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

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

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.2010.21 ◽

2010 ◽

Vol 4 (3) ◽

pp. 193-194 ◽

Cited By ~ 4

Author(s):

Eric Toner ◽

Richard Waldhorn

Keyword(s):

Critical Care ◽

Acute Care ◽

Capacity Planning ◽

Acute Care Hospitals ◽

Mechanical Ventilators ◽

Surge Capacity

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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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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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Prevalence of SARS-CoV-2 antibodies in health care personnel of two acute care hospitals in Linz, Austria

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1681 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Margot Egger ◽

Christian Bundschuh ◽

Kurt Wiesinger ◽

Elisabeth Bräutigam ◽

Thomas Berger ◽

...

Keyword(s):

Health Care ◽

Acute Care ◽

Acute Care Hospitals ◽

Health Care Personnel

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Effectiveness of Ultraviolet-C Room Disinfection on Preventing Healthcare-Associated Clostridioides difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.512 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s33-s33

Author(s):

Michihiko Goto ◽

Erin Balkenende ◽

Gosia Clore ◽

Rajeshwari Nair ◽

Loretta Simbartl ◽

...

Keyword(s):

Acute Care ◽

Acute Care Hospitals ◽

Incidence Rates ◽

Positive Test ◽

Negative Binomial Regression Model ◽

Test Results ◽

Clostridioides Difficile ◽

Ultraviolet C ◽

Healthcare Associated ◽

Uv C

Background: Enhanced terminal room cleaning with ultraviolet C (UVC) disinfection has become more commonly used as a strategy to reduce the transmission of important nosocomial pathogens, including Clostridioides difficile, but the real-world effectiveness remains unclear. Objectives: We aimed to assess the association of UVC disinfection during terminal cleaning with the incidence of healthcare-associated C. difficile infection and positive test results for C. difficile within the nationwide Veterans Health Administration (VHA) System. Methods: Using a nationwide survey of VHA system acute-care hospitals, information on UV-C system utilization and date of implementation was obtained. Hospital-level incidence rates of clinically confirmed hospital-onset C. difficile infection (HO-CDI) and positive test results with recent healthcare exposures (both hospital-onset [HO-LabID] and community-onset healthcare-associated [CO-HA-LabID]) at acute-care units between January 2010 and December 2018 were obtained through routine surveillance with bed days of care (BDOC) as the denominator. We analyzed the association of UVC disinfection with incidence rates of HO-CDI, HO-Lab-ID, and CO-HA-LabID using a nonrandomized, stepped-wedge design, using negative binomial regression model with hospital-specific random intercept, the presence or absence of UVC disinfection use for each month, with baseline trend and seasonality as explanatory variables. Results: Among 143 VHA acute-care hospitals, 129 hospitals (90.2%) responded to the survey and were included in the analysis. UVC use was reported from 42 hospitals with various implementation start dates (range, June 2010 through June 2017). We identified 23,021 positive C. difficile test results (HO-Lab ID: 5,014) with 16,213 HO-CDI and 24,083,252 BDOC from the 129 hospitals during the study period. There were declining baseline trends nationwide (mean, −0.6% per month) for HO-CDI. The use of UV-C had no statistically significant association with incidence rates of HO-CDI (incidence rate ratio [IRR], 1.032; 95% CI, 0.963–1.106; P = .65) or incidence rates of healthcare-associated positive C. difficile test results (HO-Lab). Conclusions: In this large quasi-experimental analysis within the VHA System, the enhanced terminal room cleaning with UVC disinfection was not associated with the change in incidence rates of clinically confirmed hospital-onset CDI or positive test results with recent healthcare exposure. Further research is needed to understand reasons for lack of effectiveness, such as understanding barriers to utilization.Funding: NoneDisclosures: None

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Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.956 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s343-s344

Author(s):

Margaret A. Dudeck ◽

Katherine Allen-Bridson ◽

Jonathan R. Edwards

Keyword(s):

Acute Care ◽

National Level ◽

Bloodstream Infections ◽

Acute Care Hospitals ◽

Central Line ◽

Patient Specific ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Repeat Infection ◽

Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

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The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

Canadian Journal of Nursing Research ◽

10.1177/08445621211014421 ◽

2021 ◽

pp. 084456212110144

Author(s):

Behdin Nowrouzi-Kia ◽

Mary T. Fox ◽

Souraya Sidani ◽

Sherry Dahlke ◽

Deborah Tregunno

Keyword(s):

Emergency Department ◽

Role Conflict ◽

Acute Care ◽

Acute Care Hospitals ◽

Cross Sectional Survey ◽

Eligibility Criteria ◽

Cross Sectional ◽

Medical Unit ◽

Scale Scores ◽

Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

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