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Unplanned icu transfer

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https://www.readbyqxmd.com/read/28608513/out-of-office-hours-elective-surgical-intensive-care-admissions-and-their-associated-complications
#1
David J R Morgan, Kwok Ming Ho, Yang Jian Ong, Marlene L Kolybaba
BACKGROUND: The 'weekend' effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during 'out-of-office hours' time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units (ICU) during 'out-of-office hours' time periods mitigates this affect through higher staffing ratios and seniority. METHODS: Over a 3-year period in Western Australia's largest private hospital, this retrospective nested-cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred 'in-office hours' (Monday-Friday 08...
June 12, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28601043/pediatric-intermediate-care-and-pediatric-intensive-care-units-picu-metrics-and-an-analysis-of-patients-that-use-both
#2
Andrew S Geneslaw, Haomiao Jia, Adam R Lucas, Michael S D Agus, Jeffrey D Edwards
PURPOSE: To examine how intermediate care units (IMCUs) are used in relation to pediatric intensive care units (PICUs), characterize PICU patients that utilize IMCUs, and estimate the impact of IMCUs on PICU metrics. MATERIALS & METHODS: Retrospective study of PICU patients discharged from 108 hospitals from 2009 to 2011. Patients admitted from or discharged to IMCUs were characterized. We explored the relationships between having an IMCU and several PICU metrics: physical length-of-stay (LOS), medical LOS, discharge wait time, admission severity of illness, unplanned PICU admissions from wards, and early PICU readmissions...
May 26, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28595614/a-multicentre-randomised-intervention-study-of-the-paediatric-early-warning-score-study-protocol-for-a-randomised-controlled-trial
#3
Claus Sixtus Jensen, Hanne Aagaard, Hanne Vebert Olesen, Hans Kirkegaard
BACKGROUND: Patients' evolving critical illness can be predicted and prevented. However, failure to identify the signs of critical illness and subsequent lack of appropriate action for patients developing acute and critical illness remain a problem. Challenges in assessing whether a child is critically ill may be due to children's often uncharacteristic symptoms of serious illness. Children may seem relatively unaffected until shortly before circulatory and respiratory failure and cardiac arrest...
June 8, 2017: Trials
https://www.readbyqxmd.com/read/28552091/quality-assessment-of-home-births-in-denmark
#4
Sabrina Jensen, Lotte B Colmorn, Anne-Mette Schroll, Lone Krebs
INTRODUCTION: The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births compared with hospital births and to discuss which data are needed to evaluate the safety of home births. METHODS: This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR)...
May 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28532980/risk-factors-for-unplanned-transfer-to-the-intensive-care-unit-after-emergency-department-admission-methodological-issues
#5
Saeid Safiri, Erfan Ayubi
No abstract text is available yet for this article.
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28501797/predictors-of-procedural-complications-in-adult-fontan-patients-undergoing-non-cardiac-procedures
#6
Alexander C Egbe, Arooj R Khan, Naser M Ammash, David W Barbara, William C Oliver, Sameh M Said, Emmanuel Akintoye, Carole A Warnes, Heidi M Connolly
OBJECTIVE: Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients). METHODS: To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation <90% and procedural hypoxia as saturation <80% or a decrease in saturation >10% from baseline...
May 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28445240/evaluation-of-a-pediatric-early-warning-score-across-different-subspecialty-patients
#7
Nathan P Dean, J B Fenix, Michael Spaeder, Amanda Levin
OBJECTIVE: To evaluate the ability of a Pediatric Early Warning Score to predict deterioration in different subspecialty patient populations. DESIGN: Single center, retrospective cohort study. Patients were classified into five groups: 1) cardiac; 2) hematology/oncology/bone marrow transplant; 3) surgical; 4) neurologic; and 5) general medical. The relationship between the Pediatric Early Warning Score and unplanned ICU transfer requiring initiation of specific ICU therapies (intubation, high-flow nasal cannula, noninvasive ventilation, inotropes, or aggressive fluid hydration within 12 hr of transfer) was evaluated...
April 25, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28436569/association-of-waist-circumference-with-outcomes-in-an-acute-general-surgical-unit
#8
Thomas Ryan, Preet Gosal, Alexa Seal, Joe McGirr, Nicholas Williams
BACKGROUND: Obesity prevalence is increasing in Australia, particularly in non-metropolitan areas. The effect of obesity on acute surgical outcomes is not known. We aimed to record waist circumference (WC) (surrogate for obesity) amongst acute surgical unit (ASU) patients in a New South Wales regional hospital, and compare outcome measures (length of stay (LOS), unplanned return to theatre, readmission rates, intensive care unit (ICU) admission and mortality). METHODS: Retrospective cohort study of 4 months of consecutive ASU admissions, excluding age <16, pregnancy, out-of-area transfer and incomplete data...
June 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28398923/the-association-between-visiting-intensivists-and-icu-outcomes
#9
Tony Whitehouse, James Hodson, Philip Pemberton, Tonny Veenith, Catherine Snelson, Julian Bion, Gordon D Rubenfeld
OBJECTIVES: We hypothesized that intensivists unfamiliar with an ICU team and the context of that ICU would affect patient outcomes. We examined differences in mortality when ICU patients were admitted under intensivists routinely working in that ICU and compared with those admitted by intensivists familiar with an ICU elsewhere in the same hospital. DESIGN, SETTINGS, AND PATIENTS: A 5-year natural experimental crossover study involving patients admitted to four ICUs in a large U...
April 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28330941/nurse-driven-clinical-pathway-for-inpatient-asthma-a-randomized-controlled-trial
#10
Catherine M Pound, Victoria Gelt, Salwa Akiki, Kaylee Eady, Katherine Moreau, Franco Momoli, Barbara Murchison, Roger Zemek, Brett Mulholland, Tom Kovesi
OBJECTIVE: We examined the impact of a nurse-driven clinical pathway on length of stay (LOS) for children hospitalized with asthma. METHODS: We conducted a randomized controlled trial involving children hospitalized with asthma. Nurses of children in the intervention group weaned salbutamol frequency using an asthma scoring tool, whereas physicians weaned salbutamol frequency for the control group patients as per standard care. The primary outcome was LOS in hours...
April 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28302375/risk-factors-for-unplanned-transfer-to-the-intensive-care-unit-after-emergency-department-admission
#11
Lena M Boerma, Eef P J Reijners, Roger A P A Hessels, Martijn A A V Hooft
INTRODUCTION: Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24h after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED...
March 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28156198/a-multicenter-record-review-of-in-hospital-adverse-drug-events-requiring-a-higher-level-of-care
#12
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...
June 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
#13
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
#14
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
#15
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-24hours-of-ed-admission
#16
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...
March 2017: 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
#17
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
#18
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
#19
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
#20
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
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