Children are commonly harmed by adverse events in intensive care units

Purpose: To describe factors (demographics and clinical characteristics) that predict patients who are at an increased risk of adverse events or unplanned return visits to a health-care facility following discharge direct to home (DDH) from intensive care units (ICUs). Methods: Prospective cohort study of all adult patients who survived their stay in our medical–surgical–trauma ICU between February 2016 and 2017 and were discharged directly home. Patients were followed for 8 weeks postdischarge. Univariable and multivariable logistic regression analyses were performed to identify factors associated with adverse events or unplanned return visits to a health-care facility following DDH from ICU. Results: A total of 129 DDH patients were enrolled and completed the 8-week follow-up. We identified 39 unplanned return visits (URVs). There was 0% mortality at 8 weeks postdischarge. Eight potential predictors of hospital URVs ( P < .2) were identified in the univariable analysis: prior substance abuse (odds ratio [OR] of URV of 2.50 [95% confidence interval: 1.08-5.80], hepatitis (OR: 6.92 [1.68-28.48]), sepsis (OR: 11.03 [1.19-102.29]), admission nine equivalents of nursing manpower score (NEMS) <24 (OR: 2.28 [1.03-5.04], no fixed address (OR: 22.9 [1.2-437.3]), ICU length of stay (LOS) <2 days (OR: 2.95 [1.28-6.78]), home discharge within London, Ontario (OR: 2.44 [1.00-5.92]), and left against medical advice (AMA; OR: 6.06 [2.04-17.98]). Conclusions: Our study identified 8 covariates that were potential predictors of URV: prior substance abuse, hepatitis, sepsis, admission NEMS <24, no fixed address, ICU LOS <2 days, home discharge within London, Ontario, and left AMA. The practice of direct discharges home from the ICU would benefit from adequately powered multicenter study in order to construct a clinical prediction model (that would require further testing and validation).

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Assessment of patient safety culture in intensive care units and factors affecting it

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.530 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M A Tlili ◽

W Aouicha ◽

H Lamine ◽

E Taghouti ◽

M B e n Dhiab ◽

...

Keyword(s):

Patient Safety ◽

Intensive Care ◽

Adverse Events ◽

Intensive Care Units ◽

Safety Culture ◽

Improve Patient Safety ◽

Healthcare Quality ◽

Patient Safety Culture ◽

Cross Sectional ◽

Learning From Errors

Abstract Background The intensive care units are a high-risk environments for the occurrence of adverse events with serious consequences. The development of patient safety culture is a strategic focus to prevent these adverse events and improve patient safety and healthcare quality. This study aimed to assess patient safety culture in Tunisian intensive care units and to determine its associated factors. Methods It is a multicenter, descriptive cross-sectional study, among healthcare professionals of the intensive care units in the Tunisian center. The data collection was spread over a period of 2 months (October-November 2017). The measuring instrument used is the validated French version of the Hospital Survey On Patient Safety Culture questionnaire. Data entry and analysis was carried out by the Statistical Package for Social Sciences (SPSS 20.0) and Epi Info 6.04. Chi-square test was used to explore factors associated with patient safety culture. Results A total of 404 professionals participated in the study with a participation rate of 81.94%, spread over 10 hospitals and 18 units. All dimensions were to be improved. The overall perception of safety was 32.35%. The most developed dimension was teamwork within units with a score of 47.87% and the least developed dimension was the non-punitive response to error (18.6%). The patient safety culture was significantly more developed in private hospitals in seven of the 10 dimensions. Participants working in small units had a significantly higher patient safety culture. It has been shown that when workload is reduced the patient safety culture was significantly increased. Conclusions This study has shown that the patient safety culture still needs to be improved and allowed a clearer view of the safety aspects requiring special attention. Thus, improving patient safety culture. by implementing the quality management and error reporting systems could contribute to enhance the quality of healthcare provided to patients. Key messages The culture of culpability is the main weakness in the study. Encouraging event reporting and learning from errors s should be priorities in hospitals to enhance patient safety and healthcare quality.

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Handwash versus hand-rub practices for preventing nosocomial infection in hospital intensive care units: A systematic review and meta-analysis

Canadian Journal of Infection Control ◽

10.36584/cjic.2020.009 ◽

2020 ◽

pp. 82-90

Author(s):

S Bello ◽

EA Bamgboye ◽

DT Ajayi ◽

EN Ossai ◽

EC Aniwada ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Adverse Events ◽

Nosocomial Infection ◽

Intensive Care Units ◽

Meta Analysis ◽

Healthcare Providers ◽

Length Of Hospital Stay ◽

Clinical Effectiveness ◽

Infection Rates

Background: Compliance with handwashing in busy healthcare facilities, such as intensive care units (ICUs), is suboptimal and alcohol hand-rub preparations have been suggested to improve compliance. There is no evidence on the comparative effectiveness between handwash and hand-rub strategies. This systematic review was to assess the effectiveness of handwash versus hand-rub strategies for preventing nosocomial infection in ICUs. Methods Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and hand-rub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of healthcare-associated infections (HCAIs), length of ICU/hospital stays, and adverse events. Studies were independently screened and data extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software. Results: Seven studies published between 1992-2009 and involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%). On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of hand rub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%). The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies;1504 patients; I2 = 0%) in favour of hand rub. Overall quality of evidence was low. Conclusion: Hand rub appeared more effective when compared to handwash in ICUs.

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Mortality assessment in intensive care units via adverse events using artificial neural networks

Artificial Intelligence in Medicine ◽

10.1016/j.artmed.2005.07.006 ◽

2006 ◽

Vol 36 (3) ◽

pp. 223-234 ◽

Cited By ~ 41

Author(s):

Álvaro Silva ◽

Paulo Cortez ◽

Manuel Filipe Santos ◽

Lopes Gomes ◽

José Neves

Keyword(s):

Neural Networks ◽

Artificial Neural Networks ◽

Intensive Care ◽

Adverse Events ◽

Intensive Care Units ◽

Artificial Neural

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Prevalence of adverse events in pediatric intensive care units in the United States*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0b013e3181d8e405 ◽

2010 ◽

Vol 11 (5) ◽

pp. 568-578 ◽

Cited By ~ 88

Author(s):

Swati Agarwal ◽

David Classen ◽

Gitte Larsen ◽

Nancy M. Tofil ◽

Leslie W. Hayes ◽

...

Keyword(s):

United States ◽

Intensive Care ◽

Adverse Events ◽

Intensive Care Units ◽

Pediatric Intensive Care ◽

The United States ◽

Pediatric Intensive Care Units

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Eventos adversos em Unidades de Terapia Intensiva: estudo bibliométrico Adverse events in Intensive Care Units: bibliometric study

Revista de Pesquisa Cuidado é Fundamental Online ◽

10.9789/2175-5361.2017.v9i3.669-675 ◽

2017 ◽

Vol 9 (3) ◽

pp. 669

Author(s):

Dariele Dias Dutra ◽

Marcella Costa Souto Duarte ◽

Karla Fernandes De Albuquerque ◽

Jiovana De Souza Santos ◽

Kaliny Monteiro Simões ◽

...

Keyword(s):

Intensive Care ◽

Adverse Events ◽

Intensive Care Units ◽

Bibliometric Study ◽

Terapia Intensiva

Objetivo: investigar as produções científicas acerca dos eventos adversos ocorridos em Unidades de Terapia Intensiva. Método: estudo bibliométrico, abordagem quantitativa, de base documental, constituído por 20 artigos da base de dados eletrônica Scientific Eletronic Library Online (Scielo), Base de Dados Bibliográficos Especializada na Área de Enfermagem (BDENF), e banco de teses e dissertações no período de 2004 à 2014. Resultados: foi possível identificar produções cientificas acerca de eventos adversos em UTIs dos últimos 10 anos, ressalta a predominância de trabalhos publicados pela enfermagem, com destaque para EAs relacionados a erros de medicação e infecção nosocomial, intensificados pela sobrecarga de trabalho. Conclusão: o estudo apresenta limitações quanto ao número reduzido de publicações sobre a temática. Desse modo a escassez de publicações no que concerne à temática em questão, dificulta atualizações sobre o assunto.

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