scholarly journals Tele-Rapid Response Team (Tele-RRT): Implementation and outcomes of Safety Network System. Before and after cohort study.

2021 ◽  
Author(s):  
Ahmed N. Balshi ◽  
Mohammed A. Al-Odat ◽  
Abdulrahman M. Alharthy ◽  
Rayan A. Alshaya ◽  
Hanan M. Alenzi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Early Recognition ◽  
Vital Signs ◽  
Hospital Length ◽  
Rapid Response ◽  
Warning Signs ◽  
Hospital Length Of Stay ◽  
Multivariable Logistic Regression Model ◽  
Icu Admission ◽  
Before And After

Background Rapid Response Teams were developed to provide interventions for deteriorating patients. Their activation depends on timely detection of deterioration. Automated calculation of warning signs may lead to early recognition, and improvement of RRT effectiveness. Method This was a Before and After study, in the Before period ward nurses activated RRT after manually recording vital signs and calculating warning scores. In the After period, vital signs and warning calculations were automatically relayed to RRT through a wireless monitoring network. Results The After group had significantly lower incidence and rates of cardiopulmonary resuscitation compared to the Before group (2.3 / 1000 inpatient days versus 3.8 / 1000 inpatient days respectively, p = 0.01), the Before group had a significantly higher hospital length of stay, and significantly fewer visits by the RRT. In multivariable logistic regression model, being in the After group decreases odds of CPR by 30% (OR = 0.7 [95% CI: 0.44 to 0.97]; p = 0.02). There was no difference between groups in unplanned ICU admission or readmission. Conclusion Automated activation of the RRT resulted in significant reduction of CPR events and rate, reduction of hospital length of stay, and increase in the number of visits by the RRT. There was no difference in unplanned ICU admission or readmission.

scholarly journals Association of prescription opioid use on mortality and hospital length of stay in the intensive care unit

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250320
Author(s):  
Nicole Hardy ◽  
Fatima Zeba ◽  
Anaelia Ovalle ◽  
Alicia Yanac ◽  
Christelle Nzugang-Noutonsi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Icu Admission ◽  
Prescription Opioid Use

Objective Several studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases. However, the association of outpatient prescription opioid use on morbidity and mortality has not been adequately evaluated in a critical care setting. The purpose of this study was to determine if there is an association between chronic opioid use and mortality after an ICU admission. Design A single-center, longitudinal retrospective cohort study of all Intensive Care Unit (ICU) patients admitted to a tertiary-care academic medical center from 2001 to 2012 using the MIMIC-III database. Setting Medical Information Mart for Intensive Care III database based in the United States. Patients Adult patients 18 years and older were included. Exclusion criteria comprised of patients who expired during their hospital stay or presented with overdose; patients with cancer, anoxic brain injury, non-prescription opioid use; or if an accurate medication reconciliation was unable to be obtained. Patients prescribed chronic opioids were compared with those who had not been prescribed opioids in the outpatient setting. Interventions None. Measurements and main results The final sample included a total of 22,385 patients, with 2,621 (11.7%) in the opioid group and 19,764 (88.3%) in the control group. After proceeding with bivariate analyses, statistically significant and clinically relevant differences were identified between opioid and non-opioid users in sex, length of hospital stay, and comorbidities. Opioid use was associated with increased mortality in both the 30-day and 1-year windows with a respective odds ratios of 1.81 (95% CI, 1.63–2.01; p<0.001) and 1.88 (95% CI, 1.77–1.99; p<0.001), respectively. Conclusions Chronic opioid usage was associated with increased hospital length of stay and increased mortality at both 30 days and 1 year after ICU admission. Knowledge of this will help providers make better choices in patient care and have a more informed risk-benefits discussion when prescribing opioids for chronic usage.

scholarly journals MP38: The impact of physician handoffs on the outcomes of emergency department patients: a medical administrative database retrospective cohort study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S56-S56
Author(s):  
A. Mokhtari ◽  
D. Simonyan ◽  
A. Pineault ◽  
M. Mallet ◽  
S. Blais ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Physician ◽  
Retrospective Cohort ◽  
Independent Predictor ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Emergency Physicians ◽  
Icu Admission ◽  
The Impact

Introduction: A physician handoff is the process through which physicians transfer the primary responsibility of a care unit. The emergency department (ED) is a fast-paced and crowded environment where the risk of information loss between shifts is significant. Yet, the impact of handoffs between emergency physicians on patient outcomes remains understudied. We performed a retrospective cohort study in the ED to determine if handed-off patients, when compared to non-handed-off patients, were at higher risk of negative outcomes. Methods: We included every adult patient first assessed by an emergency physician and subsequently admitted to hospital in one of the five sites of the CHU de Québec-Université Laval during fiscal year 2016-17. Data were extracted from the local hospital discharge database and the ED information system. Primary outcome was mortality. Secondary outcomes were incidence of ICU admission and surgery and hospital length of stay. We conducted multilevel multivariate regression analyses, accounting for patient and hospital clusters and adjusting for demographics, CTAS score, comorbidities, admitting department delay before evaluation by an emergency physician and by another specialty, emergency department crowding, initial ED orientation and handoff timing. We conducted sensitivity analyses excluding patients that had an ED length of stay > 24 hours or events that happened after 72 hours of hospitalization. Results: 21,136 ED visits and 17,150 unique individuals were included in the study. Median[Q1-Q3] age, Charlson index score, door-to-emergency-physician time and ED length of stay were 71[55-83] years old, 3[1-4], 48 [24,90] minutes, 20.8[9.9,32.7] hours, respectively. In multilevel multivariate analysis (OR handoff/no handoff [CI95%] or GMR[SE]), handoff status was not associated with mortality 0.89[0.77,1.02], surgery 0.95[0.85,1.07] or hospital length of stay (-0.02[0.03]). Non-handed-off patients had an increased risk of ICU admission (0.75[0.64,0.87]). ED occupancy rate was an independent predictor of mortality and ICU admission rate irrespectively of handoff status. Sensitivity and sub-group based analyses yielded no further information. Conclusion: Emergency physicians’ handoffs do not seem to increase the risk of severe in-hospital adverse events. ED occupancy rate is an independent predictor of mortality. Further studies are needed to explore the impact of ED handoffs on adverse events of low and moderate severity.

scholarly journals Compliance with American College of Chest Physicians (ACCP) recommendations for thromboembolic prophylaxis in the intensive care unit: a level I trauma center experience

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael J. Waxman ◽  
Daniel Griffin ◽  
Erica Sercy ◽  
David Bar-Or
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Study Groups ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Thromboembolic Prophylaxis ◽  
Vte Prophylaxis ◽  
Icu Admission ◽  
Trauma Service ◽  
Pharmacologic Prophylaxis

Abstract Background Recommendations are for nearly universal venous thromboembolism (VTE) prophylaxis in critically ill hospitalized patients because of their well-recognized risks. In those intensive care units (ICUs) where patient care is more uniformly directed, it may be expected that VTE prophylaxis would more closely follow this standard over units that are less uniform, such as open-model ICUs. Methods This was a retrospective cohort study on all patients aged 18+ admitted to an open ICU between 6/1/2017 and 5/31/2018. Patients were excluded if they had instructions to receive comfort measures only or required therapeutic anticoagulant administration. Prophylaxis administration practices, including administration of mechanical and/or pharmacologic prophylaxis and delayed (≥48 h post-ICU admission) initiation of pharmacologic prophylaxis, were compared between patients admitted to the ICU by the trauma service versus other departments. Root causes for opting out of pharmacological prophylaxis were documented and compared between the two study groups. Results One-hundred two study participants were admitted by the trauma service, and 98 were from a non-trauma service. Mechanical (98% trauma vs. 99% non-trauma, P = 0.99) and pharmacologic (54% vs. 44%, P = 0.16) prophylaxis rates were similar between the two admission groups. The median time from ICU admission to pharmacologic prophylaxis initiation was 53 h for the trauma service and 10 h for the non–trauma services (P ≤ 0.01). In regression analyses, trauma-service admission (odds ratio (OR) = 2.88, 95% confidence interval (CI) 1.21–6.83) and increasing ICU length of stay (OR = 1.13, 95% CI 1.05–1.21) were independently associated with pharmacologic prophylaxis use. Trauma-service admission (OR = 8.30, 95% CI 2.18–31.56) and increasing hospital length of stay (OR = 1.15, 95% CI 1.03–1.28) were independently associated with delayed prophylaxis initiation. Conclusions Overall, the receipt of VTE prophylaxis of any type was close to 100%, due to the nearly universal use of mechanical compression devices among ICU patients in this study. However, when examining pharmacologic prophylaxis specifically, the rate was considerably lower than is currently recommended: 54% among the trauma services and 44% among non-trauma services.

scholarly journals Effect of length time to surgery on postoperative hospital length of stay among neurosurgical patients

2020 ◽  
Vol 11 ◽  
pp. 144
Author(s):  
Yahya H. Khormi ◽  
Andrew Nataraj
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Outcome Variable ◽  
University Of Alberta ◽  
Postoperative Stay ◽  
Urgent Surgery ◽  
Neurosurgical Patients ◽  
Before And After ◽  
The Mean

Background: In most hospitals, inpatient urgent surgery is triaged based on the degree of urgency and time of surgical booking. A longer wait for semi-urgent surgery due to sharing resources between specialties might impact the postoperative course. The objective of this study is to determine the effect of length time to semi- urgent surgery on postoperative hospital length of stay among neurosurgical patients. Methods: A retrospective cohort study was conducted included all admitted adult patients placed on semi-urgent University of Alberta Hospital surgical list between 2008 and 2013. Linear and logistic regression analyses were performed. The main exposure variable was time from surgical booking to the time of surgery, and the outcome variable was time from surgery to discharge. Results: A total of 1367 neurosurgical cases were included in the study. The mean age was 54.3 years. The mean length of time in the hospital before and after surgery was 1.2 and 12.5 days, respectively. Overall, the time from booking to surgery did not affect the time from surgery to discharge. Increased age, higher ASA score, and surgeries performed after 24 h from booking in the group of patients who were discharged to another facility were associated with a longer postoperative stay. Conclusion: Neurosurgery patients booked for surgery to be done within 24 h waited longer to have their procedure completed. Overall, there was no significant association between length of time waiting for surgery and postoperative stay, although there was an increase in postoperative stays among patients who were discharged to another facility and had their surgeries performed after 24 h.

scholarly journals Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress

2021 ◽  
Vol 22 (4) ◽  
pp. 979-987
Author(s):  
Zachary Jarou ◽  
David Beiser ◽  
Willard Sharp ◽  
Ravi Ravi Chacko ◽  
Deirdre Goode ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Respiratory Distress ◽  
Hospital Length ◽  
High Flow ◽  
Nasal Cannula ◽  
Hospital Length Of Stay ◽  
High Flow Nasal Cannula ◽  
Before And After ◽  
Progressive Respiratory Failure

Introduction: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay. Methods: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol. Results: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts. Conclusions: The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19

scholarly journals Evaluation of the Initial General Ward Early Warning Score and ICU Admission, Hospital Length of Stay and Mortality

2021 ◽  
Vol 22 (5) ◽  
pp. 1132-1138
Author(s):  
Anneke Gielen ◽  
Kristine Koekkoek ◽  
Marijke van der Steen ◽  
Martijn-Looijen Looijen ◽  
Arthur van Zanten
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
General Hospital ◽  
Early Warning ◽  
Hospital Length ◽  
Hospital Ward ◽  
Hospital Length Of Stay ◽  
Early Warning Score ◽  
Icu Admission

Introduction: Despite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown. We aimed to evaluate associations between the initial EWS and in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS). Methods: We performed a retrospective cohort study of adult patients admitted to a general hospital ward between July 1, 2014–December 31, 2017. Data were obtained from electronic health records (EHR). The primary outcome was in-hospital mortality. Secondary outcomes were ICU admission and hospital LOS. We categorized patients into three risk groups (low, medium or high risk of clinical deterioration) based on EWS. Descriptive analyses were used. Results: After applying inclusion and exclusion criteria, we included 53,180 patients for analysis. We found that the initial (low- vs high-risk) EWS was associated with an increased in-hospital mortality (1.5% vs 25.3%, P <0.001), an increased ICU admission rate (3.1% vs 17.6%, P <0.001), and an extended hospital LOS (4.0 days vs 8.0 days, P <0.001). Conclusion: Our findings suggest that an initial high-risk EWS in patients admitted to a general hospital ward was associated with an increased risk of in-hospital mortality, ICU admission, and prolonged hospital LOS. Close monitoring and precise documentation of the EWS in the EHR may facilitate predicting poor outcomes in individual hospitalized patients and help to identify patients for whom timely and adequate management may improve outcomes.

Prevalence, Risk Factors, and Clinical Consequences of Recurrent Activation of a Rapid Response Team: A Multicenter Observational Study

2018 ◽  
Vol 34 (10) ◽  
pp. 782-789 ◽  
Author(s):  
Shannon M. Fernando ◽  
Peter M. Reardon ◽  
Damon C. Scales ◽  
Kyle Murphy ◽  
Peter Tanuseputro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Health Care Providers ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
Care Providers ◽  
Term Care ◽  
Home Setting

Introduction: Rapid response teams (RRTs) are groups of health-care providers, implemented by hospitals to respond to distressed hospitalized patients on the hospital wards. Patients assessed by the RRT for deterioration may be admitted to the intensive care unit (ICU) or may be triaged to remain on the wards, putting them at risk of recurrent deterioration and repeat RRT activation. Previous studies evaluating outcomes of patients with recurrent deterioration and multiple RRT activations have produced conflicting results. Methods: We used a prospectively collected multicenter registry from 2 hospitals within a single tertiary-level hospital system between 2012 and 2016. Comparisons were made between patients with a single RRT activation and those with multiple RRT activations over the course of their admission. Primary outcome was in-hospital mortality, which was analyzed using multivariable logistic regression. Results: A total of 5995 patients who had any RRT activation were analyzed. Of that, 1183 (19.7%) patients had recurrent deterioration and multiple RRT activations during their admission. Risk factors for recurrent deterioration included admission from a home setting (as opposed to a long-term care facility), RRT activation during nighttime hours, and delay (>1 hour) to RRT activation. Recurrent deterioration was associated with increased odds of mortality (adjusted odds ratio [OR]: 1.44 [1.28-1.64], P = <.001). Increasing number of RRT activations were associated with increasing risk of mortality. Patients with recurrent deterioration had prolonged median hospital length of stay (21.0 days vs 12.0 days, P < .001), while patients with only a single activation were more likely to be admitted to the ICU (adjusted OR: 2.30 [1.96-2.70], P < .001). Conclusions: Recurrent deteriorations leading to RRT activations among hospitalized patients are associated with increased odds of mortality and prolonged hospital length of stay. This work identifies a group of patients who warrant closer attention to help reduce adverse outcomes.

scholarly journals Mortality and Length of Stay Trends Following Implementation of a Rapid Response System and Real-Time Automated Clinical Deterioration Alerts

2016 ◽  
Vol 32 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Marin H. Kollef ◽  
Kevin Heard ◽  
Yixin Chen ◽  
Chenyang Lu ◽  
Nelda Martin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Real Time ◽  
General Medicine ◽  
Hospital Length ◽  
Rapid Response ◽  
Clinical Deterioration ◽  
Hospital Length Of Stay ◽  
Rapid Response System ◽  
Response System ◽  
Lengths Of Stay

A study was performed to determine the potential influence of a rapid response system (RRS) employing real-time clinical deterioration alerts (RTCDAs) on patient outcomes involving 8 general medicine units. Introduction of the RRS occurred in 2006 with staged addition of the RTCDAs in 2009. Statistically significant year-to-year decreases in mortality were observed through 2014 ( r = −.794; P = .002). Similarly, year-to-year decreases in the number of cardiopulmonary arrests (CPAs; r = −.792; P = .006) and median lengths of stay ( r = −.841; P = .001) were observed. There was a statistically significant year-to-year increase in the number of RRS activations for these units ( r = .939; P < .001) that was inversely correlated with the occurrence of CPAs ( r = −.784; P = .007). In this single-institution retrospective study, introduction of a RRS employing RTCDAs was associated with lower hospital mortality, CPAs, and hospital length of stay.

98 The Epidemiology of Acute Stress Disorder Among Inpatient Adult Patients with Burn Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S67-S67
Author(s):  
Daniel M Schneider ◽  
John W Keyloun ◽  
Taryn E Travis ◽  
Laura S Johnson ◽  
Shawn Tejiram ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Stress Disorder ◽  
Acute Stress ◽  
Burn Injury ◽  
Hospital Length ◽  
Operative Intervention ◽  
Hospital Length Of Stay ◽  
Icu Admission ◽  
Injury Characteristic ◽  
Injured Patients

Abstract Introduction Burn injured patients are at high risk for developing Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) following injury. ASD itself is a reliable predictor for the development of PTSD, which usually persists once established. Injury-related characteristics in burn patients (TBSA and anatomic location of burn) do not predict the development of psychological trauma. There is a paucity of literature examining acute psychosocial evaluations of patients with burn injury to address the need for early interventions. Behavioral health assessment and treatment in burn centers may foster improved detection and management of ASD among a variety of other mental health conditions. The goal of this study is to investigate the demographic and injury characteristics associated with new ASD diagnoses in a cohort of inpatient burn survivors. Methods Burn injured patients who were admitted to a regional burn center between June 2019 and June 2020 and referred for burn psychology evaluation were retrospectively reviewed. Minors, non-burn injured patients, and those with incomplete evaluations were excluded. Demographic, injury characteristic, health history, and psychologic evaluation results were collected from the medical record. ASD diagnosis was defined by criteria outlined in the PTSD Checklist for DSM-5 (PCL-5). Demographic and injury characteristic were compared between patients with and without ASD diagnoses. Statistical analysis was performed with Mann-Whitney, Chi-square, and Fisher’s Exact test as appropriate. Significance was set at a p=0.05. Results Fifty-two patients with median age of 49.5 (IQR, 29–62) years and median TBSA of 6 (2.8–14.4) % met inclusion criteria. Of these, 11 (21%) patients were diagnosed with ASD. Patients with ASD were more often female, (73% vs. 29%, p=0.01), younger (38.5 years vs. 46 years, p=0.05), involved in a structural fire (45.5% vs. 10%, p=0.01), and employed at the time of injury (63% vs. 14.6%, p=0.002). There were no significant differences between groups in TBSA, hospital length of stay, ICU admission, or proportion of patients requiring operative intervention. Among patients who required operative intervention, those in the ASD group underwent fewer total procedures (1 vs. 4, p=0.05). Conclusions Patients who developed ASD were younger, more likely female, more often involved in structural fires, and employed. Markers of injury severity such as TBSA, need for operative intervention, ICU admission and hospital length of stay were not associated with the development of ASD.

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