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https://www.readbyqxmd.com/read/28156198/a-multicenter-record-review-of-in-hospital-adverse-drug-events-requiring-a-higher-level-of-care
#1
Kristel Marquet, Neree Claes, Elke De Troy, Gaby Kox, Martijn Droogmans, Arthur Vleugels
OBJECTIVE: Adverse drug events (ADEs) are a worldwide concern, particularly when leading to a higher level of care. This study defines a higher level of care as an unplanned (re)admission to an intensive care unit or an intervention by a Medical Emergency Team. The objectives are to describe the incidence and preventability of ADEs leading to a higher level of care, to assess the types of drug involved, and to identify the risk factors. METHODS: A three-stage retrospective review was performed in six Belgian hospitals...
February 3, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/28072705/posterior-only-vertebral-column-resection-for-revision-surgery-in-post-laminectomy-rotokyphoscoliosis-associated-with-late-onset-paraplegia-a-case-report-and-literature-review
#2
REVIEW
Youping Tao, Jigong Wu, Huasong Ma
RATIONALE: Severe post-laminectomy spinal deformity associated with late-onset paraplegia is a complex and rare disorder. Little is known about revision surgery in post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia treated by the single stage posterior-only vertebral column resection (VCR) procedure. PATIENT CONCERNS AND DIAGNOSES: The patient was a 14-year-old male diagnosed as post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28057565/development-and-validation-of-a-continuously-age-adjusted-measure-of-patient-condition-for-hospitalized-children-using-the-electronic-medical-record
#3
Michael J Rothman, Joseph J Tepas, Andrew J Nowalk, James E Levin, Joan M Rimar, Albert Marchetti, Allen L Hsiao
Awareness of a patient's clinical status during hospitalization is a primary responsibility for hospital providers. One tool to assess status is the Rothman Index (RI), a validated measure of patient condition for adults, based on empirically derived relationships between 1-year post-discharge mortality and each of 26 clinical measurements available in the electronic medical record. However, such an approach cannot be used for pediatrics, where the relationships between risk and clinical variables are distinct functions of patient age, and sufficient 1-year mortality data for each age group simply does not exist...
January 2, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/27979496/evidence-based-practice-in-action-ensuring-quality-of-pediatric-assessment-frequency
#4
Katelyn McDonald, Ann L Eckhardt
: Optimal frequency of head-to-toe assessment in hospitalized pediatric patients is unknown. An alteration in head-to-toe assessment frequency was proposed at a Midwestern regional hospital. The purpose of this descriptive study was to evaluate patient safety and staff satisfaction following a change in head-to-toe assessment frequency. METHOD: Chart audits were performed on all patients upon discharge and after any change in level of care to assess the risk to patient safety following the change in head-to-toe assessment frequency...
December 12, 2016: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/27974226/adverse-event-and-error-of-unexpected-life-threatening-events-within-24h-of-emergency-department-admission
#5
Ewai Zhang, Shih-Chiang Hung, Chien-Hung Wu, Ling-Ling Chen, Ming-Ta Tsai, Wen-Huei Lee
OBJECTIVES: Errors and adverse events associated with unexpected life-threatening events including unplanned transfer to the intensive care unit (ICU) and unexpected death after emergency department (ED) hospitalization are not well characterized. We performed this study to investigate the role of unexpected life-threatening events as a trigger to capture errors and adverse events for ED patient safety. METHODS: This prospective observational study enrolled adult non-trauma patients with unexpected life-threatening events within 24h of general ward admission from the ED of a medical center in Taiwan...
November 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27827332/a-preventative-respiratory-protocol-to-identify-trauma-subjects-at-risk-for-respiratory-compromise-on-a-general-in-patient-ward
#6
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
https://www.readbyqxmd.com/read/27692506/development-of-the-24-7-nurse-practitioner-model-on-the-inpatient-pediatric-general-surgery-service-at-a-large-tertiary-care-children-s-hospital-and-associated-outcomes
#7
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...
January 2017: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/27658885/development-and-validation-of-an-electronic-medical-record-based-alert-score-for-detection-of-inpatient-deterioration-outside-the-icu
#8
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
https://www.readbyqxmd.com/read/27623400/unplanned-transfer-from-the-telemetry-unit-to-the-intensive-care-unit-in-hospitalized-patients-with-suspected-acute-coronary-syndrome
#9
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...
November 2016: Journal of Electrocardiology
https://www.readbyqxmd.com/read/27601481/proper-development-of-an-early-pediatric-intensive-care-unit-readmission-risk-prediction-tool
#10
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
https://www.readbyqxmd.com/read/27537689/delayed-recognition-of-deterioration-of-patients-in-general-wards-is-mostly-caused-by-human-related-monitoring-failures-a-root-cause-analysis-of-unplanned-icu-admissions
#11
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
https://www.readbyqxmd.com/read/27528106/clinical-pathway-implementation-improves-efficiency-of-care-in-a-maxillofacial-head-and-neck-surgery-unit
#12
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...
January 2017: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27241571/a-critical-analysis-of-unplanned-icu-transfer-within-48-hours-from-ed-admission-as-a-quality-measure
#13
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
https://www.readbyqxmd.com/read/27214465/po02-clinical-profile-of-children-admitted-to-a-paediatric-intensive-care-unit-due-to-acute-clinical-deterioration
#14
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
https://www.readbyqxmd.com/read/27037267/incorporating-patient-acuity-rating-score-into-patient-handoffs-and-the-correlation-with-rapid-responses-and-unexpected-icu-transfers
#15
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
https://www.readbyqxmd.com/read/27000277/medical-emergency-team-how-do-we-play-when-we-stay-characterization-of-met-actions-at-the-scene
#16
Raquel Silva, Manuel Saraiva, Teresa Cardoso, Irene C Arag√£o
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...
March 22, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/26724305/rapid-response-team-calls-and-unplanned-transfers-to-the-pediatric-intensive-care-unit-in-a-pediatric-hospital
#17
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
https://www.readbyqxmd.com/read/26692076/a-role-for-the-early-warning-score-in-early-identification-of-critical-postoperative-complications
#18
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
https://www.readbyqxmd.com/read/26691875/mortality-and-morbidity-of-neck-of-femur-fractures-a-comparison-between-orange-and-peripheral-centres
#19
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
https://www.readbyqxmd.com/read/26601595/analysis-of-the-impact-of-limitation-of-medical-treatment-orders-during-unplanned-transfers-from-sub-acute-care-to-emergency-departments
#20
MULTICENTER STUDY
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
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