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Unplanned icu transfer

Bethany A Nyland, Sarah K Spilman, Meghan E Halub, Keith D Lamb, Julie A Jackson, Trevor W Oetting, Sheryl M Sahr
BACKGROUND: Patients are at risk for respiratory complications after sustaining blunt chest trauma, yet contradictory evidence exists about the utility of prophylactic respiratory therapy to reduce respiratory complications in this population. This study assessed the effectiveness of a proactive respiratory protocol on an in-patient ward to identify trauma patients at risk for pulmonary complications, administer appropriate therapies, and prevent deterioration requiring transfer to the ICU...
December 2016: Respiratory Care
Marketa Rejtar, Lee Ranstrom, Christina Allcox
Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011...
September 27, 2016: Journal of Pediatric Health Care
Patricia Kipnis, Benjamin J Turk, David A Wulf, Juan Carlos LaGuardia, Vincent Liu, Matthew M Churpek, Santiago Romero-Brufau, Gabriel J Escobar
BACKGROUND: Patients in general medical-surgical wards who experience unplanned transfer to the intensive care unit (ICU) show evidence of physiologic derangement 6-24h prior to their deterioration. With increasing availability of electronic medical records (EMRs), automated early warning scores (EWSs) are becoming feasible. OBJECTIVE: To describe the development and performance of an automated EWS based on EMR data. MATERIALS AND METHODS: We used a discrete-time logistic regression model to obtain an hourly risk score to predict unplanned transfer to the ICU within the next 12h...
December 2016: Journal of Biomedical Informatics
Michele M Pelter, Denise Loranger, Teri M Kozik, Richard Fidler, Xiao Hu, Mary G Carey
BACKGROUND: Most patients presenting with suspected acute coronary syndrome (ACS) are admitted to telemetry units. While telemetry is an appropriate level of care, acute complications requiring a higher level of care in the intensive care unit (ICU) occur. PURPOSE: Among patients admitted to telemetry for suspected ACS, we determine the frequency of unplanned ICU transfer, and examine whether ECG changes indicative of myocardial ischemia, and/or symptoms preceded unplanned transfer...
August 26, 2016: Journal of Electrocardiology
Harsheen Kaur, James M Naessens, Andrew C Hanson, Karen Fryer, Michael E Nemergut, Sandeep Tripathi
OBJECTIVE: No risk prediction model is currently available to measure patient's probability for readmission to the pediatric intensive care unit (PICU). This retrospective case-control study was designed to assess the applicability of an adult risk prediction score (Stability and Workload Index for Transfer [SWIFT]) and to create a pediatric version (PRediction Of PICU Early Readmissions [PROPER]). DESIGN: Eighty-six unplanned early (<48 hours) PICU readmissions from January 07, 2007, to June 30, 2014, were compared with 170 random controls...
September 6, 2016: Journal of Intensive Care Medicine
Louise S van Galen, Patricia W Struik, Babiche E J M Driesen, Hanneke Merten, Jeroen Ludikhuize, Johannes I van der Spoel, Mark H H Kramer, Prabath W B Nanayakkara
BACKGROUND: An unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol...
2016: PloS One
Jacob G Yetzer, Phillip Pirgousis, Zhuo Li, Rui Fernandes
PURPOSE: Clinical pathways have become an important and simple method of improving patient outcomes and decreasing health care resource usage. The purpose of this study was to evaluate early outcomes associated with the implementation of a clinical pathway in a maxillofacial head and neck surgery unit. MATERIALS AND METHODS: This investigation is a retrospective cohort study of patients who underwent microvascular reconstruction of the head and neck from January 1, 2014 through December 31, 2014...
July 21, 2016: Journal of Oral and Maxillofacial Surgery
Cassidy M Dahn, A Travis Manasco, Alan H Breaud, Samuel Kim, Natalia Rumas, Omer Moin, Patricia M Mitchell, Kerrie P Nelson, William Baker, James A Feldman
HYPOTHESIS: Unplanned intensive care unit (ICU) transfer (UIT) within 48 hours of emergency department (ED) admission increases morbidity and mortality. We hypothesized that a majority of UITs do not have critical interventions (CrIs) and that CrI is associated with worse outcomes. OBJECTIVE: The objective of the study is to characterize all UITs (including patients who died before ICU transfer), the proportion with CrI, and the effect of having CrI on mortality...
August 2016: American Journal of Emergency Medicine
Claus Sixtus Jensen, Hanne Aagaard, Hanne Vebert Olesen, Hans Kirkegaard
UNLABELLED: Theme: Intensive care Background: There has been an increased number of critically ill patients admitted to paediatric departments. Only a few studies have described the various causes of unplanned admission to paediatric intensive care units (PICU) due to clinical deterioration. However, an understanding of the nature of illness is important to patient safety. PURPOSE: This study described the frequency, clinical characteristics and outcomes of children who experience unplanned admission to a PICU due to clinical deterioration...
May 9, 2016: Nursing Children and Young People
Christopher O'Donnell, Samantha Thomas, Crystal Johnson, Lalit Verma, Jonathan Bae, David Gallagher
Handoffs and rapid response team (RRT) activations have been a focus for quality improvement in hospital medicine. This study aimed to incorporate a previously used scoring system (1-7) for severity of illness on initial encounter as a handoff adjunct and to determine its impact on the number of RRTs and intensive care unit transfers. The Patient Acuity Rating (PAR) scale correlates with subsequent RRTs and transfers to a higher level of care, with higher scores leading to increased rates of RRTs and transfers...
April 1, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Raquel Silva, Manuel Saraiva, Teresa Cardoso, Irene C Aragão
BACKGROUND: The creation, implementation and effectiveness of a medical emergency team (MET) in every hospital is encourage and supported by international bodies of quality certification. Issues such as what is the best composition of the team or the interventions performed by the MET at the scene and the immediate outcomes of the patients after MET intervention have not yet been sufficiently explored. The purpose of the study is to characterize MET actions at the scene and the immediate patient outcome...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Stacey Humphreys, Balagangadhar R Totapally
BACKGROUND: Variability in disposition of children according to the time of rapid response calls is unknown. OBJECTIVE: To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care. METHODS: Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively...
January 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Robert H Hollis, Laura A Graham, John P Lazenby, Daran M Brown, Benjamin B Taylor, Martin J Heslin, Loring W Rue, Mary T Hawn
OBJECTIVE: We examined whether an early warning score (EWS) could predict inpatient complications in surgical patients. BACKGROUND: Abnormal vitals often precede in-hospital mortality. The EWS calculated using vital signs has been developed to identify patients at risk for mortality. METHODS: Inpatient general surgery procedures with National Surgical Quality Improvement Project data from 2013 to 2014 were matched with enterprise data on vital signs and neurologic status to calculate the EWS for each postoperative vital set measured on the ward...
May 2016: Annals of Surgery
Timothy Marshall, Mayuran Suthersan, Mun Khin Chan, Bridget Jenkins, Mingzhou Toh, Vanessa Giddins, Evan Jones
OBJECTIVE: The aim of this study is to examine and compare the mortality and morbidity of patients with neck of femur (NOF) fracture who presented initially to either Orange Health Service (OHS), a secondary orthopaedic referral centre or to a peripheral hospital and subsequently transferred to OHS. DESIGN, SETTING AND PARTICIPANTS: This study is designed as a retrospective review of medical records of 151 patients with NOF fractures who were treated operatively between March 2013 and March 2014 at OHS...
August 2016: Australian Journal of Rural Health
Maryann Street, Julie Considine
BACKGROUND: The impact of limitation of medical treatment orders (LOMT) on patient outcomes following transfer from sub-acute care to the Emergency Department remains unclear. METHODS: Retrospective medical record review of 431 adult in-patients who required ambulance transfer following clinical deterioration during a sub-acute care admission during 2010. RESULTS: Common reasons for transfer were respiratory (18.9%) or neurological (19.0%) conditions; 35...
February 2016: Australasian Emergency Nursing Journal: AENJ
Regis Goulart Rosa, Cintia Roehrig, Roselaine Pinheiro de Oliveira, Juçara Gasparetto Maccari, Ana Carolina Peçanha Antônio, Priscylla de Souza Castro, Felippe Leopoldo Dexheimer Neto, Patrícia de Campos Balzano, Cassiano Teixeira
PURPOSE: Early discharge from the intensive care unit (ICU) may constitute a strategy of resource consumption optimization; however, unplanned readmission of hospitalized patients to an ICU is associated with a worse outcome. We aimed to compare the effectiveness of the Stability and Workload Index for Transfer score (SWIFT), Sequential Organ Failure Assessment score (SOFA) and simplified Therapeutic Intervention Scoring System (TISS-28) in predicting unplanned ICU readmission or unexpected death in the first 48 hours after discharge from the ICU...
2015: PloS One
Iris M Mandell, Francine Bynum, Lori Marshall, Robert Bart, Jeffrey I Gold, Sarah Rubin
BACKGROUND AND OBJECTIVES: Early unplanned Pediatric Intensive Care Unit (PICU) readmission is associated with greater length of stay and mortality. No tools exist to identify children at risk for PICU readmission. The Pediatric Early Warning Score (PEWS) currently identify children at risk for deterioration on the ward. Our primary objective was to evaluate the ability of PEWS to identify children at risk for unplanned PICU readmission. METHODS: A single-center case-control study of 189 children (38 cases and 151 age-matched controls) 18years or younger transferred from the PICU to the pediatric ward from January 1, 2010-March 30, 2013, at an urban tertiary care children's hospital was conducted...
October 2015: Journal of Critical Care
Tomoko Fujii, Shigehiko Uchino, Masanori Takinami
BACKGROUND: Postoperative patients who require intensive monitoring, intervention with an arterial line, vasoactive drugs and prolonged ventilator weaning are admitted to the postoperative intermediate care unit (IMCU). OBJECTIVES: The aim of this study was to estimate the prevalence of life-threatening complications within 7 days after IMCU discharge. Furthermore, we searched for associations between perioperative risk factors and these life-threatening complications...
January 2016: European Journal of Anaesthesiology
J Trent Magruder, Markos Kashiouris, Joshua C Grimm, Damon Duquaine, Barbara McGuinness, Sara Russell, Megan Orlando, Marc Sussman, Glenn J R Whitman
BACKGROUND: Readmissions or "bounce back" to the intensive care unit (ICU) following cardiac surgery is associated with an increased risk of morbidity and mortality. We sought to identify clinical and system-based factors associated with ICU bounce backs in order to generate a Bounce Back After Transfer (BATS) prediction score. METHODS: We prospectively collected the clinical and financial records of all patients undergoing coronary artery bypass grafting (CABG) or surgical aortic valve replacement (AVR) between May 2013 and March 2014...
September 2015: Journal of Cardiac Surgery
Kerry C Litman, Helen Lau, Michael H Kanter, Jason P Jones
BACKGROUND: Mortality reviews are a foundation of inpatient quality improvement (QI), but low levels of harm among a random or sequential sample may not yield actionable improvement opportunities. To increase the efficiency of mortality reviews at identifying QI opportunities, Kaiser Permanente Southern California (KPSC) developed a condition-specific hybrid electronic/manual chart review called the "e-autopsy." METHODS: KPSC hospital deaths are filtered electronically by predetermined criteria...
October 2014: Joint Commission Journal on Quality and Patient Safety
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