National Healthcare Quality and Disparities Report
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Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Events (5)
- Blood Pressure (1)
- Care Coordination (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (2)
- Children/Adolescents (3)
- Chronic Conditions (2)
- Communication (2)
- Critical Care (7)
- Education: Continuing Medical Education (2)
- Elderly (2)
- Electronic Health Records (EHRs) (2)
- Emergency Department (1)
- Evidence-Based Practice (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (5)
- Healthcare Costs (1)
- Health Information Technology (HIT) (1)
- Heart Disease and Health (1)
- Hospitalization (2)
- Hospital Readmissions (1)
- Inpatient Care (1)
- (-) Intensive Care Unit (ICU) (24)
- Medication (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (1)
- Newborns/Infants (1)
- Nursing (1)
- Organizational Change (1)
- Outcomes (3)
- Patient-Centered Healthcare (1)
- Patient and Family Engagement (1)
- Patient Safety (12)
- Policy (1)
- Prevention (4)
- Provider (1)
- Public Reporting (1)
- Quality Improvement (1)
- Quality of Care (2)
- Shared Decision Making (1)
- Surgery (2)
- Training (3)
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 24 of 24 Research Studies DisplayedChen R, Strait KM, Dharmarajan K
Hospital variation in admission to intensive care units for patients with acute myocardial infarction.
This study investigates how contemporary hospitals use this resource-intensive setting of intensive care units (ICUs) and whether higher use is associated with better outcomes. It found that rates of ICU admission for patients with AMI vary substantially across hospitals and were not associated with differences in mortality, but were associated with greater use of critical care therapies.
AHRQ-funded; HS020672.
Citation: Chen R, Strait KM, Dharmarajan K .
Hospital variation in admission to intensive care units for patients with acute myocardial infarction.
Am Heart J 2015 Dec;170(6):1161-9. doi: 10.1016/j.ahj.2015.09.003.
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Keywords: Hospitalization, Intensive Care Unit (ICU), Heart Disease and Health
Rehder KJ, Giuliano JS, Jr., Napolitano N
Increased occurrence of tracheal intubation-associated events during nights and weekends in the PICU.
Little is known about how the incidence of tracheal intubation-associated events is affected by the time of day, day of the week, or presence of in-hospital attending-level intensivists. After analyzing 5,096 tracheal intubation courses from the prospective multicenter National Emergency Airway Registry for Children, the researchers found that a higher occurrence of tracheal intubation-associated events was observed during nights and weekends, due primarily to emergent intubations.
AHRQ-funded; HS022464; HS021583.
Citation: Rehder KJ, Giuliano JS, Jr., Napolitano N .
Increased occurrence of tracheal intubation-associated events during nights and weekends in the PICU.
Crit Care Med 2015 Dec;43(12):2668-74. doi: 10.1097/ccm.0000000000001313.
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Keywords: Newborns/Infants, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Critical Care
Kerlin MP, Cooke CR
Understanding costs when seeking value in critical care.
The authors discuss a study by Gershengorn and colleagues about daily ICU costs in five ICUs within a single medical center. They argue that although the authors should be commended on advancing the understanding of ICU costs, we should also recognize that efforts to reduce ICU length of stay will necessarily be insufficient to make a real dent in our health care economy.
AHRQ-funded; HS020672.
Citation: Kerlin MP, Cooke CR .
Understanding costs when seeking value in critical care.
Ann Am Thorac Soc 2015 Dec;12(12):1743-4. doi: 10.1513/AnnalsATS.201510-660ED.
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Keywords: Critical Care, Healthcare Costs, Intensive Care Unit (ICU)
Wolfe H, Maltese MR, Niles DE
Blood pressure directed booster trainings improve intensive care unit provider retention of excellent cardiopulmonary resuscitation skills.
The authors incorporated arterial blood pressure (ABP) tracings into Booster Trainings, hypothesizing that ABP-directed CPR Booster Trainings would improve intensive care unit (ICU) provider 3-month retention of excellent CPR skills without need for interval retraining. They found that the ABP-directed CPR booster trainings improved ICU provider 3-month retention of excellent CPR skills without the need for interval retraining.
AHRQ-funded; HS022469; HS022464.
Citation: Wolfe H, Maltese MR, Niles DE .
Blood pressure directed booster trainings improve intensive care unit provider retention of excellent cardiopulmonary resuscitation skills.
Pediatr Emerg Care 2015 Nov;31(11):743-7. doi: 10.1097/pec.0000000000000394.
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Keywords: Blood Pressure, Education: Continuing Medical Education, Intensive Care Unit (ICU), Patient Safety, Training
Carayon P, Weinger MB, Brown R
How do residents spend their time in the intensive care unit?
The researchers described the work of residents and the distribution of their time in 6 intensive care units (ICUs) of 2 medical centers (MCs). The found that residents spent most time performing direct patient care and care coordination activities. The distribution of activities, which varied across MCs and across ICUs, highlights the need to consider the local context on residents' work in ICUs.
AHRQ-funded; HS015274.
Citation: Carayon P, Weinger MB, Brown R .
How do residents spend their time in the intensive care unit?
Am J Med Sci 2015 Nov;350(5):403-8. doi: 10.1097/maj.0000000000000520.
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Keywords: Education: Continuing Medical Education, Intensive Care Unit (ICU), Provider, Training
McElroy LM, Macapagal KR, Collins KM
Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study.
The goal of this study is to use qualitative research methods to describe clinician perceptions of OR-to-ICU handoffs, and to elucidate attributes of the handoff process associated with high quality, as well as those with poor quality that can lead to patient harm. The findings suggest that ambiguous roles and conflicting expectations of team members during the OR-to-ICU handoff can increase risk of patient harm.
AHRQ-funded; HS000078.
Citation: McElroy LM, Macapagal KR, Collins KM .
Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study.
Am J Surg 2015 Oct;210(4):629-35. doi: 10.1016/j.amjsurg.2015.05.008..
Keywords: Patient Safety, Intensive Care Unit (ICU), Surgery, Adverse Events, Care Coordination
Valley TS, Sjoding MW, Ryan AM
Association of intensive care unit admission with mortality among older patients with pneumonia.
The purpose of this study was to estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia. It concluded that among Medicare beneficiaries hospitalized with pneumonia, ICU admission of patients for whom the decision appeared to be discretionary was associated with improved survival and no significant difference in costs.
AHRQ-funded; HS020672.
Citation: Valley TS, Sjoding MW, Ryan AM .
Association of intensive care unit admission with mortality among older patients with pneumonia.
JAMA 2015 Sep 22-29;314(12):1272-9. doi: 10.1001/jama.2015.11068..
Keywords: Patient Safety, Intensive Care Unit (ICU), Elderly, Mortality, Hospitalization
Theodoro D, Olsen MA, Warren DK
Emergency department central line-associated bloodstream infections (CLABSI) incidence in the era of prevention practices.
The incidence of central line–associated bloodstream infections (CLABSI) attributed to central venous catheters (CVCs) inserted in the emergency department (ED) is not widely reported. The goal of this study was to report the incidence of ED CLABSI. It concluded that the CLABSI rates in this academic medical center ED were in the range of those reported by the ICU.
AHRQ-funded; HS018092; HS019455.
Citation: Theodoro D, Olsen MA, Warren DK .
Emergency department central line-associated bloodstream infections (CLABSI) incidence in the era of prevention practices.
Acad Emerg Med 2015 Sep;22(9):1048-55. doi: 10.1111/acem.12744..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Emergency Department, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Prevention
Costarino AT, Dai D, Feng R
Gastric acid suppressant prophylaxis in pediatric intensive care: current practice as reflected in a large administrative database.
The researchers described the use of histamine 2 receptor blockers and proton pump inhibitors and associated factors among a national sample of pediatric intensivecare unit (PICU) patients with stress-related gatrointestinal bleeding. Histamine 2 receptor blocker and proton pump inhibitor are prescribed in most PICU patients, but significant variation exists across health conditions and hospitals.
AHRQ-funded; HS018425.
Citation: Costarino AT, Dai D, Feng R .
Gastric acid suppressant prophylaxis in pediatric intensive care: current practice as reflected in a large administrative database.
Pediatr Crit Care Med 2015 Sep;16(7):605-12. doi: 10.1097/pcc.0000000000000427.
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Keywords: Children/Adolescents, Intensive Care Unit (ICU), Children/Adolescents, Medication
McElroy LM, Collins KM, Koller FL
Operating room to intensive care unit handoffs and the risks of patient harm.
The goal of this study was to assess systems and processes involved in the operating room(OR) to intensive care unit (ICU) handoff in an attempt to understand the criticality of specific steps of the handoff. In total, 81 process failures were identified, Process failures with the greatest risk of harm were lack of preliminary OR to ICU communication, team member absence during handoff communication, and transport equipment malfunction.
AHRQ-funded; HS000078.
Citation: McElroy LM, Collins KM, Koller FL .
Operating room to intensive care unit handoffs and the risks of patient harm.
Surgery 2015 Sep;158(3):588-94. doi: 10.1016/j.surg.2015.03.061..
Keywords: Intensive Care Unit (ICU), Patient Safety, Surgery, Communication, Adverse Events
Croft LD, Harris AD, Pineles L
The effect of universal glove and gown use on adverse events in intensive care unit patients.
The researchers assessed if wearing gloves and gowns during all patient contact in the intensive care unit (ICU) changes adverse event rates. They found that in ICUs where healthcare workers donned gloves and gowns for all patient contact, patients were no more likely to experience adverse events than in control ICUs. Concerns of adverse events resulting from universal glove and gown use were not supported.
AHRQ-funded; 29020060001.
Citation: Croft LD, Harris AD, Pineles L .
The effect of universal glove and gown use on adverse events in intensive care unit patients.
Clin Infect Dis 2015 Aug 15;61(4):545-53. doi: 10.1093/cid/civ315..
Keywords: Patient Safety, Intensive Care Unit (ICU), Adverse Events, Healthcare-Associated Infections (HAIs), Critical Care
Carayon P, Wetterneck TB, Alyousef B
Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit.
This study assessed the impact of EHR technology on the work and workflow of ICU physicians and compared time spent by ICU resident and attending physicians on various tasks before and after EHR implementation. It found that after EHR implementation, both residents and attending physicians spent more of their time on clinical review and documentation (40 percent and 55 percent increases, respectively).
AHRQ-funded; HS000083; HS015274.
Citation: Carayon P, Wetterneck TB, Alyousef B .
Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit.
Int J Med Inform 2015 Aug;84(8):578-94. doi: 10.1016/j.ijmedinf.2015.04.002..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU)
Kiyoshi-Teo H, Blegen M
Influence of institutional guidelines on oral hygiene practices in intensive care units.
The purpose of this study was to explore how characteristics of institutional guidelines for oral hygiene influence nurses’ oral hygiene practices and perceptions of that practice. It concluded that the content and dissemination method of institutional guidelines on oral hygiene do influence the oral hygiene practices of critical care nurses.
AHRQ-funded; HS018879.
Citation: Kiyoshi-Teo H, Blegen M .
Influence of institutional guidelines on oral hygiene practices in intensive care units.
Am J Crit Care 2015 Jul;24(4):309-18. doi: 10.4037/ajcc2015920..
Keywords: Intensive Care Unit (ICU), Nursing, Critical Care, Prevention, Guidelines
Rock C, Harris AD, Johnson JK
Infrequent air contamination with Acinetobacter baumannii of air surrounding known colonized or infected patients.
The researchers, by using a validated air sampling method, found Acinetobacter baumannii in the air surrounding only 1 of 12 patients known to be colonized or infected with A. baumannii. Patients’ closed-circuit ventilator status, frequent air exchanges in patient rooms, and short sampling time may have contributed to this low burden.
AHRQ-funded; HS022291.
Citation: Rock C, Harris AD, Johnson JK .
Infrequent air contamination with Acinetobacter baumannii of air surrounding known colonized or infected patients.
Infect Control Hosp Epidemiol 2015 Jul;36(7):830-2. doi: 10.1017/ice.2015.68..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU)
Morgan DJ, Pineles L, Shardell M
Effect of chlorhexidine bathing and other infection control practices on the Benefits of Universal Glove and Gown (BUGG) trial: a subgroup analysis.
The researchers report the results of a subgroup analysis of the Benefits of Universal Glove and Gown trial. In 20 intensive care units, the reduction in acquisition of methicillin-resistant Staphylococcus aureus observed in this trial was observed in units also using chlorhexidine bathing and in those that previously performed active surveillance.
AHRQ-funded; HS018111; 290200600015.
Citation: Morgan DJ, Pineles L, Shardell M .
Effect of chlorhexidine bathing and other infection control practices on the Benefits of Universal Glove and Gown (BUGG) trial: a subgroup analysis.
Infect Control Hosp Epidemiol 2015 Jun;36(6):734-7. doi: 10.1017/ice.2015.33..
Keywords: Patient Safety, Prevention, Intensive Care Unit (ICU), Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs)
Sjoding MW, Prescott HC, Wunsch H
Hospitals with the highest intensive care utilization provide lower quality pneumonia care to the elderly.
The researchers investigate the relationship between a hospital’s ICU admission rate for elderly patients with pneumonia and the quality of care it provided to patients with pneumonia. They found that quality of care was lower among hospitals with the highest rates of ICU admission for elderly patients with pneumonia; such hospitals were less likely to deliver pneumonia processes of care and had worse outcomes for patients with pneumonia.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Prescott HC, Wunsch H .
Hospitals with the highest intensive care utilization provide lower quality pneumonia care to the elderly.
Crit Care Med 2015 Jun;43(6):1178-86. doi: 10.1097/ccm.0000000000000925..
Keywords: Intensive Care Unit (ICU), Elderly, Inpatient Care, Quality of Care, Outcomes
Brown SE, Ratcliffe SJ, Halpern SD
Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms.
This study sought to determine whether ICU readmission rates changed after the 2003 Accreditation Council for Graduate Medical Education Resident Duty Hours reform and whether there were temporally corresponding changes in other ICU outcomes. The decrease in ICU readmission rates after reform, without corresponding changes in mortality, suggest that ICU readmissions are not causally related to other untoward patient outcomes.
AHRQ-funded; HS018406.
Citation: Brown SE, Ratcliffe SJ, Halpern SD .
Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms.
Chest 2015 Mar;147(3):626-36. doi: 10.1378/chest.14-1060..
Keywords: Intensive Care Unit (ICU), Hospital Readmissions, Quality of Care, Patient Safety, Outcomes
Tarquinio KM, Howell JD, Montgomery V
Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study.
The objective of this study was to evaluate the association of medication selection on specific tracheal intubation–associated events across pediatric intensive care units. It found that fentanyl, midazolam, and ketamine were the most commonly used induction agents, and the majority of tracheal intubations involved neuromuscular blockade. Ketamine use was not associated with lower prevalence of hypotension.
AHRQ-funded; HS022464; HS021583.
Citation: Tarquinio KM, Howell JD, Montgomery V .
Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study.
Pediatr Crit Care Med 2015 Mar;16(3):210-8. doi: 10.1097/pcc.0000000000000319..
Keywords: Children/Adolescents, Patient Safety, Intensive Care Unit (ICU), Adverse Events, Medication
Edwards JD, Vasilevskis EE, Yoo EJ
Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units.
The purpose of the study is to compare demographics, intensive care unit (ICU) admission characteristics, and ICU outcomes among adults with childhood-onset chronic conditions (COCCs) admitted to US pediatric and adult ICUs. It found that adults with COCCs admitted to pediatric units were significantly more likely to be younger, have lower functional status, and be nontrauma patients than those in adult units.
AHRQ-funded; HS017716.
Citation: Edwards JD, Vasilevskis EE, Yoo EJ .
Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units.
J Crit Care 2015 Feb;30(1):201-6. doi: 10.1016/j.jcrc.2014.10.016..
Keywords: Intensive Care Unit (ICU), Chronic Conditions, Critical Care
Sjoding MW, Cooke CR
Chronic critical illness: a growing legacy of successful advances in critical care*.
As the population ages, and advances in critical care continue to improve survival among the most severely ill patients, many assert that the incidence of chronic critical illness (CCI) will continue to rise. The authors discuss an article (Kahn, et al) in the same issue that highlights the growing incidence of CCI and the problems it poses.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Cooke CR .
Chronic critical illness: a growing legacy of successful advances in critical care*.
Crit Care Med 2015 Feb;43(2):476-7. doi: 10.1097/ccm.0000000000000780..
Keywords: Critical Care, Chronic Conditions, Intensive Care Unit (ICU)
Gold JA, Tutsch AS, Gorsuch A
Integrating the electronic health record into high-fidelity interprofessional intensive care unit simulations.
The authors described the impact of integrating the electronic health record (EHR) into high-fidelity, interprofessional intensive care unit (ICU) simulations, and the errors induced. They found a number of safety issues directly related to the EHR, and they now have an infrastructure to focus educational initiative and deploy informatics solutions to mitigate these safety issues.
AHRQ-funded; HS021637.
Citation: Gold JA, Tutsch AS, Gorsuch A .
Integrating the electronic health record into high-fidelity interprofessional intensive care unit simulations.
J Interprof Care 2015;29(6):562-3. doi: 10.3109/13561820.2015.1063482.
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Keywords: Shared Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Training
Rangachari P, Madaio M, Rethemeyer RK
The evolution of knowledge exchanges enabling successful practice change in two intensive care units.
There are gaps in understanding the mechanisms by which top-down communications enable practice change. The authors sought to address these gaps in order to help identify evidence-based management strategies for successful practice change at the unit level. They found that both intensive care units studied experienced substantially improved outcomes and indicated a statistically significant increase in proactive communications. Early in the study, champions emerged within each unit to initiate process improvements. The authors concluded that the study helped to identify evidence-based management strategies for successful practice change at the unit level.
AHRQ-funded; HS019785.
Citation: Rangachari P, Madaio M, Rethemeyer RK .
The evolution of knowledge exchanges enabling successful practice change in two intensive care units.
Health Care Manage Rev 2015 Jan-Mar;40(1):65-78. doi: 10.1097/hmr.0000000000000001.
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Keywords: Intensive Care Unit (ICU), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Critical Care, Communication, Evidence-Based Practice, Organizational Change, Prevention, Patient Safety
Sjoding MW, Cooke CR
The importance of rigorous evaluation of quality measurement programs.
The authors comment on a study evaluating a California program to determine whether public reporting of ICU mortality rates improved patient outcomes. They argue that as these programs move from public reporting to pay-for-performance as a primary mechanism for incentivizing improvement, the research community must ensure they are both fair and effective.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Cooke CR .
The importance of rigorous evaluation of quality measurement programs.
Ann Am Thorac Soc 2015 Jan;12(1):107-8. doi: 10.1513/AnnalsATS.201412-588ED..
Keywords: Quality Improvement, Public Reporting, Intensive Care Unit (ICU), Policy, Outcomes
Baird J, Davies B, Hinds PS
What impact do hospital and unit-based rules have upon patient and family-centered care in the pediatric intensive care unit?
This qualitative, grounded theory study identified the existence of explicit and implicit rules in a pediatric intensive care unit, all of which negatively affected the family's ability to receive care that was attentive to their needs. The rules also placed the registered nurse in the challenging position of serving as rule enforcer and facilitator of patient and family-centered care.
AHRQ-funded; HS000063.
Citation: Baird J, Davies B, Hinds PS .
What impact do hospital and unit-based rules have upon patient and family-centered care in the pediatric intensive care unit?
J Pediatr Nurs 2015 Jan-Feb;30(1):133-42. doi: 10.1016/j.pedn.2014.10.001.
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Keywords: Children/Adolescents, Intensive Care Unit (ICU), Patient and Family Engagement, Patient-Centered Healthcare, Children/Adolescents