scholarly journals Joint management format at the mixed-surgical intermediate care unit: an interrupted time series analysis

2018 ◽  
Vol 3 (1) ◽  
pp. e000177 ◽  
Author(s):  
Joost D J Plate ◽  
Linda M Peelen ◽  
Luke P H Leenen ◽  
R Marijn Houwert ◽  
Falco Hietbrink
Keyword(s):  
Time Series ◽  
Critical Care ◽  
Interrupted Time Series ◽  
Utilization Efficiency ◽  
Complex Case ◽  
Intermediate Care ◽  
Level Of Evidence ◽  
Case Load ◽  
Joint Management ◽  
Intermediate Care Unit

BackgroundThe management format of the mixed-surgical intermediate care unit (IMCU) affects its performance. A format of combined supervision of surgeons with additional critical care certifications and admitting specialists, named the “joint format”, may herein be a promising new model of specialized critical care. This study aims to assess the performance of the joint management format.MethodsThis observational cohort study compared three IMCU management formats at the stand-alone, mixed-surgical IMCU of a tertiary referral hospital using interrupted time series analyses. All admissions from 2001 until 2015 were included. Predetermined criteria for performance (utilization, efficiency, and safety) were applied to three different management format periods: open (2001–2006), closed (2006–2011), and joint (2011–2015) formats.ResultsA total of 8894 admissions were analyzed. In terms of case load (utilization), there was an overall increase in the number of surgical patients (0.25%/year) (p<0.001), age (0.38/year) (p<0.001), and readmissions from the ward (0.16%/year) (p<0.001) and from the intensive care unit (ICU) (0.17%/year) (p=0.014). In terms of efficiency, the admission duration decreased (1.58 hours/year) (p<0.001). Transfer to the ICU within 24  hours, readmission within 24  hours from the ward, and unplanned mortality (eg, safety) did not change over time.DiscussionAt a time of increasingly complex case load, the joint format at the mixed-surgical IMCU is an efficient and safe management format in which the admitting specialist continues to provide specialized care. Specialty-specific supervision at IMCUs is a safe option which should be considered in healthcare policy decisions.Level of evidenceLevel IV.

scholarly journals Impact of staffing a surgical intermediate care unit with a critical care specialist

2019 ◽  
Author(s):  
Graldine Paratte ◽  
Tobias Zingg ◽  
Valrie Addor ◽  
Hlne Krief ◽  
Markus Schfer ◽  
...  
Keyword(s):  
Critical Care ◽  
Intermediate Care ◽  
Intermediate Care Unit ◽  
Care Specialist

scholarly journals The impact of the introduction of critical care outreach services in England: a multicentre interrupted time-series analysis

Critical Care ◽  
2007 ◽  
Vol 11 (5) ◽  
pp. R113 ◽  
Author(s):  
Haiyan Gao ◽  
David A Harrison ◽  
Gareth J Parry ◽  
Kathleen Daly ◽  
Christian P Subbe ◽  
...  
Keyword(s):  
Time Series ◽  
Critical Care ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Outreach Services ◽  
The Impact ◽  
Critical Care Outreach

Decreased Resistance of Pseudomonas aeruginosa with Restriction of Ciprofloxacin in a Large Teaching Hospital's Intensive Care and Intermediate Care Units

2012 ◽  
Vol 33 (4) ◽  
pp. 368-373 ◽  
Author(s):  
G. Jonathan Lewis ◽  
Xiangming Fang ◽  
Michael Gooch ◽  
Paul P. Cook
Keyword(s):  
Time Series ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Tertiary Care ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Intermediate Care ◽  
Interrupted Time Series Analysis ◽  
Gram Negative

Objective.To examine the effect of restricting ciprofloxacin on the resistance of nosocomial gram-negative bacilli, including Pseudomonas aeruginosa, to antipseudomonal carbapenems.Design.Interrupted time-series analysis.Setting.Tertiary care teaching hospital with 11 intensive care and intermediate care units with a total of 295 beds.Patients.All nosocomial isolates of P. aeruginosa.Intervention.Restriction of ciprofloxacin.Results.There was a significant decreasing trend observed in the percentage (P = .0351) and the rate (P = .0006) of isolates of P. aeruginosa that were resistant to antipseudomonal carbapenems following the restriction of ciprofloxacin. There was also a significant decreasing trend observed in the percentage (P = .0017) and the rate (P = .0001) of isolates of ciprofloxacin-resistant P. aeruginosa. The rate of cefepime-resistant P. aeruginosa isolates declined (P = .004 ) but the percentage of cefepime-resistant P. aeruginosa isolates did not change. There were no significant changes observed in the rate or the percentage of piperacillin-tazobactam-resistant P. aeruginosa isolates. There were no significant changes observed in the susceptibilities of nosocomial Enterobacteriaciae or Acinetobacter baumannii isolates that were resistant to carbapenems. Over the study period there was a significant increase in the use of carbapenems (P = .0134); the use of ciprofloxacin decreased significantly (P = .0027). There were no significant changes in the use of piperacillin-tazobactam or cefepime.Conclusion.Restriction of ciprofloxacin was associated with a decreased resistance of P. aeruginosa isolates to antipseudomonal carbapenems and ciprofloxacin in our hospital's intermediate care and intensive care units. There were no changes observed in the susceptibilities of nosocomial Enterobacteriaciae or A. baumannii to carbapenems, despite increased carbapenem use. Reducing ciprofloxacin use may be a means of controlling multidrug-resistant P. aeruginosa.

scholarly journals Impact of ICD-9-CM to ICD-10-CM coding transition on trauma hospitalization trends among young adults in 12 states

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yuri V. Sebastião ◽  
Gregory A. Metzger ◽  
Deena J. Chisolm ◽  
Henry Xiang ◽  
Jennifer N. Cooper
Keyword(s):  
Time Series ◽  
Young Adults ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Interrupted Time Series ◽  
Positive Trend ◽  
Level Of Evidence ◽  
Severity Of Injury ◽  
Icd 10 ◽  
The Impact

Abstract Background We aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S. states. Methods Interrupted time series analyses were conducted using statewide inpatient databases from 12 states and including traumatic injury-related hospitalizations in adults aged 19–44 years in 2011–2017. Segmented regression models were used to estimate the impact of the October 2015 coding transition on external cause of injury (ECOI) completeness (percentage of hospitalizations with a documented ECOI code) and on population-level rates of injury-related hospitalizations by nature, intent, mechanism, and severity of injury. Results The transition to ICD-10-CM was associated with a drop in ECOI completion in the transition month (− 3.7%; P < .0001), but there was no significant change in the positive trend in ECOI completion from the pre- to post-transition periods. There were significant increases post-transition in the measured rates of hospitalization for traumatic brain injury (TBI), unintentional injury, mild injury (injury severity score (ISS) < 9), and injuries caused by drowning, firearms, machinery, other pedestrian, suffocation, and unspecified mechanism. Conversely, there were significant decreases in October 2015 in the rates of hospitalization for assault, injuries of undetermined intent, injuries of moderate severity (ISS 9–15), and injuries caused by fire/burn, other pedal cyclist, other transportation, natural/environmental, and other specified mechanism. A significant increase in the percentage of hospitalizations classified as resulting from severe injury (ISS > 15) was observed when the general equivalence mapping maximum severity method for converting ICD-10-CM codes to ICD-9-CM codes was used. State-specific results for the outcomes of ECOI completion and TBI-related hospitalization rates are provided in an online supplement. Conclusions The U.S. transition from ICD-9-CM to ICD-10-CM coding led to a significant decrease in ECOI completion and several significant changes in measured rates of injury-related hospitalizations by injury intent, mechanism, nature, and severity. The results of this study can inform the design and analysis of future traumatic injury-related health services research studies that use both ICD-9-CM and ICD-10-CM coded data. Level of evidence II (Interrupted Time Series)

Audit and Feedback to Reduce Broad-Spectrum Antibiotic Use among Intensive Care Unit Patients A Controlled Interrupted Time Series Analysis

2012 ◽  
Vol 33 (4) ◽  
pp. 354-361 ◽  
Author(s):  
Marion Elligsen ◽  
Sandra A. N. Walker ◽  
Ruxandra Pinto ◽  
Andrew Simor ◽  
Samira Mubareka ◽  
...  
Keyword(s):  
Time Series ◽  
Critical Care ◽  
Intensive Care ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Broad Spectrum Antibiotic ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

Objective.We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients.Design.Prospective, controlled interrupted time series.SettingSingle tertiary care center with 3 intensive care units.Patients and Interventions.A formal review of all critical care patients on their third or tenth day of broad-spectrum antibiotic therapy was conducted, and suggestions for antimicrobial optimization were communicated to the critical care team.Outcomes.The primary outcome was broad-spectrum antibiotic use (days of therapy per 1000 patient-days; secondary outcomes included overall antibiotic use, gram-negative bacterial susceptibility, nosocomial Clostridium difficile infections, length of stay, and mortality.Results.The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000 patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the postintervention period (P < .0001); time series modeling confirmed an immediate decrease (± standard error) of 119 ± 37.9 days of therapy per 1,000 patient-days (P = .0054). In contrast, no changes were identified in the use of broad-spectrum antibiotics in the control group (nonintervention medical and surgical wards) or in the use of control medications in critical care (stress ulcer prophylaxis). The incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units, whereas the incidence increased from 87 to 116 cases in the control wards (P = .04). Overall gram-negative susceptibility to meropenem increased in the critical care units. Intensive care unit length of stay and mortality did not change.Conclusions.Institution of a formal prospective audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care.

scholarly journals Effect of Information Disclosure Policy on Control of Infectious Disease: MERS-CoV Outbreak in South Korea

2020 ◽  
Vol 17 (1) ◽  
pp. 305 ◽  
Author(s):  
Jin-Won Noh ◽  
Ki-Bong Yoo ◽  
Young Kwon ◽  
Jin Hong ◽  
Yejin Lee ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Time Series ◽  
Critical Care ◽  
Middle East ◽  
South Korea ◽  
Information Disclosure ◽  
Interrupted Time Series ◽  
Middle East Respiratory Syndrome ◽  
Korean Ministry ◽  
Care Response

This study examined the effect of disclosing a list of hospitals with Middle East respiratory syndrome coronavirus (MERS-CoV) patients on the number of laboratory-confirmed MERS-CoV cases in South Korea. MERS-CoV data from 20 May 2015 to 5 July 2015 were from the Korean Ministry of Health & Welfare website and analyzed using segmented linear autoregressive error models for interrupted time series. This study showed that the number of laboratory-confirmed cases was increased by 9.632 on 5 June (p < 0.001). However, this number was significantly decreased following disclosure of a list of hospitals with MERS-CoV cases (Estimate = −0.699; p < 0.001). Disclosing the list of hospitals exposed to MERS-CoV was critical to the prevention of further infection. It reduced the number of confirmed MERS-CoV cases. Thus, providing accurate and timely information is a key to critical care response.

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