Survey of Mechanical Ventilators in US Acute Care Hospitals: A Baseline for Critical Care Surge Capacity Planning

ObjectivesTo characterise the variation in composition, leadership, and activation criteria of rapid response and cardiac arrest teams in five north-eastern states of the USA.DesignCross-sectional study consisting of a voluntary 46-question survey of acute care hospitals in north-eastern USA.SettingAcute care hospitals in New York, New Jersey, Rhode Island, Vermont, and Pennsylvania.ParticipantsSurveys were completed by any member of the rapid response team (RRT) with a working knowledge of team composition and function. Participants were all Medicare-participating acute care hospitals, including teaching and community hospitals as well as hospitals from rural, urban and suburban areas.ResultsOut of 378 hospitals, contacts were identified for 303, and 107 surveys were completed. All but two hospitals had an RRT, 70% of which changed members daily. The most common activation criteria were clinical concern (95%), single vital sign abnormalities (77%) and early warning score (59%). Eighty one per cent of hospitals had a dedicated cardiac arrest team.RRT composition varied widely, with respiratory therapists, critical care nurses, physicians and nurse managers being the most likely to attend (89%, 78%, 64% and 51%, respectively). Consistent presence of critical care physicians was uncommon and both cardiac arrest teams and teams were frequently led by trainee physicians, often without senior supervision.ConclusionsAs the largest study to date in the USA, we have demonstrated wide heterogeneity, rapid team turnover and a lack of senior supervision of RRT and cardiac arrest teams. These factors likely contribute to the mixed results seen in studies of RRTs.

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(P2-78) Creating Alternate Care Sites and Community-Based Care Centers for the Delivery of Medical Care During Public Health Emergencies

Prehospital and Disaster Medicine ◽

10.1017/s1049023x1100522x ◽

2011 ◽

Vol 26 (S1) ◽

pp. s161-s161

Author(s):

M. Reilly

Keyword(s):

Public Health ◽

Acute Care ◽

Care Center ◽

Acute Care Hospitals ◽

Public Health Emergency ◽

Care Hospital ◽

Community Based ◽

Surge Capacity ◽

Public Health Emergencies ◽

Concept Of Operations

IntroductionDeveloping alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites or community-based care centers which can serve as areas for primary screening and triage or short-term medical treatment can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Additionally, if planned for correctly these facilities can also be used to decant less critical patients from inpatient wards thereby increasing the surge capacity of acute care hospitals.MethodsA model concept of operations plan for alternate care sites to be used during pandemics and large-scale public health emergencies was developed over a 3 year period, 2007–2010. Subject matter experts were convened and best-practice methods were used to design operational plans, clinical protocols, modified standards of care, and checklists for facilities appropriate to locate such a facility. This model plan was designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting and then ultimately return to their homes for convalescence, following a public health emergency where regional surge capacity had been exceeded.ResultsOver three years of interagency, comprehensive planning, training and review was conducted to create the model alternate care site/community-based care center concept of operations plan. Accomplishments and milestones included: Creating stakeholders, engaging community partners, site selection, staffing issues, detailed medical protocols and clinical pathways, functional role development, equipment and supplies, site security, media and communications plans, designing training programs and conducting drills and exercises.ConclusionThe key tenets of the concept, planning, operation and demobilization of an alternate care site or community-based care center will be discussed in this session. Participants will learn what has worked based on our planning experience. Lessons learned and best-practices developed in our program will be presented to assist attendees in beginning or continuing the process of creating surge capacity in the out-of-hospital setting, by planning to operate alternate care sites in their local areas.

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Characteristics of U.S. Acute Care Hospitals That Have Implemented Telemedicine Critical Care

Critical Care Explorations ◽

10.1097/cce.0000000000000468 ◽

2021 ◽

Vol 3 (7) ◽

pp. e0468

Author(s):

Uchenna R. Ofoma ◽

Thomas M. Maddox ◽

Chamila Perera ◽

R. J. Waken ◽

Anne M. Drewry ◽

...

Keyword(s):

Critical Care ◽

Acute Care ◽

Acute Care Hospitals

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Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

BMC Palliative Care ◽

10.1186/s12904-021-00900-5 ◽

2022 ◽

Vol 21 (1) ◽

Author(s):

Kanako Yamamoto ◽

Yuki Yonekura ◽

Kazuhiro Nakayama

Keyword(s):

Critical Care ◽

Acute Care ◽

Healthcare Providers ◽

Acute Care Hospitals ◽

Cross Sectional Study ◽

Decision Making Process ◽

Sectional Study ◽

Cross Sectional ◽

Icu Patients ◽

Advance Care

Abstract Background In acute-care hospitals, patients treated in an ICU for surgical reasons or sudden deterioration are treated in an outpatient ward, ICU, and other multiple departments. It is unclear how healthcare providers are initiating advance care planning (ACP) for such patients and assisting them with it. The purpose of this study is to clarify healthcare providers’ perceptions of the ACP support provided to patients receiving critical care in acute-care hospitals. Methods A cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACP support, the participants’ degree of confidence in providing ACP support, the patients’ treatment preferences, and the decision-making process, and whether any discussion was conducted on change of values. Results Responses were obtained from 598 participants from 157 hospitals, 41.4% of which reportedly supported ACP provision to ICU patients. The subjects with the highest level of ACP understanding were surgeons (45.8%), and differences in understanding were observed across specialties (P < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACP support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process. Conclusions Among the participating hospitals, 40% provided ACP support to patients receiving critical care. The low number is possibly because support providers lack understanding of the content of patients’ ACP or about how to support and use ACP. Second, it is sometimes too late to start providing ACP support after ICU admission. Third, healthcare providers differ in their perception of ACP, widely considered an ambiguous concept. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients.

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Impact of the Staffing Structure of Intensive Care Units and High Care Units on In-Hospital Mortality Among Patients with Sepsis: A Retrospective Analysis of Japanese Nationwide Claims Data

10.21203/rs.3.rs-796517/v1 ◽

2021 ◽

Author(s):

Kota Nishimoto ◽

Takeshi Umegaki ◽

Takahiko Kamibayashi

Keyword(s):

Critical Care ◽

Intensive Care ◽

Hospital Mortality ◽

Intensive Care Units ◽

Acute Care ◽

Patient Outcomes ◽

Acute Care Hospitals ◽

High Care

Abstract Background: Critical care in Japan is provided in intensive care units (ICUs) and high care units (HCUs), which are categorized based on their fulfillment of different staffing criteria. Under Japan’s medical fee reimbursement system, units with higher staffing levels are eligible to receive higher reimbursements. However, the different staffing structure of these units may affect the quality of care and patient outcomes. This study aimed to analyze the impact of ICU/HCU staffing structure on in-hospital mortality among septic patients in Japan’s acute care hospitals using a nationwide claims database.Methods: We conducted a large-scale multicenter retrospective cohort study of adult septic patients (aged ≥18 years) who received critical care in acute care hospitals throughout Japan between April 2018 and March 2019. Patients were categorized into three groups according to the type of unit in which they received critical care: Type 1 ICUs (fulfilling stringent staffing criteria such as experienced intensivists and high nurse-to-patient ratios), Type 2 ICUs (fulfilling less stringent criteria), and HCUs (fulfilling the least stringent criteria). A Cox proportional hazards regression model was constructed with in-hospital mortality as the dependent variable and the ICU/HCU groups as the main independent variable of interest. Other covariates included age, emergency or non-emergency admission, major diagnostic categories, mechanical ventilation, noninvasive positive airway pressure ventilation, oxygen therapy, and renal replacement therapy.Results: We analyzed 2411 patients (178 hospitals) in the Type 1 ICU group, 3653 patients (422 hospitals) in the Type 2 ICU group, and 4904 patients (521 hospitals) in the HCU group. When compared with the HCU group, the adjusted hazard ratios for in-hospital mortality were 0.74 (95% confidence interval: 0.71–0.77; P<0.001) for the Type 1 ICU group and 0.83 (0.80–0.85; P<0.001) for the Type 2 ICU group. Emergency hospital admission had the highest hazard ratio for in-hospital mortality (hazard ratio: 4.78; P<0.001).Conclusions: ICUs that fulfill more stringent staffing criteria were associated with lower in-hospital mortality in septic patients than HCUs after adjusting for confounders. Optimizing the staffing structure of these units may contribute to the improvement of patient outcomes.

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Mechanical Ventilators in US Acute Care Hospitals

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.2010.18 ◽

2010 ◽

Vol 4 (3) ◽

pp. 199-206 ◽

Cited By ~ 42

Author(s):

Lewis Rubinson ◽

Frances Vaughn ◽

Steve Nelson ◽

Sam Giordano ◽

Tom Kallstrom ◽

...

Keyword(s):

Public Health ◽

Mechanical Ventilation ◽

Acute Care ◽

Acute Care Hospitals ◽

Developed Countries ◽

Median Number ◽

Mechanical Ventilators ◽

American Hospital ◽

American Hospital Association ◽

Supply And Distribution

ABSTRACTObjective: The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric mechanical ventilators at US acute care hospitals.Methods: A total of 5752 US acute care hospitals included in the 2007 American Hospital Association database were surveyed. We measured the quantities of mechanical ventilators and their features.Results: Responding to the survey were 4305 (74.8%) hospitals, which accounted for 83.8% of US intensive care unit beds. Of the 52 118 full-feature mechanical ventilators owned by respondent hospitals, 24 204 (46.4%) are pediatric/neonatal capable. Accounting for nonrespondents, we estimate that there are 62 188 full-feature mechanical ventilators owned by US acute care hospitals. The median number of full-feature mechanical ventilators per 100 000 population for individual states is 19.7 (interquartile ratio 17.2–23.1), ranging from 11.9 to 77.6. The median number of pediatric-capable device full-feature mechanical ventilators per 100 000 population younger than 14 years old is 52.3 (interquartile ratio 43.1–63.9) and the range across states is 22.1 to 206.2. In addition, respondent hospitals reported owning 82 755 ventilators other than full-feature mechanical ventilators; we estimate that there are 98 738 devices other than full-feature ventilators at all of the US acute care hospitals.Conclusions: The number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply. There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.(Disaster Med Public Health Preparedness. 2010;4:199-206)

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(P1-78) Utilizing New York City Pediatric Disaster Coalition Site Visits to Create Hospital Pediatric Critical Care Surge Plans

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11004109 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s124-s124

Author(s):

A. Flamm ◽

G. Foltin ◽

K. Uraneck ◽

A. Cooper ◽

B.M. Greenwald ◽

...

Keyword(s):

New York ◽

New York City ◽

Critical Care ◽

York City ◽

Emergency Preparedness ◽

Capacity Planning ◽

Mass Casualty ◽

Federal Grant ◽

Surge Capacity ◽

Pediatric Critical Care

PurposeThe New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has supported a federal grant establishing a Pediatric Disaster Coalition (PDC) comprised of pediatric critical care (PCC) and emergency preparedness consultants from major city hospitals and health agencies. One of the PDC's goals was to develop recommendation for hospital-based PCC surge plans.MethodsMembers of the PDC convened bi-weekly and among other projects, developed guidelines for creating PCC surge capacity plans. The PDC members, acting as consultants, conducted scheduled visits to hospitals in NYC and actively assisted in drafting PCC surge plans as annexes to existing hospital disaster plans. The support ranged from facilitating meetings to providing draft language and content, based on each institutions request.ResultsNew York City has 25 hospitals with PCC services with a total of 244 beds. Five major hospitals have completed plans, thereby adding 92 PCC beds to surge capacity. Thirteen additional hospitals are in the process of developing a plan. The PDC consultants participated in meetings at 11 of the planning hospitals, and drafted language for 10 institutions. The PDC continues to reach out to all hospitals with the goal of initiating plans at all 25 PCC hospitals.ConclusionsProviding surge guidelines and the utilization of on-site PDC consultants was a successful model for the development and implementation of citywide PCC surge capacity planning. Visiting hospitals and actively assisting them in creating their plans was an effective, efficient and well received, method to create increased PCC surge capacity. By first planning with major hospitals, a significant increase of surge beds (92 or 38%) was created, from a minimal number of hospitals. Once hospitals complete plans, it is anticipated that there will be the addition of at least 200 PCC surge beds that can be incorporated in to regional city-wide response to pediatric mass-casualty incident.

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Healthcare Providers' Perception of Advance Care Plans for Patients with Critical Illnesses in Acute-Care Hospitals: A Cross-Sectional Study

10.21203/rs.3.rs-793021/v1 ◽

2021 ◽

Author(s):

KANAKO YAMAMOTO

Keyword(s):

Critical Care ◽

Acute Care ◽

Healthcare Providers ◽

Acute Care Hospitals ◽

Cross Sectional Study ◽

Decision Making Process ◽

Sectional Study ◽

Cross Sectional ◽

Care Plans ◽

Advance Care

Abstract BackgroundIt is unclear how healthcare providers provide advance care plans (ACPs) support to the patients treated in ICUs. The purpose of this study is to clarify healthcare providers’ perceptions of the ACPs support provided to patients receiving critical care in acute-care hospitals.MethodsA cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACPS support, the participants’ degree of confidence in providing ACPS support, the patients’ treatment preferences and the decision-making process, and whether there was any discussion on and succession of values.ResultsResponses were obtained from 598 participants from 157 hospitals. Sixty-five hospitals (41.4%) reportedly supported ACPs provision to ICU patients. The subjects with the highest level of ACPs understanding were surgeons, 27 out of 59 (45.8%), and differences in understanding were observed across specialties (p < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACPs support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process.ConclusionsAmong the participating hospitals, 40% provided ACPs support to patients receiving critical care. This is probably because support providers lack ACPs knowledge and it is sometimes too late to start providing ACPs support after ICU admission. In addition, the perception of ACPs, widely considered an ambiguous concept, differs among healthcare providers. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients’ family members and healthcare providers.

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Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

International Psychogeriatrics ◽

10.1017/s104161021700240x ◽

2017 ◽

Vol 30 (7) ◽

pp. 991-1000 ◽

Cited By ~ 8

Author(s):

Miharu Nakanishi ◽

Yasuyuki Okumura ◽

Asao Ogawa

Keyword(s):

Acute Care ◽

Financial Incentive ◽

Physical Restraint ◽

Acute Care Hospitals ◽

Dementia Care ◽

Lower Percentage ◽

Public Healthcare ◽

Cross Sectional ◽

Insurance Program ◽

Healthcare Insurance

ABSTRACTBackground:In April 2016, the Japanese government introduced an additional benefit for dementia care in acute care hospitals (dementia care benefit) into the universal benefit schedule of public healthcare insurance program. The benefit includes a financial disincentive to use physical restraint. The present study investigated the association between the dementia care benefit and the use of physical restraint among inpatients with dementia in general acute care settings.Methods:A national cross-sectional study design was used. Eight types of care units from acute care hospitals under the public healthcare insurance program were invited to participate in this study. A total of 23,539 inpatients with dementia from 2,355 care units in 937 hospitals were included for the analysis. Dementia diagnosis or symptoms included any signs of cognitive impairment. The primary outcome measure was “use of physical restraint.”Results:Among patients, the point prevalence of physical restraint was 44.5% (n= 10,480). Controlling for patient, unit, and hospital characteristics, patients in units with dementia care benefit had significantly lower percentage of physical restraint than those in any other units (42.0% vs. 47.1%; adjusted odds ratio, 0.76; 95% confident interval [0.63, 0.92]).Conclusions:The financial incentive may have reduced the risk of physical restraint among patients with dementia in acute care hospitals. However, use of physical restraint was still common among patients with dementia in units with the dementia care benefit. An educational package to guide dementia care approach including the avoidance of physical restraint by healthcare professionals in acute care hospitals is recommended.

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