scholarly journals Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4)

2014 ◽  
Vol 25 (5) ◽  
pp. 951-957 ◽  
Author(s):  
Michael Gaies ◽  
David S. Cooper ◽  
Sarah Tabbutt ◽  
Steven M. Schwartz ◽  
Nancy Ghanayem ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Quality Improvement ◽  
Resource Utilisation ◽  
Cardiac Intensive Care Unit ◽  
Mortality And Morbidity ◽  
Congenital Cardiac Disease ◽  
Cardiac Intensive Care ◽  
Cardiac Critical Care

AbstractDespite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care.

Abstract 19519: Closing the Cardiac Intensive Care Unit: Cost-Savings Associated with a “Closed” versus “Open” Model of Critical Care Delivery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Arun K Das ◽  
Jacqueline M Harden ◽  
Mathi M Ravichandran ◽  
Anton Lishmanov ◽  
Linda Raftery ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Unit Cost ◽  
Cardiac Intensive Care Unit ◽  
Closed Model ◽  
Cardiac Intensive Care ◽  
The Impact ◽  
Care Costs

Introduction: A recent AHA scientific statement highlighted the evolving complexity of critical care delivery for cardiac patients, and the emerging need for novel staffing models. In this document, a “closed” unit structure - in which a dedicated intensive care team treats all admitted patients - was specifically advocated. However, in light of escalating critical care costs within US hospitals, there is a pressing need to better understand the financial impact of different care platforms. Methods: In July 2013, our academic cardiac intensive care unit (CICU) was transitioned from an “open” to a “closed” model of care. In a before-and-after study design, consecutive admission records were reviewed from Aug 2012-Dec 2012 (“open” unit) and from Aug 2013-Dec 2013 (“closed” unit). Routinely collected financial and demographic data were examined, and the impact of case-mix index (CMI) on cost was evaluated. Results: In the “open” and “closed” models, there were 333 patient-visits accounting for 1,891 patient-days and 397 visits accounting for 2,558 patient-days, respectively. While demographics, payor mix, and fixed vs. variable cost distribution were unchanged (Table), the total cost-per-patient and cost-per-patient-day were lower within the “closed” CICU ($8,676 vs. $10,118 and $1,346 vs. $1,782, respectively) despite a greater average CMI (4.6 vs. 3.6). Total and 30d CICU readmission rates were also lower in the “closed” unit (Table). Readmissions in the "closed" unit resulted in greater cost-per-patient-day than new admits ($1,576 vs. $1,339). Conclusions: A “closed” CICU staffing model is associated with lower health care costs. This may be partly explained by lower CICU recidivism, but likely is multifactorial. Additional study will focus on the influence of resource use, critical care delivery to key sub-populations, and the development of effective strategies for further cost containment.

Abstract 322: The Mayo Cardiac Intensive Care Unit Admission Risk Score Predicts Resource Utilization During Hospitalization

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Thomas J Breen ◽  
Courtney E Bennett ◽  
Nandan S Anavekar ◽  
Joseph G Murphy ◽  
Malcolm R Bell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Resource Utilization ◽  
Risk Score ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Vasoactive Medications

Background: With the rising cost of critical care and limited availability of critical care resources, improvements are need in the current cardiac intensive care unit (CICU) triage process. We sought to determine whether the Mayo Clinic Intensive Care Unit Admission Risk Score (M-CARS) could be used to predict which CICU patients will require critical care resources. Methods: Adult patients admitted to our CICU from 2007 to 2018 were retrospectively reviewed. The M-CARS was calculated using data from the time of admission. Groups were compared using Wilcoxon test for continuous variables and chi-squared test for categorical variables. Results: We included 12,428 patients with a mean age of 67 ± 15 years (37% females). The mean M-CARS was 2.1 ± 2.1, including 5,890 (47.4%) patients with M-CARS <2 and 644 (5.2%) patients with M-CARS >6. Critical care therapies were frequently used, including mechanical ventilation in 28.0%, vasoactive medications in 25.5%, dialysis in 4.8% and invasive lines in 44.3%. The low-risk cohort with M-CARS <2 was less likely to require invasive or noninvasive mechanical ventilation (8.0% vs. 46.1%), vasoactive medications (10.1% vs. 38.8%), dialysis (1.0% vs. 8.2%) or invasive lines (34.6% vs. 53.0%), as compared to patients with M-CARS ≥2 (all p<0.001). A higher M-CARS was associated with greater use of critical care therapies and longer CICU and hospital length of stay. Conclusions: In addition to predicting hospital mortality, the M-CARS predicts resource utilization during CICU admission and could be used in the triage of critically ill cardiac patients. Patients with M-CARS <2 infrequently require critical care resources and have extremely low mortality, yet account for nearly half of all CICU admissions, suggesting a potential to avoid CICU admission in many patients.

Comprehensive Management Considerations of Select Noncardiac Organ Systems in the Cardiac Intensive Care Unit

2018 ◽  
Vol 9 (6) ◽  
pp. 685-695
Author(s):  
Christin Huff ◽  
Christopher W. Mastropietro ◽  
Christine Riley ◽  
Jonathan Byrnes ◽  
David M. Kwiatkowski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiac Disease ◽  
Pediatric Patients ◽  
Cardiac Intensive Care Unit ◽  
Comprehensive Management ◽  
Expert Review ◽  
Congenital Cardiac Disease ◽  
Organ Systems ◽  
Cardiac Intensive Care

As the acuity and complexity of pediatric patients with congenital cardiac disease have increased, there are many noncardiac issues that may be present in these patients. These noncardiac problems may affect clinical outcomes in the cardiac intensive care unit and must be recognized and managed. The Pediatric Cardiac Intensive Care Society sought to provide an expert review of some of the most common challenges of the respiratory, gastrointestinal, hematological, renal, and endocrine systems in pediatric cardiac patients. This review provides a brief overview of literature available and common practices.

Abstract 11345: Resource Demands and the Incidence of Cardiopulmonary Resuscitation Within a Pediatric Cardiac Intensive Care Unit

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Matthew K Bacon ◽  
Stephanie J Conrad ◽  
Brittney C Hatch ◽  
John D Hughes ◽  
Michelle K Terrell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Critical Care ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Cardiac Intensive Care Unit ◽  
Delivery Of Care ◽  
Cardiac Intensive Care ◽  
Nurse Assignment ◽  
Hospital Morbidity

Background: Econometric evidence suggests exponential declines in the ability to provide critical care services as variable demands exceed a relatively fixed supply of available critical care resources. We hypothesized that increasing demands upon resources within a pediatric cardiac intensive care unit (CICU) is also associated with increases in the incidence and rate of cardiopulmonary resuscitation. Methods and Results: Records from each twelve-hour nursing shift within an eighteen-bed pediatric CICU from 1 July 2010 through 30 April 2014 were retrospectively reviewed. There were 2716 reports available for review from 2769 shifts (97%). During the study period, there were 1,803 surgical and 1,215 medical admissions, accounting for a median census of 15 (interquartile range [IQR] 13-17) patients per shift, and a total of 20,269 patient days (40,538 patient-shifts) over the 44-month study period. Median bed capacity was 83% (IQR 72-94%), and median patient to nursing assignment ratio was 1.5 (IQR 1.4-1.6 patients per nurse assignment). Cardiac arrest (defined as administration of chest compressions) was identified in 138 occasions in 134 shifts, an arrest rate of 3.4 arrests per 1000 patient-shifts. Arrests were no more frequent during night versus day shifts (3.2 v. 3.6 per 1000 patient shifts, p=0.40), nor were they greater during weekend versus weekday shifts (2.9 v. 3.9 per 100 patient-shifts, p=0.14). There was a trend toward an increase in the incidence of cardiac arrest with patient to nurse assignment ratios of less than 1.5 (2.8 v. 3.9 arrests per 1000 patient shifts, p=0.06). Unit occupancy exceeding 85% was associated with a 45% greater rate of cardiac arrest (2.6 v 4.1 arrests per 1000 patient-shifts, 95%CI 0.3 to 2.6 increase, p=0.01). Conclusions: We report a significant increase in the incidence of cardiopulmonary resuscitation at times of greater resource consumption within a pediatric CICU as defined by unit capacity. Multi-institutional studies are necessary to identify generalizable organizational characteristics that may promote efficient allocation of resources and optimize delivery of care to a population of patients at greater risk for significant hospital morbidity.

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Cardiac Intensive Care ◽  
Hospital Protocol

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

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