scholarly journals Association of community-level social vulnerability with US acute care hospital intensive care unit capacity during COVID-19

Healthcare ◽  
2021 ◽  
pp. 100611
Author(s):  
Thomas C. Tsai ◽  
Benjamin H. Jacobson ◽  
E. John Orav ◽  
Ashish K. Jha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Social Vulnerability ◽  
Acute Care Hospital ◽  
Community Level ◽  
Care Hospital ◽  
Hospital Intensive Care Unit ◽  
Unit Capacity

Rate of Healthcare Worker–Patient Interaction and Hand Hygiene Opportunities in an Acute Care Setting

2014 ◽  
Vol 35 (3) ◽  
pp. 225-230 ◽  
Author(s):  
Laura Goodliffe ◽  
Kelsey Ragan ◽  
Michael Larocque ◽  
Emily Borgundvaag ◽  
Sophia Khan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Healthcare Worker ◽  
Acute Care ◽  
Healthcare Workers ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Factors Affecting ◽  
Patient Interactions

Objective.Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital.Design.Prospective observational study.Setting.Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012.Participants.Healthcare workers.Methods.One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the “Four Moments for Hand Hygiene.” Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day.Results.During 257 hours of observation, 948 healthcare worker-patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37-0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29-0.77]) as did patients without precautions.Conclusions.Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use-based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.

scholarly journals Predicting Discharge to a Long-Term Acute Care Hospital After Admission to an Intensive Care Unit

2014 ◽  
Vol 23 (4) ◽  
pp. e46-e53 ◽  
Author(s):  
C. R. Szubski ◽  
A. Tellez ◽  
A. K. Klika ◽  
M. Xu ◽  
M. W. Kattan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital

scholarly journals Implementing Hospital-Acquired Pressure Injury (HAPI) Prevention Program

2020 ◽  
pp. 1-51
Author(s):  
Marisa Raynaldo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Injury Severity ◽  
Evidence Based ◽  
Care Hospital ◽  
Preventive Program ◽  
Moisture Management ◽  
Pressure Injury ◽  
Hospital Acquired

Practice Problem: Hospital-Acquired Pressure Injury (HAPI) is a serious problem in patient care and has deleterious implications for the patient and the healthcare system. A 530-bed acute care hospital in the Rio Grande Valley identified a similar challenge and implemented a HAPI preventive program. PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the Intensive Care Unit/Medical Intensive Care Unit (ICU/MICU) patients aged 18 and older, does a pressure preventive bundle, compared to routine pressure injury care, reduce the incidence of pressure injury, within 21 days? Evidence: The reviewed literature supported evidence of effective use of a pressure injury preventive bundle in reducing the incidence of pressure injuries in an acute care setting. Seven articles met the inclusion criteria and were used for this literature review. Intervention: The evidence-based pressure injury preventive bundle are interventions that included consistent skin risk assessment and the application of a group of clinical practice guidelines composing of moisture management, optimizing nutrition and hydration and minimizing pressure, shear, and friction that were proven to prevent the occurrence of pressure injuries. Outcome: Post-implementation findings showed that there was no reduction in the incidence of HAPI but significant decrease in the severity of the pressure injury from Stage two to Stage one. Conclusion: The staff education, training, and implementation of an evidence-based bundle intervention to prevent the incidence of HAPI proved a positive outcome on reducing the pressure injury severity from Stage Two pressure injuries to Stage One pressure injuries.

scholarly journals A Physical Function Test for Use in the Intensive Care Unit: Validity, Responsiveness, and Predictive Utility of the Physical Function ICU Test (Scored)

2013 ◽  
Vol 93 (12) ◽  
pp. 1636-1645 ◽  
Author(s):  
Linda Denehy ◽  
Natalie A. de Morton ◽  
Elizabeth H. Skinner ◽  
Lara Edbrooke ◽  
Kimberley Haines ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Physical Function ◽  
Convergent Validity ◽  
Acute Care Hospital ◽  
Predictive Ability ◽  
Principal Component ◽  
Inpatient Rehabilitation ◽  
Hospital Length Of Stay ◽  
Care Hospital

Background Several tests have recently been developed to measure changes in patient strength and functional outcomes in the intensive care unit (ICU). The original Physical Function ICU Test (PFIT) demonstrates reliability and sensitivity. Objective The aims of this study were to further develop the original PFIT, to derive an interval score (the PFIT-s), and to test the clinimetric properties of the PFIT-s. Design A nested cohort study was conducted. Methods One hundred forty-four and 116 participants performed the PFIT at ICU admission and discharge, respectively. Original test components were modified using principal component analysis. Rasch analysis examined the unidimensionality of the PFIT, and an interval score was derived. Correlations tested validity, and multiple regression analyses investigated predictive ability. Responsiveness was assessed using the effect size index (ESI), and the minimal clinically important difference (MCID) was calculated. Results The shoulder lift component was removed. Unidimensionality of combined admission and discharge PFIT-s scores was confirmed. The PFIT-s displayed moderate convergent validity with the Timed “Up & Go” Test (r=−.60), the Six-Minute Walk Test (r=.41), and the Medical Research Council (MRC) sum score (rho=.49). The ESI of the PFIT-s was 0.82, and the MCID was 1.5 points (interval scale range=0–10). A higher admission PFIT-s score was predictive of: an MRC score of ≥48, increased likelihood of discharge home, reduced likelihood of discharge to inpatient rehabilitation, and reduced acute care hospital length of stay. Limitations Scoring of sit-to-stand assistance required is subjective, and cadence cutpoints used may not be generalizable. Conclusions The PFIT-s is a safe and inexpensive test of physical function with high clinical utility. It is valid, responsive to change, and predictive of key outcomes. It is recommended that the PFIT-s be adopted to test physical function in the ICU.

scholarly journals Variation in Long-Term Acute Care Hospital Use After Intensive Care

2012 ◽  
Vol 69 (3) ◽  
pp. 339-350 ◽  
Author(s):  
Jeremy M. Kahn ◽  
Rachel M. Werner ◽  
Shannon S. Carson ◽  
Theodore J. Iwashyna
Keyword(s):  
Intensive Care ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Patient Characteristics ◽  
Hierarchical Regression ◽  
Care Hospital ◽  
Hospital Size ◽  
For Profit ◽  
Medicare Claims Data

Long-term acute care hospitals (LTACs) are an increasingly common discharge destination for patients recovering from intensive care. In this article the authors use U.S. Medicare claims data to examine regional- and hospital-level variation in LTAC utilization after intensive care to determine factors associated with their use. Using hierarchical regression models to control for patient characteristics, this study found wide variation in LTAC utilization across hospitals, even controlling for LTAC access within a region. Several hospital characteristics were independently associated with increasing LTAC utilization, including increasing hospital size, for-profit ownership, academic teaching status, and colocation of the LTAC within an acute care hospital. These findings highlight the need for research into LTAC admission criteria and the incentives driving variation in LTAC utilization across hospitals.

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