Pre- and inter-hospital transport of the critically ill and injured

2016 ◽  
Author(s):  
Kelly R. Klein ◽  
Paul E. Pepe
Keyword(s):  
Critical Care ◽  
Hospital Setting ◽  
Optimal Care ◽  
Mortality And Morbidity ◽  
Intensive Monitoring ◽  
Modern Health Care ◽  
Secondary Support ◽  
Key Issues ◽  
Hospital Resources ◽  
Hospital Transport

Pre- and inter-hospital transport medicine has become a highly specialized branch of critical care and emergency medicine practices, and is an integral part of modern health care. It can have a significant impact on mortality and morbidity when used appropriately. However, it also poses very unique challenges involving extension of hospital resources into often unfamiliar and sometimes austere and hostile arenas in the out-of-hospital setting. The very nature of critical care also means that the patient is profoundly ill or injured, and needs intensive monitoring and treatment with limited secondary support and personnel in the limited space of an ambulance, helicopter, or fixed wing aircraft. Accordingly, to optimize safety and patient care under these circumstances, specific guidelines and strict regulations regarding critical care transport have been implemented. Protocols and policies need to be in place to ensure optimal care, and safety for both patients and transport crews with contingencies for unanticipated weather and altitude challenges, and should also address key issues.

Measles pneumonia in the critically ill child: application of alternative ventilation strategies

1995 ◽  
Vol 15 (2) ◽  
pp. 39-39 ◽  
Author(s):  
D Claytor ◽  
L Margherita ◽  
K Penn ◽  
LS Franck
Keyword(s):  
Critical Care ◽  
Measles Virus ◽  
Critical Care Nurses ◽  
Nursing Interventions ◽  
Optimal Care ◽  
Mortality And Morbidity ◽  
Life Threatening ◽  
Ventilation Strategies ◽  
Bilateral Lung ◽  
The Impact

Measles pneumonia is a life-threatening complication in children infected with the measles virus. The increased number of reported cases over the last several years suggests a need for heightened awareness of the complication among pediatric critical care nurses. Application of alternative ventilation strategies in the critical care setting continues to be explored in children with ARDS refractory to more conventional ventilation support, because the mortality and morbidity associated with ARDS in children remain high. Patients who present with diffuse, bilateral lung injury, such as in measles pneumonia, may be candidates for alternative ventilation strategies. Few investigators have studied alternative ventilation strategies in the pediatric ICU setting. Therefore, nursing research related to the impact of nursing interventions during alternative ventilation strategies is needed. Specifically, evaluation of ET suctioning practices and other interventions that influence oxygen delivery and consumption are necessary to plan effective care during alternative ventilation strategies and improve patient outcome. Prevention of measles pneumonia is clearly the preferred "treatment." Preventive healthcare is paramount in providing optimal care for children. However, until we can address the environmental factors that predispose children to communicable diseases such as measles, critical care nurses must be knowledgeable about the assessment and management of measles pneumonia.

COMMITTEE ON FETUS AND NEWBORN

PEDIATRICS ◽  
1967 ◽  
Vol 40 (5) ◽  
pp. 923-923
Author(s):  
JEROLD F. LUCEY ◽  
AUDREY K. BROWN ◽  
ALICE GAMBLE BEARD ◽  
MARVIN CORNBLATH ◽  
MOSES GROSSMAN ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Optimal Care ◽  
Mortality And Morbidity ◽  
New Approaches ◽  
Neonatal Patient ◽  
High Risk Infants ◽  
Health Laws ◽  
Periodic Inspections ◽  
Health Administrators

THE physical design of and routine practices in neonatal units (especially nurseries for high-risk infants) are presently influenced almost entirely by considerations related to the risk of spreading infection in the nursery by fomites and personnel. The role of nursery design and specific routines in preventing epidemics is considered so important that the details are encoded in many local, state, and federal health laws or regulations. These are enforced by periodic inspections and conformity is made a prerequisite for official approval, allocation of funds, etc. Although there is little reason to doubt that these policies have had the effect of reducing the incidence of nursery epidemics, there is growing concern that official rigidity in these matters may interfere with optimal care of the very ill infant, as well as with research designed to improve care and find solutions to the overall problems of neonatal mortality and morbidity. Infections are an important and frequent cause of disease in the newborn. They are, however, clearly outdistanced by major non-infectious disorders that account for the majority of deaths and brain damage in the neonatal period (respiratory distress, asphyxia, acidosis, hypoglycemia, and hyperbilirubinemia). Some of the precautionary techniques used to reduce the risk of infections have the practical disadvantages of making it difficult (1) to approach the neonatal patient and (2) to apply modern diagnostic maneuvers and therapeutic aids in order to improve the neonatal patient's chances for intact survival. As a result the nursery-based infants in this country are, in general, quite well protected from the risks of nosocomial infections; but, they receive less than ideal management for cardiorespiratory disorders, a major cause of neonatal mortality. It is obvious that new solutions are required to solve the problem of hospital care of the sick neonate. Unfortunately, both the search for new approaches to neonatal care and the application of some newly established knowledge are now being impaired by rigid rules and construction codes which do not permit innovation. Although these rules cannot be completely abandoned until safe alternatives have been demonstrated, the Committee believes that public health administrators and hospital committees must permit cautious, responsible exploration and evaluation of new approaches to the multiple problems involved.

scholarly journals Pre-NELA vs NELA – has anything changed, or is it just an audit exercise?

2016 ◽  
Vol 98 (8) ◽  
pp. 554-559 ◽  
Author(s):  
M Mak ◽  
AR Hakeem ◽  
V Chitre
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Uneventful Recovery ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
High Risk Patients ◽  
Possum Score ◽  
Operative Severity Score ◽  
Risk Patients ◽  
Set Up

BACKGROUND Following evidence suggestive of high mortality following emergency laparotomies, the National Emergency Laparotomy Audit (NELA) was set up, highlighting key standards in emergency service provision. Our aim was to compare our NHS trust’s adherence to these recommendations immediately prior to, and following, the launch of NELA, and to compare patient outcome. METHODS This was a retrospective study of patients who underwent an emergency laparotomy over the course of 6 months – 3 months either side of the initiation of NELA. RESULTS There were 44 patients before the initiation of NELA (pre-NELA, PN group) and 55 in the first 3 months of NELA (N group). We saw a significant increase in the proportion of patients whose decision to operate was made by the consultant: 75.0% in the PN group vs 100% in N group (subsequent data presented in this order) (P < 0.001). The presence of a consultant surgeon (75.0% vs 83.6%, P = 0.321) and anaesthetist (100.0% vs 90.9%, P = 0.064) in theatres were comparable in both groups. Risk stratification based on Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) score showed no difference in high-risk patients in both groups (47.7% vs 36.4%, P = 0.306). With the NELA initiative, however, significantly more patients were admitted directly from theatres to the critical care unit, when compared with the pre-NELA period (9.1% vs 27.3%, P = 0.038). This also reflected a significant reduction in unexpected escalation to a higher level of care during this period (10.0% vs 0%, P = 0.036). Significantly more patients had uneventful recovery in the NELA period (52.3 vs 76.4%, P = 0.018), although there was no difference in 30-day mortality between the groups (2.3% vs 7.3%, P = 0.378). CONCLUSIONS This study demonstrated a greater degree of consultant involvement in the decision to operate during NELA. More high-risk patients have been identified preoperatively with diligent risk assessment and, hence, have been proactively admitted to critical care units following laparotomy, which may account for the significant reduction in unexpected escalation to level 2 or level 3 care and thus in overall better patient outcomes.

scholarly journals "EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity"

2016 ◽  
Vol 134 (6) ◽  
pp. 543-554 ◽  
Author(s):  
Alessandra Carvalho Goulart ◽  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Local Community ◽  
Hospital Setting ◽  
Public Healthcare ◽  
Stroke Mortality ◽  
Community Based ◽  
Mortality And Morbidity ◽  
Risk Of Death

ABSTRACT CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). CONCLUSION: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.

scholarly journals Hospital beds and personal protective equipment planning for COVID-19 pandemic: A computer simulation approach

2020 ◽  
Author(s):  
Yiruo Lu ◽  
Yongpei Guan ◽  
Jennifer Fishe ◽  
Thanh Hogan ◽  
Xiang Zhong
Keyword(s):  
Computer Simulation ◽  
Personal Protective Equipment ◽  
Census Data ◽  
Discrete Event ◽  
Hospital Setting ◽  
Case Fatality ◽  
Protective Equipment ◽  
Simulation Approach ◽  
Number Of Patients ◽  
Hospital Resources

Abstract Health care systems are at the frontline to fight the COVID-19 pandemic. An emergent question for each hospital is how many general ward and intensive care unit beds are needed and how much personal protective equipment to be purchased. However, hospital pandemic preparedness has been hampered by a lack of sufficiently specific planning guidelines. In this paper, we developed a computer simulation approach to evaluating bed utilizations and the corresponding supply needs based on the operational considerations and constraints in individual hospitals. We built a data-driven SEIR model which is adaptive to control policies and can be utilized for regional forecast targeting a specific hospital’s catchment area. The forecast model was integrated into a discrete-event simulation which modeled the patient flow and the interaction with hospital resources. We tested the simulation model outputs against patient census data from UF Health Jacksonville, Jacksonville, FL. Simulation results were consistent with the observation that the hospital has ample bed resources to accommodate the regional COVID patients. After validation, the model was used to predict future bed utilizations given a spectrum of possible scenarios to advise bed planning and stockpiling decisions. Lastly, how to optimally allocate hospital resources to achieve the goal of reducing the case fatality rate while helping a maximum number of patients to recover was discussed. This decision support tool is tailored to a given hospital setting of interest and is generalizable to other hospitals to tackle the pandemic planning challenge.

scholarly journals Improving emotional well-being for hospital-based patients with dementia

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stephanie Petty ◽  
Amanda Griffiths ◽  
Donna Maria Coleston ◽  
Tom Dening
Keyword(s):  
Nursing Staff ◽  
Hospital Care ◽  
Personal Information ◽  
Hospital Setting ◽  
Well Being ◽  
Hospital Staff ◽  
Content Type ◽  
Hospital Nursing ◽  
People With Dementia ◽  
Hospital Resources

Purpose Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting. Design/methodology/approach A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis. Findings Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes. Research limitations/implications The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research. Originality/value In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.

Implementation of Electronic Systems for Prescribing and Delivering Medication in Hospitals: Issues in Real Practice

2007 ◽  
Vol 51 (11) ◽  
pp. 740-744 ◽  
Author(s):  
Jennie J. Gallimore ◽  
Peter K. Wong
Keyword(s):  
Patient Monitoring ◽  
Hospital Setting ◽  
Future Research ◽  
Electronic Systems ◽  
Research Needs ◽  
Computer Technologies ◽  
Hospital Resources ◽  
Real Practice

Electronic systems are being purchased by hospitals to improve procuring, prescribing, dispensing, administering medications and patient monitoring processes. The purpose of this paper is to describe issues related to implementation of computer technologies to support the pharmaceutical process in a real hospital setting. Examining the issues can help to improve processes and systems and provides an indication where hospital resources may need to be directed to solve problems of immediate concern. Future research needs for improving electronic systems are presented.

The Impact of Relocating Vasectomies from Hospital Outpatient Departments to Non-Hospital Sites

1995 ◽  
Vol 8 (1) ◽  
pp. 46-51
Author(s):  
Wendy Young ◽  
Vivek Goel
Keyword(s):  
Descriptive Analysis ◽  
Age Distribution ◽  
Hospital Setting ◽  
Insurance Plan ◽  
Ontario Health Insurance Plan ◽  
Funding Policies ◽  
Outpatient Departments ◽  
Hospital Resources ◽  
The Impact ◽  
Hospital Outpatients

The objective of this study was to estimate the net dollar value of hospital resources that would be released if vasectomies currently performed in outpatient departments were performed in non-hospital sites. This article provides a descriptive analysis using administrative data for all non-hospital sites and all acute care institutions in Ontario performing vasectomies. It is based on 23,741 records of patients for whom a vasectomy was billed to the Ontario Health Insurance Plan (OHIP) in 1991–92. No substantial differences in the age distribution of patients were seen in non-hospital sites and those in hospital settings. About 75% of hospital outpatients received a local anesthetic that could have been administered in a non-hospital setting. Approximately $4.4 million in hospital resources would be released if 75% of all outpatient vasectomies were performed in non-hospital settings while OHIP billings would increase only by about $140,000. The demands on hospital funds available for patient activity could have been decreased by about $6.2 million, if this shift had occurred in 1991–92. Although opportunities exist in Ontario to release hospital resources by shifting vasectomies to non-hospital sites, current hospital and physician funding policies may represent a disincentive to shift activity away from institutional-based care.

scholarly journals Pre-hospital use of intravenous in-line fluid warmers to reduce morbidity and mortality for major trauma patients: A review of the current literature.

2015 ◽  
Vol 12 (2) ◽  
Author(s):  
Nicholas Collins ◽  
Stuart Daly ◽  
Patricia Johnson ◽  
Gavin Smith
Keyword(s):  
Patient Outcomes ◽  
Major Trauma ◽  
Hospital Setting ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Hospital Emergency ◽  
Mortality And Morbidity ◽  
Poor Patient ◽  
Patient Morbidity ◽  
Lethal Triad

IntroductionIn-line fluid warmers are an established treatment for delivering warmed intravenous (IV) fluid in the hospital setting. Recently their potential application within the pre-hospital setting has been highlighted to potentially reduce mortality and morbidity. Currently ambulance paramedics only administer warmed fluid to patients assessed as hypothermic, and this fluid is subject to further cooling on exposure to ambient environmental conditions. This review examined the peer-reviewed literature to determine the available evidence for in-line fluid warmer effectiveness and potential inclusion in pre-hospital emergency care.MethodsA review of the electronic literature, including the Medline and Ebscohost databases was conducted using the terms “intravenous fluid warmers” “hypothermia”, “ trauma”, “ fluid”, “coagulopathy”, “ acidosis”, “hypothermia and trauma patients”, “accidental hypothermia”, “lethal triad” and “trauma care”. Articles were included if they represented a study of in-line fluid warmers within the surgical, general hospital or pre-hospital emergency care settings. Articles not available in English or as full text were excluded.ResultsThe review identified 23 relevant articles for analysis. Of note, up to 40% of trauma patients with signs of hypoperfusion were reported to arrive at hospital in a hypothermic state post-incident. Hypothermia plays a significant role in contributing to the ‘triad of death’- a condition that results in poor patient outcomes and high mortality rates.ConclusionThis review identified that current pre-hospital practice does not prescribe warmed fluid to the normothermic trauma patient. The review also identified that there is a need for in-line fluid warmers in ambulance practice to prevent or limit hypothermia and reduce patient morbidity and mortality associated with trauma.

Management of pandemic critical illness

2016 ◽  
Author(s):  
Robert Fowler ◽  
Abhijit Duggal
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Control Programme ◽  
Mortality And Morbidity ◽  
Care Services ◽  
Secondary Infections ◽  
Viral Therapy ◽  
Number Of Patients ◽  
Distribution Of Resources ◽  
Principles Of Justice

Adequate and appropriate provision of critical care services during pandemics may dramatically alter vital outcomes of patients who develop acute respiratory distress syndrome and critical illness. Specific anti-viral therapy, antibiotics directed towards probable secondary infections, supportive ventilation and oxygenation, and adherence to multisystem critical care ‘best practices’ can prevent substantial mortality and morbidity, and lessen the pandemic’s impact on global health. However, severe acute respiratory syndrome and the 2009 H1N1 pandemic also highlighted the limited capacity for increased provision of critical care, even in well-resourced settings, and the potential for dramatic differences in mortality in under-resourced settings. Pandemic preparedness hinges on the development of appropriately-trained staff with well-defined roles, and the ability to manage surge in the number of patients. A rigorous infection control programme, and triage protocols based on equitable distribution of resources and ethical principles of justice, beneficence and non-maleficence. Research preparedness, with approved protocols, electronic case report forms and harmonized clinical trials is necessary.

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