National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (10)
- Antibiotics (4)
- Antimicrobial Stewardship (3)
- Behavioral Health (2)
- Burnout (1)
- Cardiovascular Conditions (2)
- Caregiving (4)
- Catheter-Associated Urinary Tract Infection (CAUTI) (4)
- Central Line-Associated Bloodstream Infections (CLABSI) (4)
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- Communication (2)
- COVID-19 (5)
- Critical Care (42)
- Decision Making (3)
- Diagnostic Safety and Quality (6)
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- Education: Continuing Medical Education (3)
- Elderly (2)
- Electronic Health Records (EHRs) (3)
- Emergency Department (3)
- Emergency Preparedness (1)
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- Healthcare-Associated Infections (HAIs) (6)
- Healthcare Cost and Utilization Project (HCUP) (2)
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- (-) Intensive Care Unit (ICU) (73)
- Medical Errors (2)
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- Neonatal Intensive Care Unit (NICU) (8)
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- Patient Experience (2)
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- Provider: Nurse (1)
- Provider: Pharmacist (1)
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- Quality Indicators (QIs) (1)
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- Quality of Life (1)
- Racial and Ethnic Minorities (2)
- Registries (3)
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- Simulation (2)
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- Transitions of Care (1)
- Urinary Tract Infection (UTI) (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 73 Research Studies DisplayedRamsden SC, Pergjika A, Janssen AC
A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings.
This systematic review evaluated the effectiveness and safety of droperidol for the management of acute, severe agitation in children in acute care settings. The authors conclude that existing data indicate that droperidol is both effective and safe; however, data are limited by study designs that may introduce bias.
AHRQ-funded; HS026385.
Citation: Ramsden SC, Pergjika A, Janssen AC .
A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings.
Acad Emerg Med 2022 Dec;29(12):1466-74. doi: 10.1111/acem.14515..
Keywords: Children/Adolescents, Medication, Medication: Safety, Intensive Care Unit (ICU), Patient Safety
Rosen A, Carter D, Applebaum JR
Critical care clinicians' experiences of patient safety during the COVID-19 pandemic.
The purpose of this mixed methods, multi-institutional study was to explore how the COVID-19 pandemic worsened preexisting issues of patient safety and created new challenges for patient safety within United States intensive care units (ICU.) The researchers conducted a national survey of critical care clinicians to assess their experiences related to patient safety during the pandemic. The survey instrument was distributed via email through the Society of Critical Care Medicine listserv, with results reported as percentages while free-text responses were analyzed and coded for themes. The study found that of the 355 survey responses received, 61% believed that conditions during the pandemic were more hazardous when compared with the period prior to the pandemic. When compared with providers who cared for mostly non-COVID-19 or no COVID-19 patients, the professionals who cared for primarily COVID-19 patients had an increased likelihood of perceiving that care was more hazardous. In the coded free-text responses, providers identified themes in patient safety risks including ventilator-related lung injury, medication and diagnostic errors, oversedation, oxygen device removal, and falls. The study concluded that higher levels of COVID-19 case burden were significantly related with perceptions of a less safe patient care environment by frontline ICU clinicians, and further identified specific hazards in intensive care units.
AHRQ-funded; HS026121.
Citation: Rosen A, Carter D, Applebaum JR .
Critical care clinicians' experiences of patient safety during the COVID-19 pandemic.
J Patient Saf 2022 Dec 1;18(8):e1219-e25. doi: 10.1097/pts.0000000000001060..
Keywords: COVID-19, Patient Safety, Critical Care, Intensive Care Unit (ICU)
Cheung PC, Kramer MR, Kempker JA
Intermediate or intensive care unit admission across race and ethnicity.
This study’s aim was to assess the association between race and ethnicity and admission to intermediate (IMCUs) or intensive care units (ICUs) among hospitalized patients. Florida hospital discharge data from the State Inpatient Database was used to assess the relationship between race (White, Black, Other) and Hispanic ethnicity and IMCU or ICU admission. After controlling for demographics and comorbidities, the prevalence of IMCU or ICU admission was higher among non-Hispanic Blacks and non-Hispanic patients of other races compared with non-Hispanic Whites. The prevalence of IMCU or ICU use was lower among Hispanic Whites and Hispanics of other races compared with non-Hispanic Whites after controlling for other demographic characteristics and comorbidities.
AHRQ-funded; HS025240.
Citation: Cheung PC, Kramer MR, Kempker JA .
Intermediate or intensive care unit admission across race and ethnicity.
South Med J 2022 Dec;115(12):913-18. doi: 10.14423/smj.0000000000001487..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Intensive Care Unit (ICU)
Levinson Z, Cantor J, Williams MV
The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.
Investigators sought to identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics. They found that hospitals with large Black patient shares experienced greater strain during the pandemic. These hospitals received more federal relief; however, funding was not targeted overall toward hospitals with high ICU occupancy rates.
AHRQ-funded; HS024067.
Citation: Levinson Z, Cantor J, Williams MV .
The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.
Health Serv Res 2022 Dec;57(Suppl 2):279-90. doi: 10.1111/1475-6773.14028..
Keywords: COVID-19, Intensive Care Unit (ICU), Critical Care, Racial and Ethnic Minorities, Hospitals
Govindan S, O'Malley ME, Flanders SA
The MI-PICC Score: a risk-Prediction Model for PICC-associated Complications in the ICU.
The authors examined predictive factors for adverse events in critically ill patients with peripherally inserted central catheters (PICCs). They found that PICC-related complications in the ICU were significantly associated with history of deep vein thrombosis, active diagnosis of cancer, presence of a second central venous catheter, blood transfusion through the PICC, and PICC dwell time.
AHRQ-funded; HS025891.
Citation: Govindan S, O'Malley ME, Flanders SA .
The MI-PICC Score: a risk-Prediction Model for PICC-associated Complications in the ICU.
Am J Respir Crit Care Med 2022 Nov 15;206(10):1286-89. doi: 10.1164/rccm.202204-0760LE..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Critical Care, Intensive Care Unit (ICU), Risk, Adverse Events
Kang D, Charlton P, Applebury DE
Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit.
The authors conducted a study using high-fidelity electronic health record (EHR)-based simulations with incorporated eye tracking to understand the workflow of critical care pharmacists within the EHR, with specific attention to the data elements most frequently viewed. They found that, in addition to medication information, laboratory data and clinical notes are key focuses of intensive care unit pharmacist review of patient records and that navigation to multiple screens is required in order to view these data with the EHR.
AHRQ-funded; HS023793.
Citation: Kang D, Charlton P, Applebury DE .
Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit.
Am J Health Syst Pharm 2022 Nov 7;79(22):2018-25. doi: 10.1093/ajhp/zxac158..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Critical Care, Provider: Pharmacist
Klawetter S, Cetin N, Ilea P
"All these people saved her life, but she needs me too": understanding and responding to parental mental health in the NICU.
The purpose of this qualitative study was to examine the mental health needs of parents of infants in a neonatal intensive care unit (NICU), and the challenges and solutions to meeting those needs. Through interviews with 15 parents and staff at a level IV NICU in the United States, the study found: the relationship between staff and parents filter protect from trauma and distress; information needs and mental health needs change over time, a lack of continuity of care affects response to mental health concerns, and NICU plays a critical role in addressing the mental health of parents. The researchers concluded that mental health support should be integrated into and customized to the entire NICU trajectory, with emphasis on parents living in rural locations and non-English-speaking parents.
AHRQ-funded; HS026370.
Citation: Klawetter S, Cetin N, Ilea P .
"All these people saved her life, but she needs me too": understanding and responding to parental mental health in the NICU.
J Perinatol 2022 Nov;42(11):1496-503. doi: 10.1038/s41372-022-01426-1..
Keywords: Caregiving, Newborns/Infants, Critical Care, Intensive Care Unit (ICU), Behavioral Health
Sullivan BA, Panda A, Wallman-Stokes A
Antibiotic spectrum index: a new tool comparing antibiotic use in three NICUs.
This study looked at a new tool called the antibiotic spectrum index (ASI) which quantifies antibiotic exposure by relative antimicrobial activity, adding information to exposure measured by days of therapy (DOT). This index was tested with very low-birth-weight infants (VLBW, <1500g) in 3 level-4 NICUs for 2 years at 2 sites and for 1 year at a third site. The authors calculated the ASI per antibiotic days and DOT per patient days for all admitted VLBW infants <32 weeks gestational age. The site with the highest DOT per patient days was found to have the lowest ASI per antibiotic days and the site with the highest mortality and infection rates were found to have the highest ASI per antibiotic days. Antibiotic utilization varied by center.
AHRQ-funded; HS026742.
Citation: Sullivan BA, Panda A, Wallman-Stokes A .
Antibiotic spectrum index: a new tool comparing antibiotic use in three NICUs.
Infect Control Hosp Epidemiol 2022 Nov;43(11):1553-57. doi: 10.1017/ice.2021.467..
Keywords: Antibiotics, Medication, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Antimicrobial Stewardship
Krauss DM, Molefe A, Hung L
AHRQ Author: Henderson S, Miller M
Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic.
In this study, researchers summarized themes for maintaining infection prevention activities learned from the implementation of a quality improvement (QI) program during the COVID-19 pandemic. They concluded that future shocks such as the pandemic must be anticipated, and the healthcare system must be resilient to the resulting disruptions to healthcare-associated infection prevention activities. Their study encountered four themes for successful maintenance of infection prevention activities during the current pandemic: the value of a pre-existing infection prevention infrastructure; a flexibility in approach; broad buy-in for maintaining QI programs; and the facilitation of idea-sharing.
AHRQ-authored; AHRQ-funded; 233201500016I.
Citation: Krauss DM, Molefe A, Hung L .
Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic.
BMJ Open Qual 2022 Nov;11(4):e001926. doi: 10.1136/bmjoq-2022-001926..
Keywords: COVID-19, Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Quality Improvement, Quality of Care, Critical Care, Intensive Care Unit (ICU), Prevention, Urinary Tract Infection (UTI), Infectious Diseases
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Laverriere EK, Fiadjoe JE, McGowan N
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.
The primary goal of this study was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation in pediatric patients is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events. Findings showed that implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with a high level of adherence, yet was not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.
AHRQ-funded; HS024511; HS021583; HS022464.
Citation: Laverriere EK, Fiadjoe JE, McGowan N .
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.
Paediatr Anaesth 2022 Sep;32(9):1015-23. doi: 10.1111/pan.14505..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Education: Continuing Medical Education
Ramesh S, Ayres B, Eyck PT
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
This retrospective study used chart reviews of critically ill children in the pediatric intensive care unit (PICU) to determine the impact of subspecialty consultations on diagnosis. The majority of patients (87 of 101) were provided subspecialty consultations at the request of the PICU clinician. The consultations were equally for diagnosis (65%) and treatment (66%). There was a change in diagnosis for 21% of patients with consultants from PICU admission to discharge, with 61% attributed to subspecialty input. Forty-five percent of patients with consultations had additional imaging and/or laboratory testing and 55% had a medication change and/or a procedure performed immediately after consultation.
AHRQ-funded; HS026965.
Citation: Ramesh S, Ayres B, Eyck PT .
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
Diagnosis 2022 Aug;9(3):379-84. doi: 10.1515/dx-2021-0137..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality
Ofoma UR, Drewry AM, Maddox TM
Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care.
This study compared survival rates for inpatients who suffered in-hospital cardiac arrest (IHCA) who had access to Telemedicine Critical Care (TCC) during nights and weekends (off-hours) compared to those who did not. The authors identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. The majority (60.6%) of IHCAs occurred in an ICU, and 32.2% participants suffered IHCA at hospitals with TCC. No difference was found in acute resuscitation survival rates or survival to discharge rates for either IHCA between TCC and non-TCC hospitals. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival or survival to discharge.
AHRQ-funded; HS019455.
Citation: Ofoma UR, Drewry AM, Maddox TM .
Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care.
Resuscitation 2022 Aug;177:7-15. doi: 10.1016/j.resuscitation.2022.06.008..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Outcomes, Critical Care, Intensive Care Unit (ICU)
Wayne MT, Seelye S, Molling D
Variation in U.S. hospital practices for bronchoscopy in the intensive care unit.
The authors sought to measure bronchoscopy rates among mechanically ventilated ICU patients and to assess for variation across hospitals. In this cohort of over 150 diverse hospitals across the United States, they found that nearly 4% of mechanically ventilated ICU patients underwent bronchoscopy, representing a more than 20-fold variation in its use, which was only minimally attenuated after adjusting for patient and hospital characteristics. They recommended future studies to understand the drivers and impact of this variation on patient outcomes.
AHRQ-funded; HS028038.
Citation: Wayne MT, Seelye S, Molling D .
Variation in U.S. hospital practices for bronchoscopy in the intensive care unit.
Ann Am Thorac Soc 2022 Jun;19(6):1061-65. doi: 10.1513/AnnalsATS.202110-1141RL..
Keywords: Hospitals, Intensive Care Unit (ICU), Critical Care, Respiratory Conditions
Viglianti EM, Ervin JN, Newton CA
Time-limited trials in the ICU: a mixed-methods sequential explanatory study of intensivists at two academic centres.
Investigators sought to understand intensivist perceptions of the appropriateness of time-limited trials (TLTs), a strategy to align life-sustaining care with patient goals and values in the midst of clinical uncertainty. They conducted semi-structured interviews with intensivists, revealing that having clarity about patient goals and clinical endpoints facilitated successful TLTs while lack of an evidenced-based framework was a barrier. More than half of the physicians who responded had conducted or participated in a TLT.
AHRQ-funded; HS028038.
Citation: Viglianti EM, Ervin JN, Newton CA .
Time-limited trials in the ICU: a mixed-methods sequential explanatory study of intensivists at two academic centres.
BMJ Open 2022 Apr 4;12(4):e059325. doi: 10.1136/bmjopen-2021-059325..
Keywords: Intensive Care Unit (ICU), Critical Care, Decision Making
Chiotos K, Fitzgerald JC, Hayes M
Improving vancomycin stewardship in critically ill children.
The purpose of this study was to describe a quality improvement intervention to reduce the use of vancomycin in a tertiary care Pediatric Intensive Care Unit. Over a period of 3 years, the researchers conducted 3 quality improvement (QI) interventions including 1) stakeholder education, 2) development of a consensus-based guideline for empiric vancomycin use, and 3) implementation of the guideline through clinical decision support. The study found that of 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias. Over the 3-year period of the QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). The study concluded that the intervention reduced overall vancomycin use in the Pediatric Intensive Care Unit without evidence of harm.
AHRQ-funded; HS026393.
Citation: Chiotos K, Fitzgerald JC, Hayes M .
Improving vancomycin stewardship in critically ill children.
Pediatrics 2022 Apr;149(4):e2021052165. doi: 10.1542/peds.2021-052165..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Capone CA, Emerson B, Sweberg T
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
The purpose of this study was to describe Tracheal Intubation (TI) practice and outcomes in pediatric Emergency Departments as compared to those in intensive care units (ICUs) and use the resulting data to identify targets for quality improvement. The researchers analyzed consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018. The study found a total of 12,512 TIs in 51 pediatric/cardiac ICUs, and 756 TIs in 13 pediatric EDs and were reported. Proportion of TIs for shock (26% ED vs. 14% ICU), respiratory decompensation (52% vs. 64%), and neurologic deterioration (30% vs. 11%) also differed by location. Limited neck mobility was reported more often in the ED (16% vs. 6%). TIs in the ED were performed more often via video laryngoscopy (64% vs. 29%). Oxygen desaturation was less commonly reported in ED TIs (13.6%) than ICU TIs (17%). Among ED TIs, shock as an indication and limited mouth opening were independently associated with adverse TI-associated events (TIAEs). The study concluded that TI characteristics vary between pediatric EDs and ICUs, yet outcomes are similar.
AHRQ-funded; HS022464.
Citation: Capone CA, Emerson B, Sweberg T .
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
Acad Emerg Med 2022 Apr;29(4):406-14. doi: 10.1111/acem.14431..
Keywords: Children/Adolescents, Emergency Department, Registries, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Critical Care, Intensive Care Unit (ICU)
Anesi GL, Liu VX, Chowdhury M
Association of ICU admission and outcomes in sepsis and acute respiratory failure.
ICU capacity is strained and its capacity and effectiveness are limited because many patient admission decisions are not evidence-based regarding who benefits from admission triage. The purpose of the study was to measure the benefits of admission to the ICU in patients who were experiencing sepsis or acute respiratory failure. Researchers looked retrospectively from 2013 to 2018 at cohorts within 27 U.S. hospitals across two health systems. They compared ICU admission vs ward admission among patients with sepsis and/ or acute respiratory failure who did not require vasopressors or mechanical ventilation in the emergency department. Study results revealed in patients with sepsis that ICU admission was associated with a hospital stay of 1.32 days longer than ward admissions, with a higher in-hospital mortality ratio. In patients with respiratory failure, ICU admission was associated with a .82-day shorter length of stay and reduced in-patient mortality. Within the two groups, subgroup analysis was conducted, and results revealed that for patients with sepsis, harms were concentrated among older patients and patients with fewer comorbidities. In addition, for patients with respiratory failure, the benefits were concentrated among older patients, patients with higher lab-based acute physiology scores (“high acuity” patients), and patients with comorbidities. The study concluded that among sepsis patients with high acuity scores and not requiring life support in the emergency department, initial admission to the ward was associated with shorter length of stay and improved survival, compared to the same category of patients admitted to the ICU. This result differed from patients with acute respiratory failure, for whom triage to the ICU was associated with improved survival when compared to admission to the ward.
AHRQ-funded; HS026372.
Citation: Anesi GL, Liu VX, Chowdhury M .
Association of ICU admission and outcomes in sepsis and acute respiratory failure.
Am J Respir Crit Care Med 2022 Mar 1;205(5):520-28. doi: 10.1164/rccm.202106-1350OC..
Keywords: Intensive Care Unit (ICU), Sepsis, Respiratory Conditions, Outcomes
Boltey EM, Wright N, Mosley EA
Exploring the process of information sharing in an adult intensive care unit: an ethnographic study.
The purpose of this study was to examine how the process of information sharing takes place in the ICU from the perspectives of the professional team and family members. The researchers conducted ethnographic fieldwork focusing on behaviors and interactions of the interprofessional team and family members. Fieldwork of 17.5 observation hours, 6 shadowing sessions, and 12 semi-structured interviews with 17 total participants took place in a 20-bed medical ICU from May 2016 - October 2016. Three themes about the information sharing process were identified: 1) family factors influence information sharing; 2) clinician strategies can support engagement in the process of information sharing; and 3) the process of information sharing allows for trust building between ICU team and families. The researchers concluded that information sharing is a critical process that may act as a stimulus for effective ICU engagement with the patient and family.
AHRQ-funded; HS024552.
Citation: Boltey EM, Wright N, Mosley EA .
Exploring the process of information sharing in an adult intensive care unit: an ethnographic study.
J Interprof Care 2022 Mar-Apr;36(2):168-76. doi: 10.1080/13561820.2021.1899147..
Keywords: Intensive Care Unit (ICU), Clinician-Patient Communication, Patient and Family Engagement, Communication, Critical Care
Cifra CL, Tigges CR, Miller SL
Reporting outcomes of pediatric intensive care unit patients to referring physicians via an electronic health record-based feedback system.
Before critically ill children are sent to a pediatric intensive care unit (PICU), many receive their initial evaluations from front-line emergency care clinicians with variable levels of pediatric training. The authors state that reporting pediatric patient outcomes back to the front-line clinicians who provided the emergency care may offer valuable lessons. The purpose of the study was to evaluate a semiautomated electronic health record (EHR)-supported feedback system, developed at a single institution, to determine its usability and clinical relevance in providing timely and relevant PICU feedback to the front-line referring emergency department (ED) clinicians. Applying the Health Information Technology Safety Framework as a guiding model, the researchers conducted qualitative research with stakeholders, and then translated stakeholder, organizational, and usability objectives to design, develop, implement, and assess a semi-automated HER-supported feedback system. The study applied three cycles of an iterative process of implementation and evaluation over 6 months and determined that an EHR-supported feedback process is feasible, and can provide timely, usable, and clinically relevant feedback. In usability testing, physicians reported the process added minimal workload, was well integrated into their existing clinical workflows, and both the act of delivering and receiving feedback was relevant to their clinical practice. The study concluded that a semiautomated EHR-supported clinical feedback system to provide referring ED clinicians with patient outcome feedback was feasible, usable, and relevant to providers. The authors recommend future research to explore applicability to other, similar clinical settings and situations.
AHRQ-funded; HS027363; HS026965.
Citation: Cifra CL, Tigges CR, Miller SL .
Reporting outcomes of pediatric intensive care unit patients to referring physicians via an electronic health record-based feedback system.
Appl Clin Inform 2022 Mar;13(2):495-503. doi: 10.1055/s-0042-1748147..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Electronic Health Records (EHRs), Health Information Technology (HIT)
Vivtcharenko VY, Ramesh S, Dukes K
Diagnosis documentation of critically ill children at admission to a PICU.
This study’s objective was to describe how pediatric critical care clinicians document patients' diagnoses at PICU admission. PICU admission notes for 96 unique patients were reviewed. Findings showed that most PICU admission notes documented a rationale for the primary diagnosis and expressed diagnostic uncertainty. Clinicians varied widely in how they organized diagnostic information, used contextual details to clarify the diagnosis, and expressed uncertainty. Recommendations included future work to determine how diagnosis narratives affect clinical decision-making, patient care, and outcomes.
AHRQ-funded; HS026965; HS022087.
Citation: Vivtcharenko VY, Ramesh S, Dukes K .
Diagnosis documentation of critically ill children at admission to a PICU.
Pediatr Crit Care Med 2022 Feb;23(2):99-108. doi: 10.1097/pcc.0000000000002812..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Diagnostic Safety and Quality
Ginestra JC, Mitchell OJL, Anesi GL
COVID-19 critical illness: a data-driven review.
This paper is a data-driven review of COVID-19 critical illness, including the extreme demand for intensive care unit (ICU) resources and the rapidly evolving understanding of the disease. Almost one-third of hospitalized patients with COVID-19 experience critical illness. The most common type of organ failure experienced is acute hypoxic respiratory failure, which presents clinically as acute respiratory distress syndrome (ARDS) in three-quarters of ICU patients. Management of ARDS in COVID-19 patients is similar to that of non-COVID-19 ARDS patients. Mortality rates have decreased over the course of the pandemic likely due to increasing disease familiarity, data-driven pharmacologics, and improved adherence to evidence-based critical care.
AHRQ-funded; HS026372.
Citation: Ginestra JC, Mitchell OJL, Anesi GL .
COVID-19 critical illness: a data-driven review.
Annu Rev Med 2022 Jan 27;73:95-111. doi: 10.1146/annurev-med-042420-110629..
Keywords: COVID-19, Critical Care, Respiratory Conditions, Intensive Care Unit (ICU)
Park J, Zhong X, Dong Y
Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach.
This study used systems engineering to investigate the association between the operational conditions and the quantity of medication orders in an intensive care unit (ICU). The dataset used was 4822 unique patients admitted to the ICU at the Mayo Clinic between February 2016 and March 2018. Findings were that when the ICU was more than 50% occupied (> 18 patients), the number of medication orders per patient hour was significantly reduced. The reduction was even more pronounced when there was a higher presence of severely ill patients requiring a mechanical ventilator, which might be encountered in an ICU treating COVID-19 patients. These factors impact the ICU critical care team’s cognitive function and results in changes in the production of medication orders.
AHRQ-funded; HS026609.
Citation: Park J, Zhong X, Dong Y .
Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach.
BMC Anesthesiol 2022 Jan 4;22(1):10. doi: 10.1186/s12871-021-01548-7..
Keywords: Intensive Care Unit (ICU), Teams
Dewan M, Soberano B, Sosa T
Assessment of a situation awareness quality improvement intervention to reduce cardiac arrests in the PICU.
The purpose of this study was to use improved situation awareness to decrease cardiopulmonary resuscitation events by 25% over 18 months and demonstrate process and outcome sustainability. Findings showed that interprofessional teams using shared situation awareness may reduce cardiopulmonary resuscitation events and, thereby, improve outcomes.
AHRQ-funded; HS026975.
Citation: Dewan M, Soberano B, Sosa T .
Assessment of a situation awareness quality improvement intervention to reduce cardiac arrests in the PICU.
Pediatr Crit Care Med 2022 Jan;23(1):4-12. doi: 10.1097/pcc.0000000000002816..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Quality Improvement, Quality of Care
Groetzinger LM, Rivosecchi RM, McVerry BJ
A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults.
This study assessed outcomes of using a light-sedation protocol as needed compared to the more usual continuous infusion sedation in mechanically ventilated adults in medical intensive care units (ICUs). This retrospective review compared patients who received the as needed sedation protocol to similar patients treated initially with continuous infusion sedation at a 32-bed medical ICU in a large academic center. Over a 2-year period, 254 total mechanically ventilated patients were evaluated. Of the evaluable patients, 114 received the prioritizing as-needed sedation protocol, and 140 received the continuous infusion approach. In the as-needed group, 42% of patients never received continuous infusion sedation. The group also received significantly less opioid, propofol, and benzodiazepine; and experienced less delirium, shorter duration of mechanical ventilation, and shorter ICU length of stay compared to the continuous infusion sedation group.
AHRQ-funded; HS025455.
Citation: Groetzinger LM, Rivosecchi RM, McVerry BJ .
A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults.
Crit Care Explor 2020 Dec;2(12):e0264. doi: 10.1097/cce.0000000000000264..
Keywords: Quality Improvement, Quality of Care, Intensive Care Unit (ICU), Critical Care, Implementation