Developing a deep learning system to drive the work of the critical care outreach team

Care of patients at risk of deterioration on acute medical and surgical wards requires timely identification, increased monitoring and robust escalation procedures. The critical care outreach role brings specialist-trained critical care nurses and physicians into acute wards to facilitate these processes. Performing this role is challenging, as the breadth of information synthesis required is both high and rapidly updating. We propose a novel automated `watch-list' to identify patients at high risk of deterioration, to help prioritise the work of the outreach team. This system takes data from the electronic medical record in real-time and creates a discrete tokenized trajectory, which is fed into a recurrent neural network model. These models achieve an AUROC of 0.928 for in-patient death and 0.778 for unplanned ICU admission (within 24 hours), which compares favourably with existing early warning scores and is comparable with proof of concept deep learning systems requiring significantly more input data.

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Critical Care Outreach Team During COVID-19: Ventilatory Support in the Ward and Outcomes

Respiratory Care ◽

10.4187/respcare.08743 ◽

2021 ◽

pp. respcare-08743

Author(s):

Antonio Messina ◽

Andrea Pradella ◽

Valeria Alicino ◽

Maxim Neganov ◽

Giacomo De Mattei ◽

...

Keyword(s):

Critical Care ◽

Ventilatory Support ◽

Outreach Team ◽

Critical Care Outreach

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Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: Non-randomised population based study

Australian Critical Care ◽

10.1016/s1036-7314(04)80007-9 ◽

2004 ◽

Vol 17 (2) ◽

pp. 86-87 ◽

Cited By ~ 1

Author(s):

Wendy Chaboyer

Keyword(s):

Critical Care ◽

Patient Survival ◽

Population Based ◽

Population Based Study ◽

Outreach Team ◽

Discharge From Hospital ◽

Critical Care Outreach

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Novel Spanish Translators for Acute Care Nurses and Physicians: Usefulness and Effect on Practitioners’ Stress

American Journal of Critical Care ◽

10.4037/ajcc2005.14.6.545 ◽

2005 ◽

Vol 14 (6) ◽

pp. 545-550 ◽

Cited By ~ 2

Author(s):

Andrew C. Bernard ◽

Audra Summers ◽

Jennifer Thomas ◽

Myrna Ray ◽

Anna Rockich ◽

...

Keyword(s):

Critical Care ◽

Stress Reduction ◽

Quality Care ◽

Healthcare Providers ◽

Critical Care Nurses ◽

Survey Period ◽

Acute Care Nurses ◽

Quality Healthcare ◽

Stress Levels ◽

Nurses And Physicians

• Background Language barriers are significant impediments to providing quality healthcare, and increased stress levels among nurses and physicians are associated with these barriers. However, little evidence supports the usefulness of a translation tool specific to healthcare. • Objectives To evaluate the effectiveness of a novel English-Spanish translator designed specifically for nurses and physicians. The hypothesis was that the translator would be useful and that use of the translator would decrease stress levels among nurses and physicians caring for Spanish-speaking patients. • Methods Novel English-Spanish translators were developed entirely on the basis of input from critical care nurses and physicians. After 7 months of use, users completed surveys. Usefulness of the translator and stress levels among users were reported. • Results A total of 60% of nurses (n = 32) and 71% (n = 25) of physicians responded to the survey. A total of 96% of physicians and 97% of nurses considered the language barrier an impediment to delivering quality care. Nurses reported significantly more stress reduction than did physicians (P = .01). Most nurses and physicians had used the translator during the survey period. Overall, 91% of nurses and 72% of physicians found that the translator met their needs at the bedside some, most, or all of the time. All nurses thought that they most likely would use the translator in the future. • Conclusions The translator was useful for most critical care nurses and physicians surveyed. Healthcare providers, especially nurses, experienced decreased stress levels when they used the translator.

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Impact of a critical care outreach team on critical care readmissions and mortality

Acta Anaesthesiologica Scandinavica ◽

10.1111/j.1399-6576.2004.00509.x ◽

2004 ◽

Vol 48 (9) ◽

pp. 1096-1100 ◽

Cited By ~ 57

Author(s):

G. Garcea ◽

S. Thomasset ◽

L. Mcclelland ◽

A. Leslie ◽

D. P. Berry

Keyword(s):

Critical Care ◽

Outreach Team ◽

Critical Care Outreach

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Association between Cardiac Index and Mortality in Patients Assessed on the Ward by a Nurse-Led Critical Care Outreach Team

Journal of the Intensive Care Society ◽

10.1177/175114370800900205 ◽

2008 ◽

Vol 9 (2) ◽

pp. 118-123

Author(s):

Simon Nourse ◽

Alan Hurding ◽

Ann McGinley ◽

Gerlinde Mandersloot ◽

Rupert Pearse

Keyword(s):

Critical Care ◽

Cardiac Index ◽

Outreach Team ◽

Critical Care Outreach

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Monitoring Delirium in the Intensive Care Unit Practices, perceptions and attitudes of critical care nurses and physicians. A French National Survey

Intensive and Critical Care Nursing ◽

10.1016/j.iccn.2021.103178 ◽

2021 ◽

pp. 103178

Author(s):

C. Alaterre ◽

C. Fazilleau ◽

J.M. Constantin ◽

A. James

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

National Survey ◽

Critical Care Nurses ◽

Perceptions And Attitudes ◽

Nurses And Physicians

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Readiness of critical care physicians and nurses to handle requests for organ donation

American Journal of Critical Care ◽

10.4037/ajcc1998.7.1.4 ◽

1998 ◽

Vol 7 (1) ◽

pp. 4-12 ◽

Cited By ~ 75

Author(s):

MJ Evanisko ◽

CL Beasley ◽

LE Brigham ◽

C Capossela ◽

GR Cosgrove ◽

...

Keyword(s):

Critical Care ◽

Brain Death ◽

Organ Donation ◽

The United States ◽

Critical Care Nurses ◽

Care Staff ◽

Factual Knowledge ◽

Donation Process ◽

Nurses And Physicians ◽

Effective Procedures

BACKGROUND: Critical care nurses and physicians usually care for those patients whose condition progresses to brain death and are also often responsible for requesting organ donation from the family of a brain-dead patient. We hypothesized that staff support, knowledge, and training levels would be significantly associated with organ donation rates. OBJECTIVE: To assess the readiness of critical care staff to successfully handle requests for organ donation. METHODS: A total of 1061 critical care staff from 28 hospitals in four separate regions of the United States completed a questionnaire that assessed (1) factual knowledge about organ donation, (2) understanding of brain death, (3) previous training in procedures for requesting donations, and (4) comfort levels with the donation process. RESULTS: Staff training in effective procedures for requesting organ donations was significantly correlated with hospitals' donation rates. Less than a third of respondents, however, had received training in explaining brain death to and requesting organ donation from a grieving family. In hospitals with high rates of organ donation, 52.9% of staff had received training; in hospitals with low rates of organ donation, 23.5% of staff had received training. Levels of factual knowledge about organ donation and brain death were unexpectedly low but were not significantly related to hospitals' rates of organ donation. CONCLUSIONS: Training of critical care nurses and physicians in effective procedures for requesting organ donation is significantly associated with higher rates of organ donation, yet two thirds of critical care staff report no relevant training. Consequently, critical care staff cannot be considered ready to effectively handle requests for organ donation.

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Seeing the Patient and Family Through: Nurses and Physicians Experiences With Withdrawal of Life-Sustaining Therapy in the ICU

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118801011 ◽

2018 ◽

Vol 36 (1) ◽

pp. 13-23 ◽

Cited By ~ 7

Author(s):

Debra L. Wiegand ◽

Jooyoung Cheon ◽

Giora Netzer

Keyword(s):

Health Care ◽

Critical Care ◽

Data Analysis ◽

Health Care Providers ◽

Quality Care ◽

Phenomenological Approach ◽

Critical Care Nurses ◽

Care Providers ◽

Therapy Decision ◽

Nurses And Physicians

Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.

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