scholarly journals Implementing a program to improve handoffs and reduce adverse events in Paediatric Intensive Care Units in Argentina: a stepped wedge trial.

2020 ◽  
Author(s):  
Facundo Jorro-Baron ◽  
Ines Suarez-Anzorena ◽  
Rodrigo Burgos-Pratx ◽  
Noelia Soledad Demaio ◽  
Matias Penazzi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Adverse Events ◽  
Intensive Care Units ◽  
Intervention Group ◽  
Paediatric Intensive Care ◽  
Stepped Wedge ◽  
Stepped Wedge Trial ◽  
Paediatric Intensive Care Units ◽  
Simulation Exercises

Introduction: An effective and standardized communication anticipates and limits the appearance of possible adverse events. Objective: To evaluate the effect of the implementation of a handoff program in reducing the frequency of adverse events (AE) in Paediatric Intensive Care Units (PICUs). Methods: Facility-based, cluster randomised stepped wedge trial in six Argentine PICUs, with more than 20 admissions per month. The intervention comprised a Spanish version on the I-PASS Handoff Bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises and observation and standardized feedback of handoffs. Results: We recruited 6 cluster PICUs in 5 hospitals. We reviewed 1465 medical records (MR). We did not observed differences in the rates of preventable AE per 1000 days of hospitalization (control 60.4 [37.5 - 97.4] vs. intervention 60.4 [33.2 - 109.9], p=0.3568, RR:1.21 [CI95%:0.80 - 1.83]), and no changes in the categories or types of AE. We evaluated 847 handoffs. Compliance with all items in verbal and written handoff was significantly higher in the intervention group. We observed a longer time per patient to complete the handoff in the intervention group (7.29 minutes [5.77 - 8.81] vs. 5.96 [4.69 - 7.23]; p <0.0002, RR:1.33 [CI95%:0.64 - 2.02]), without changes in the whole time used for handoff (control: 35.7 [29.6 - 41.8] vs. intervention: 34.7 [26.5 - 42.1]; p = 0.4900, RR:1.43 [CI95%:-2.63 - 5.49]). Perception of improved communication from provider did not show changes. Conclusions: After the implementation of the I-PASS bundle, improvement in the quality of handoffs was observed. Nevertheless, no differences were observed in the frequency of AE, nor in the perception of improved communication.

Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial

2021 ◽  
pp. bmjqs-2020-012370
Author(s):  
Facundo Jorro-Barón ◽  
Inés Suarez-Anzorena ◽  
Rodrigo Burgos-Pratx ◽  
Noelia De Maio ◽  
Matías Penazzi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Control Period ◽  
Intervention Group ◽  
Paediatric Intensive Care ◽  
Stepped Wedge ◽  
Intervention Period ◽  
Programme Implementation ◽  
Stepped Wedge Trial ◽  
Paediatric Intensive Care Units

BackgroundThere are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes’ effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs).MethodsFacility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation.ResultsWe reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5–97.4) vs intervention 60.4 (33.2–109.9), p=0.99, risk ratio: 1.0 (0.74–1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6–41.8) vs intervention 34.7 min (26.5–42.1); difference 1.43 min (95% CI −2.63 to 5.49, p=0.49)). The providers’ perception of improved communication did not change.ConclusionsAfter the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs’ frequency or the perception of enhanced communication.Trial registration numberNCT03924570

scholarly journals A multinational survey on the infrastructural quality of paediatric intensive care units

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Gert Warncke ◽  
Florian Hoffmann ◽  
Michael Sasse ◽  
Georg Singer ◽  
Istvan Szilagyi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Paediatric Intensive Care ◽  
Paediatric Intensive Care Units

scholarly journals Use of Propofol Infusion in Australian and New Zealand Paediatric Intensive Care Units

2002 ◽  
Vol 30 (6) ◽  
pp. 786-793 ◽  
Author(s):  
M. Festa ◽  
J. Bowra ◽  
D. Schell
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Adverse Events ◽  
Intensive Care Units ◽  
Paediatric Intensive Care ◽  
National Guidelines ◽  
Propofol Infusion Syndrome ◽  
Serious Adverse Events ◽  
Maximum Period ◽  
Paediatric Intensive Care Units

Despite the risk of propofol infusion syndrome, a rare but often fatal complication of propofol infusion in ventilated children and possibly adults, propofol infusion remains in use in paediatric intensive care units (PICU). This questionnaire study surveys the current pattern of use of this sedative infusion in Australian and New Zealand PICUs. Thirty-three of the 45 paediatric intensive care physicians surveyed (73%), from 12 of the 13 intensive care units, returned completed questionnaires. The majority of practitioners (82%) use propofol infusion in children in PICU, the main indication being for short-term sedation in children requiring procedures. 39% of respondents consider propofol infusion useful in ventilated children requiring longer-term sedation. 67% of paediatric intensivists use maximum infusion doses that may be considered dangerously high (≥10 mg/kg/h). Nineteen per cent use propofol infusion for prolonged periods (> 72 hours). A smaller proportion (15%) of respondents indicate that they may use both higher doses and prolonged periods of infusion, a practice likely to lead to a greater chance of serious adverse events. Knowledge of local protocols for the use of propofol infusion is associated with a significantly greater level of monitoring for possible adverse events. We suggest that national guidelines for the use of propofol infusion in children should be developed. These should include clear indications and contraindications to its use, a maximum dose rate and maximum period of infusion, with a ceiling placed on the cumulative dose given and clearly stated minimum monitoring requirements.

scholarly journals Is there a sex difference in mortality rates for deaths occurring in paediatric intensive care units? Systematic literature review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e046794
Author(s):  
Ofran Almossawi ◽  
Amanda Friend ◽  
Luigi Palla ◽  
Richard Feltbower ◽  
Bianca De Stavola
Keyword(s):  
Intensive Care ◽  
Literature Review ◽  
Intensive Care Units ◽  
Systematic Literature Review ◽  
Data Extraction ◽  
Linkage Study ◽  
Paediatric Intensive Care ◽  
Admission Rates ◽  
Ethical Approval ◽  
Paediatric Intensive Care Units

IntroductionIn the general population, female children have been reported to have a survival advantage. For children admitted to paediatric intensive care units (PICUs), mortality has been reported to be lower in males despite the higher admission rates for males into intensive care. This apparent sex reversal in PICU mortality is not well studied. To address this, we propose to conduct a systematic literature review to summarise the available evidence. Our review will study the reported differences in mortality between males and females aged 0–17, who died in a PICU, to examine if there is a difference between the two sexes in PICU mortality, and if so, to describe the magnitude and direction of this difference.Methods and analysisStudies that directly or indirectly addressed the association between sex and mortality in children admitted to intensive care will be eligible for inclusion. Studies that directly address the association will be eligible for data extraction. The search strings were based on terms related to the population (children in intensive care), the exposure (sex) and the outcome (mortality). We used the databases MEDLINE (1946–2020), Embase (1980–2020) and Web of Science (1985–2020) as these cover relevant clinical publications. We will assess the reliability of included studies using the risk of bias in observational studies of exposures tool. We will consider a pooled effect if we have at least three studies with similar periods of follow up and adjustment variables.Ethics and disseminationEthical approval is not required for this review as it will synthesise data from existing studies. This manuscript is a part of a larger data linkage study, for which Ethical approval was granted. Dissemination will be via peer-reviewed journals and via public and patient groups.PROSPERO registration numberCRD42020203009.

scholarly journals Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

2021 ◽  
pp. archdischild-2020-320962
Author(s):  
Ruchi Sinha ◽  
Angela Aramburo ◽  
Akash Deep ◽  
Emma-Jane Bould ◽  
Hannah L Buckley ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Clinical Care ◽  
Adult Patients ◽  
Paediatric Intensive Care ◽  
Critically Ill Adults ◽  
Care Capacity ◽  
Ill Adults ◽  
Paediatric Intensive Care Units

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

Measuring efficiency in Australian and New Zealand paediatric intensive care units

2010 ◽  
Vol 36 (8) ◽  
pp. 1410-1416 ◽  
Author(s):  
Lahn D. Straney ◽  
Archie Clements ◽  
Jan Alexander ◽  
Anthony Slater
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Intensive Care Units ◽  
Paediatric Intensive Care ◽  
Measuring Efficiency ◽  
Paediatric Intensive Care Units

scholarly journals Factors influencing plasma transfusion practices in paediatric intensive care units around the world

Vox Sanguinis ◽  
2017 ◽  
Vol 112 (2) ◽  
pp. 140-149 ◽  
Author(s):  
O. Karam ◽  
P. Demaret ◽  
A. Duhamel ◽  
A. Shefler ◽  
P. C. Spinella ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Paediatric Intensive Care ◽  
Plasma Transfusion ◽  
Factors Influencing ◽  
The World ◽  
Paediatric Intensive Care Units

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
Author(s):  
Stacie B. Peddy ◽  
Mary Fran Hazinski ◽  
Peter C. Laussen ◽  
Ravi R. Thiagarajan ◽  
George M. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Paediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

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