatric ICUs (PICUs) may lead to the unnecessary utilization of antibiotics and related resistance to antibiotics. The purpose of this study was to utilize a participatory ergonomics (PE) approach to disseminate a quality improvement (QI) program for optimizing blood culture use in PICUs and assess the dissemination process and its impact on blood culture reduction. The study found that overall, the participating sites were able to implement the program successfully and reduce their blood culture rates from 149.4 blood cultures per 1,000 patient-days/month before implementation to 100.5 blood cultures per 1,000 patient-days/month after implementation. Differences in the dissemination process, as well as in local interventions and implementation strategies, were observed across sites. Site-specific variations in the rates of blood cultures were weakly negatively associated with the number of preintervention interactions with the coordinating team but not associated with their experiences with the six domains of the dissemination process or their interventions.
AHRQ-funded; HS025642; HS025238.
Citation: Xie A, Koontz DW, Colantuoni EA .
Application of participatory ergonomics to the dissemination of a quality improvement program for optimizing blood culture use.
Jt Comm J Qual Patient Saf 2023 Oct; 49(10):529-38. doi: 10.1016/j.jcjq.2023.06.004..
Keywords: Quality Improvement, Quality of Care, Children/Adolescents, Intensive Care Unit (ICU)
Lefrak L, Schaffer KE, Bohnert J
Blood culture procedures and practices in the neonatal intensive care unit: a survey of a large multicenter collaborative in California.
The objective of this Web-based survey was to describe variation in bedside and laboratory-level blood culture practices in neonatal intensive care units (NICUs). Participants were 28 NICUs in an antimicrobial stewardship quality improvement program in the California Perinatal Quality Care Collaborative. Results showed that recommended practices for blood culturing were not routinely performed. Most NICUs did not have a procedural competency, did not document sample volume, did not receive a culture contamination report, and/or did not require reporting to the provider if less than 1 mL of blood was drawn. Skin asepsis procedure varied across NICUs.
AHRQ-funded; HS026168.
Citation: Lefrak L, Schaffer KE, Bohnert J .
Blood culture procedures and practices in the neonatal intensive care unit: a survey of a large multicenter collaborative in California.
Infect Control Hosp Epidemiol 2023 Oct; 44(10):1576=81. doi: 10.1017/ice.2023.33..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Inpatient Care, Quality of 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
Klawetter S, Weikel B, Roybal K
Social determinants of health and parenting self-efficacy among mothers of preterm infants.
The purpose of this prospective cohort study was to utilize a social determinants of health (SDoH) framework to examine the associations between social and environmental factors and parenting self-efficacy (PSE) in mothers of preterm infants hospitalized in neonatal intensive care units (NICUs). The study found that the multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant. Significant predictors of PSE were race/ethnicity, having another child/children, and depression.
AHRQ-funded; HS026370.
Citation: Klawetter S, Weikel B, Roybal K .
Social determinants of health and parenting self-efficacy among mothers of preterm infants.
J Soc Social Work Res 2023 Summer; 14(2):411-29. doi: 10.1086/716303..
Keywords: Social Determinants of Health, Newborns/Infants, Maternal Care, Intensive Care Unit (ICU)
Giuliano J, Krishna A, Napolitano N
Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU.
The purpose of this study was to assess the implementation of a video laryngoscope (VL) as a coaching device to decrease adverse tracheal intubation associated events (TIAEs). Between 2016 and 2020 the researchers implemented VLs as coaching devices with standardized coaching language. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches. The study found that a VL was used in 71% of 5,060 tracheal intubations. VL utilization increased from a baseline of 29.7% to an implementation phase level of 89.4%. VL utilization was related with lower TIAEs compared with standard laryngoscope (SL). VL utilization was related with lower severe TIAE rate, but not related with a reduction in severe hypoxemia. VL utilization was related with greater first attempt success. In the primary analysis after adjusting for site clustering, VL utilization was related with lower adverse TIAEs. In secondary analyses, VL utilization was not significantly related with severe TIAEs, severe hypoxemia, or first attempt success. After additional controlling for patient and provider characteristics, VL utilization was independently related with a lower TIAE rate.
AHRQ-funded; HS024511.
Citation: Giuliano J, Krishna A, Napolitano N .
Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU.
Crit Care Med 2023 Jul; 51(7):936-47. doi: 10.1097/ccm.0000000000005847..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Adverse Events, Patient Safety
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
Mehta SD, Congdo M, Phillips CA
Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.
This study’s objective was to apply diagnostic process improvement frameworks to identify missed opportunities for improvement in diagnosis (MOID) in pediatric emergency transfers (ETs) and evaluate their association with outcomes. ET is defined as hospitalized patients who require ICU interventions within 1 hour of ICU transfer, which is a proximal measure of late recognition associated with increased mortality and length of stay (LOS). This single-center retrospective cohort study was conducted from January 2015 to June 2019. Primary outcome was the presence of missed opportunities for improvement in diagnosis (MOID), determined using SaferDx. MOID was identified in 37 of 129 ETs (29%). Cases with MOID differed in originating service, but not demographically, with failure to recognize urgency of an identified condition the most common diagnostic process opportunity. ET cases with MOID had higher odds of mortality and longer post-transfer LOS.
AHRQ-funded; HS028682.
Citation: Mehta SD, Congdo M, Phillips CA .
Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.
J Hosp Med 2023 Jun; 18(6):509-18. doi: 10.1002/jhm.13103..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Intensive Care Unit (ICU)
Kannan S, Song Z
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
Out-of-pocket costs for ICU care may be large at the beginning of the year due to high insurance deductibles that reset every year for US patients, and the expensive nature of ICU care. The purpose of this cross-sectional study was to explore cost-sharing changes from December to January for ICU admissions and non -ICU admissions among adults with employer-sponsored insurance. Among aggregate ICU hospitalizations, total cost-sharing averaged $1079 in December and $1871 in January, a 73.4% increase. Among non-ICU hospitalizations, total cost-sharing averaged $1043 in December and $1683 in January, a 61.3% increase. These increases and differences between ICU and non-ICU hospitalizations were greater among patients with high deductible health plans (HDHPs). For patients with HDHPs requiring an ICU stay, cost-sharing averaged $3093 per hospitalization in January vs $1301 in December.
AHRQ-funded; HS024072.
Citation: Kannan S, Song Z .
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
JAMA Health Forum 2023 May 5; 4(5):e230784. doi: 10.1001/jamahealthforum.2023.0784..
Keywords: Healthcare Costs, Hospitals, Hospitalization, Intensive Care Unit (ICU)
Sikora A, Rafiei A, Rad MG
Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model.
The Common Data Model for Intensive Care Unit (ICU) Medications (CDM-ICURx) may provide the needed infrastructure to clinicians and researchers to support artificial intelligence analysis of medication-related outcomes and healthcare costs. The purpose of this study was to identify novel patterns of medication clusters (termed 'pharmacophenotypes') correlated with ICU adverse events (e.g., fluid overload) and patient-centered outcomes (e.g., mortality). The researchers conducted a retrospective, observational cohort study of 991 critically ill adults with a total of 30,550 medication orders. To identify pharmacophenotypes, unsupervised machine learning analysis with automated feature learning was performed on the medication administration records of each patient during the first 24 hours of their stay in the intensive care unit. Five unique patient clusters and six unique pharmacophenotypes were identified. For patient outcomes, compared to patients in Clusters 1 and 3, patients in Cluster 5 had a significantly shorter duration of mechanical ventilation and ICU length of stay; for medications, Cluster 5 had a higher distribution of Pharmacophenotype 1 and a smaller distribution of Pharmacophenotype 2, compared to Clusters 1 and 3. For outcomes, patients in Cluster 2 had the highest severity of illness and greatest medication regimen complexity, but they also had the lowest overall mortality; for medications, Cluster 2 also had a higher distribution of Pharmacophenotype 6.
AHRQ-funded; HS028485.
Citation: Sikora A, Rafiei A, Rad MG .
Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model.
Crit Care 2023 May 2; 27(1):167. doi: 10.1186/s13054-023-04437-2..
Keywords: Medication, Intensive Care Unit (ICU)
Fraiman YS, Cheston CC, Morales D
A mixed methods study of perceptions of bias among neonatal intensive care unit staff.
This study’s goal was to characterize the perceptions of bias among neonatal intensive care units (NICU) staff. The authors distributed a survey to all staff (N = 245) in a single academic Level IV NICU, with a response of 178 respondents. More respondents agreed that bias had a greater impact on others vs. their own behaviors. They agreed that behaviors were influenced more by implicit than explicit biases and felt that other staff had implicit bias but that they have less bias than others. Healthcare staff provided ideas for strategies and approaches to mitigate the impact of bias. The authors propose the use of mixed methods studies as they are effective ways of understanding environment-specific perceptions of bias, and contextual assets and barriers when creating interventions to reduce bias and improve equity.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Cheston CC, Morales D .
A mixed methods study of perceptions of bias among neonatal intensive care unit staff.
Pediatr Res 2023 May; 93(6):1672-78. doi: 10.1038/s41390-022-02217-2..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Provider: Health Personnel
Valley TS, Schutz A, Miller J
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
In order to understand factors influencing how intensive care unit (ICU) admission decisions are made, researchers conducted qualitative analysis of eight U.S. hospitals. Semi-structured, one-on-one interviews with 87 participants were supplemented by site visits and clinical observations. Four hospital-level factors were identified which influenced ICU admission decisionmaking. The researchers concluded that healthcare systems should evaluate use of ICU care and establish institutional patterns to ensure that ICU admission decisions are patient-centered as well as account for resources and hospital-specific constraints.
AHRQ-funded; HS028038.
Citation: Valley TS, Schutz A, Miller J .
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
Intensive Care Med 2023 May; 49(5):505-16. doi: 10.1007/s00134-023-07031-w..
Keywords: Intensive Care Unit (ICU), Hospitals, Shared Decision Making, Hospitalization
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
Anesi GL, Dres E, Chowdhury M
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Prior research has demonstrated a connection between hospital strain and ICU admission, and has suggested that ICU admission, compared to ward admission, could be advantageous for certain patients with acute respiratory failure (ARF). The purpose of this study was to explore how strain-process-outcomes relationships in ARF patients may differ among hospitals and to identify hospital practice discrepancies that may explain such variation. The researchers analyzed high-acuity ARF patients who did not necessitate mechanical ventilation or vasopressors in the emergency department (ED) and were admitted to 27 US hospitals between 2013 and 2018. The researchers compared hospital strain-ICU admission relationships and hospital length of stay (LOS) and mortality for patients initially admitted to the ICU versus the ward. Additionally, they investigated hospital practices and assessed their associations with those processes and outcomes. The study found that substantial variation was observed among hospitals in ICU admission rates, hospital strain-ICU admission relationships, and the impact of ICU admission on hospital LOS and mortality. Overall, ED patients with ARF had a median hospital LOS that was 0.82 days shorter if initially admitted to the ICU rather than the ward. However, among the 27 hospitals this effect ranged from 5.85 days shorter to 4.38 days longer. In exploratory analyses, only a limited number of identified hospital practices—such as the presence of sepsis ED disposition guidelines and maximum ED patient capacity—were potentially linked to hospital strain-ICU admission relationships.
AHRQ-funded; HS026372.
Citation: Anesi GL, Dres E, Chowdhury M .
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Ann Am Thorac Soc 2023 Mar; 20(3):406-13. doi: 10.1513/AnnalsATS.202205-429OC.
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Hospital Discharge
Chiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis