scholarly journals Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e024548 ◽  
Author(s):  
Oscar J L Mitchell ◽  
Caroline W Motschwiller ◽  
James M Horowitz ◽  
Laura E Evans ◽  
Vikramjit Mukherjee
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Acute Care ◽  
Rhode Island ◽  
Acute Care Hospitals ◽  
Rapid Response ◽  
Early Warning Score ◽  
North Eastern ◽  
The Usa ◽  
Activation Criteria

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.

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

2021 ◽  
Vol 3 (7) ◽  
pp. e0468
Author(s):  
Uchenna R. Ofoma ◽  
Thomas M. Maddox ◽  
Chamila Perera ◽  
R. J. Waken ◽  
Anne M. Drewry ◽  
...  
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Acute Care Hospitals

scholarly journals Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

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.

scholarly journals 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

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.

Burden of Hospital-Onset Clostridium difficile Infection in Patients Discharged from Rhode Island Hospitals, 2010–2011: Application of Present on Admission Indicators

2013 ◽  
Vol 34 (7) ◽  
pp. 700-708 ◽  
Author(s):  
Yongwen Jiang ◽  
Samara Viner-Brown ◽  
Rosa Baier
Keyword(s):  
Clostridium Difficile ◽  
Hospital Discharge ◽  
Acute Care ◽  
Rhode Island ◽  
Clinical Characteristics ◽  
Acute Care Hospitals ◽  
Hospital Discharge Database ◽  
Discharged Patients ◽  
Present On Admission ◽  
Discharge Database

Objective.The year 2010 is the first time that the Rhode Island hospital discharge database included present on admission (POA) indicators, which give us the opportunity to distinguish cases of hospital-onset Clostridium difficile infection (CDI) from cases of community-onset CDI and to assess the burden of hospital-onset CDI in patients discharged from Rhode Island hospitals during 2010 and 2011.Design.Observational study.Patients.Patients 18 years of age or older discharged from one of Rhode Island's 11 acute-care hospitals between January 1, 2010, and December 31, 2011.Methods.Using the newly available POA indicators in the Rhode Island 2010 and 2011 hospital discharge database, we identified patients with hospital-onset CDI and without CDI. Adjusting for patient demographic and clinical characteristics using propensity score matching, we measured between-group differences in mortality, length of stay, and cost for patients with hospital-onset CDI and without CDI.Results.In 2010 and 2011, the 11 acute-care hospitals in Rhode Island had 225,999 discharges. Of 4,531 discharged patients with CDI (2.0% of all discharges), 1,211 (26.7%) had hospital-onset CDI. After adjusting for patient demographic and clinical characteristics, discharged patients with hospital-onset CDI were found to have higher mortality rates, longer lengths of stay, and higher costs than those without CDI.Conclusions.Our results highlight the burden of hospital-onset CDI in Rhode Island. These findings emphasize the need to track longitudinal trends to tailor and target population-health and quality-improvement initiatives.

scholarly journals Healthcare Providers' Perception of Advance Care Plans for Patients with Critical Illnesses in Acute-Care Hospitals: A Cross-Sectional Study

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.

scholarly journals Reduction of in-hospital cardiac arrest with sequential deployment of rapid response team and medical emergency team to the emergency department and acute care wards

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0241816
Author(s):  
Babith Mankidy ◽  
Christopher Howard ◽  
Christopher K. Morgan ◽  
Kartik A. Valluri ◽  
Bria Giacomino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Acute Care ◽  
Medical Emergency Team ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Arrest Rates ◽  
Emergency Team ◽  
Response Team

Purpose This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates. Methods In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team. Results Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED. Conclusion Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.

Development of A Pharmaceutical Early Warning Scoring Model for Cardiac Arrest Using Deep Learning: Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Hsiao-Ko Chang ◽  
Hui-Chih Wang ◽  
Chih-Fen Huang ◽  
Feipei Lai
Keyword(s):  
Time Series ◽  
Cardiac Arrest ◽  
Early Warning ◽  
Time Series Data ◽  
Predictive Accuracy ◽  
Vital Signs ◽  
Sliding Window ◽  
Early Warning Score ◽  
Series Data ◽  
Dynamic Time

BACKGROUND In most of Taiwan’s medical institutions, congestion is a serious problem for emergency departments. Due to a lack of beds, patients spend more time in emergency retention zones, which make it difficult to detect cardiac arrest (CA). OBJECTIVE We seek to develop a pharmaceutical early warning model to predict cardiac arrest in emergency departments via drug classification and medical expert suggestion. METHODS We propose a new early warning score model for detecting cardiac arrest via pharmaceutical classification and by using a sliding window; we apply learning-based algorithms to time-series data for a Pharmaceutical Early Warning Scoring Model (PEWSM). By treating pharmaceutical features as a dynamic time-series factor for cardiopulmonary resuscitation (CPR) patients, we increase sensitivity, reduce false alarm rates and mortality, and increase the model’s accuracy. To evaluate the proposed model we use the area under the receiver operating characteristic curve (AUROC). RESULTS Four important findings are as follows: (1) We identify the most important drug predictors: bits, and replenishers and regulators of water and electrolytes. The best AUROC of bits is 85%; that of replenishers and regulators of water and electrolytes is 86%. These two features are the most influential of the drug features in the task. (2) We verify feature selection, in which accounting for drugs improve the accuracy: In Task 1, the best AUROC of vital signs is 77%, and that of all features is 86%. In Task 2, the best AUROC of all features is 85%, which demonstrates that thus accounting for the drugs significantly affects prediction. (3) We use a better model: For traditional machine learning, this study adds a new AI technology: the long short-term memory (LSTM) model with the best time-series accuracy, comparable to the traditional random forest (RF) model; the two AUROC measures are 85%. (4) We determine whether the event can be predicted beforehand: The best classifier is still an RF model, in which the observational starting time is 4 hours before the CPR event. Although the accuracy is impaired, the predictive accuracy still reaches 70%. Therefore, we believe that CPR events can be predicted four hours before the event. CONCLUSIONS This paper uses a sliding window to account for dynamic time-series data consisting of the patient’s vital signs and drug injections. In a comparison with NEWS, we improve predictive accuracy via feature selection, which includes drugs as features. In addition, LSTM yields better performance with time-series data. The proposed PEWSM, which offers 4-hour predictions, is better than the National Early Warning Score (NEWS) in the literature. This also confirms that the doctor’s heuristic rules are consistent with the results found by machine learning algorithms.

Physical restraint to patients with dementia in acute physical care settings: effect of the financial incentive to acute care hospitals

2017 ◽  
Vol 30 (7) ◽  
pp. 991-1000 ◽  
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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