scholarly journals Assessment of the intermediate care unit triage system

2018 ◽  
Vol 3 (1) ◽  
pp. e000178 ◽  
Author(s):  
Joost D J Plate ◽  
Linda M Peelen ◽  
Luke P H Leenen ◽  
R Marijn Houwert ◽  
Falco Hietbrink
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
Nursing Care ◽  
Therapeutic Intervention ◽  
General Ward ◽  
Intermediate Care ◽  
Therapeutic Intervention Scoring System ◽  
Level Of Evidence ◽  
Triage System ◽  
Over Time

BackgroundAn important critique with respect to the utilization of intermediate care units (IMCU) is that they potentially admit patients who would otherwise be cared for on the regular ward. This would lead to an undesired waste of critical care resources. This article aims to (1) describe the caseload at the IMCU and (2) to assess the triage system at the IMCU to determine potentially unnecessary admissions.MethodsThis cohort study included all admissions at the mixed-surgical IMCU from 2001 to 2015. The Therapeutic Intervention Scoring System-28 (TISS-28) was prospectively collected for all admissions to describe the caseload at the IMCU and to identify medical criteria for admission. These were combined with logistical criteria to assess the IMCU triage system.ResultsA total of 8816 admissions were included in the study. The average TISS-28 was 20.19 (95% CI 18.05 to 22.33), corresponding with 3.57 (95% CI 3.19 to 3.94) hours of direct patient-related work per patient per nursing shift. Over time, this increased by an average of 0.27 points/year (p<0.001). Of all admissions, 6539 (74.2%) were medically considered to be justly admitted, and 7093 (80.4%) were logistically considered to be justly admitted. With these criteria combined, a total of 8324 (94.4%) were correctly admitted.DiscussionMost admissions to the IMCU are medically and/or logistically necessary, as the majority of admitted patients demand a higher level of nursing care than available on the general ward. Continuous triage is thereby essential. These findings support further utilization of the IMCU in our current healthcare system and has important implications for IMCU-related management decisions.Level of evidenceLevel VI.

scholarly journals Surge Effects and Survival to Hospital Discharge in Critical Care Patients with COVID-19 During the Early Pandemic: A Cohort Study

2020 ◽  
Author(s):  
Christopher Dale ◽  
Rachael Starcher ◽  
Shu Ching Chang ◽  
Ari Robicsek ◽  
Guilford Parsons ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Hospital Discharge ◽  
Hospital Capacity ◽  
Multivariable Logistic Regression ◽  
Critical Care Patients ◽  
Over Time

Abstract BackgroundThe early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first three months of the pandemic and the presence of any surge effects on patient outcomes.MethodsRetrospective cohort study with electronic medical record data of all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020 to May 15, 2020 admitted to intensive care units of 26 hospitals of an integrated delivery system in the Western United States. Patient demographic, comorbidity and severity of illness were measured along with exposure to pharmacologic and medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess the change in survival to hospital discharge over time during the study period.ResultsOf 620 patients with COVID-19 admitted to the study ICUs (mean age 63.5 years (SD 15.7) and 69% male), 403 (65%) survived to hospital discharge and 217 (35%) died in hospital. Survival to hospital discharge increased over the study period from 60.0% in the first two weeks of patient admission to 67.6% in the last two weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (bi-weekly change, adjusted odds ratio [aOR] 1.22, 95%CI 1.04-1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and COVID positive/PUI percent hospital capacity, and the same set of covariates, the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (bi-weekly change, aOR 1.18, 95% CI 1.00 to 1.38, P = 0.04) and a greater COVID positive/PUI percentage of hospital capacity remained significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92 to 0.98, P < 0.01).ConclusionsDuring the the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. This may have been partially explained by surge affects, as measured by a greater COVID positive/PUI percentage of hospital capacity.

scholarly journals Surge Effects and Survival to Hospital Discharge in Critical Care Patients with COVID-19 During the Early Pandemic: A Cohort Study

2021 ◽  
Author(s):  
Christopher Dale ◽  
Rachael Starcher ◽  
Shu Ching Chang ◽  
Ari Robicsek ◽  
Guilford Parsons ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Multivariable Logistic Regression Analysis ◽  
Hospital Capacity ◽  
Multivariable Logistic Regression ◽  
Critical Care Patients ◽  
Over Time

Abstract BackgroundThe early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first three months of the pandemic and the presence of any surge effects on patient outcomes.MethodsRetrospective cohort study using electronic medical record data for all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020 to May 15, 2020 at one of 26 hospitals within an integrated delivery system in the Western United States. Patient demographics, comorbidities and severity of illness were measured along with medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess temporal changes in survival to hospital discharge during the study period.ResultsOf 620 patients with COVID-19 admitted to the ICU (mean age 63.5 years (SD 15.7) and 69% male), 403 (65%) survived to hospital discharge and 217 (35%) died in the hospital. Survival to hospital discharge increased over time, from 60.0% in the first two weeks of the study period to 67.6% in the last two weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (bi-weekly change, adjusted odds ratio [aOR] 1.22, 95%CI 1.04-1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and percent hospital capacity by COVID-19 positive individuals and persons under investigation (PUI), the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (bi-weekly change, aOR 1.18, 95% CI 1.00 to 1.38, P = 0.04). The presence of greater rates of COVID-19 positive/PUI as a percentage of hospital capacity was, however, significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92 to 0.98, P < 0.01). ConclusionsDuring the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. An association was also seen between a greater COVID-19 positive/PUI percentage of hospital capacity and a lower survival rate to hospital discharge.

scholarly journals Complicações relacionadas à oxigenação por membrana extracorpórea

2018 ◽  
Vol 12 (6) ◽  
pp. 1727 ◽  
Author(s):  
Gislaine Rodrigues Nakasato ◽  
Juliana Lima Lopes ◽  
Camila Takao Lopes
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Nursing Care ◽  
Critical Care Nursing ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Membrane Oxygenation ◽  
Renal Vascular ◽  
Care Nursing ◽  
Length Of Hospitalization

RESUMOObjetivo: identificar na literatura as complicações associadas à oxigenação por membrana extracorpórea (ECMO) em adultos. Método: estudo bibliográfico, tipo revisão integrativa de artigos publicados de 2011 a 2016 em português, inglês ou espanhol, nas bases de dados Medline e CINAHL utilizando-se termos padronizados (MeSH e títulos CINAHL). Os títulos, resumos e textos na íntegra dos artigos encontrados foram lidos para aplicação dos critérios de elegibilidade e classificação do nível de evidência. As complicações da ECMO foram agrupadas em hemorrágicas, infecciosas, renais, vasculares, mecânicas, neurológicas e outras. Resultados: foram encontrados 666 estudos, dos quais 45 foram incluídos. As principais complicações identificadas foram: as hemorrágicas, encontradas em 747 indivíduos (21,23%), seguidas das infecciosas (10,85%), renais (9,18%), vasculares (5,99%), mecânicas (4,15%) e neurológicas (3,8%) Conclusão: identificaram-se as principais complicações da ECMO em pacientes adultos. Conhecê-las subsidia o planejamento do cuidado prestado, podendo evitá-las ou diagnosticá-las precocemente, diminuindo assim, a morbimortalidade, custos e tempo de internação. Descritores: Adulto; Cardiologia; Cuidados Críticos; Cuidados de Enfermagem; Oxigenação por Membrana Extracorpórea; Pneumologia.ABSTRACTObjective: to identify the complications associated with extracorporeal membrane oxygenation (ECMO) in adults, as described in the literature. Methods: An integrative review including articles published from 2011 to 2016, in Portuguese, English or Spanish, using standardized terms (MeSH and CINAHL titles) in the Medline and CINAHL databases. The complete titles, abstracts and texts of the articles meeting eligibility criteria were read and classified, based on the level of evidence. The complications of ECMO were grouped into: hemorrhagic, infectious, renal, vascular, mechanical, neurological, and other. Results: Six hundred sixty-six studies were found, of which 45 were included. The main complications identified were: hemorrhagic, in 747 individuals (21.23%), followed by infectious (10.85%), renal (9.18%), vascular (5.99%), mechanical (15%), and neurological (3.8%). Conclusion: The main complications of ECMO in adult patients were identified. The knowledge about them supports planning of care, avoiding complications and, thus, reducing morbidity and mortality, costs, and length of hospitalization. Descriptors: Adult; Cardiology; Critical Care; Nursing care; Extracorporeal membrane oxygenation; Pneumology.RESUMENObjetivo: identificar en la literatura las complicaciones de la oxigenación de membrana extracorpórea (ECMO) en adultos. Método: estudio bibliográfico de revisión integradora con artículos publicados desde 2011 hasta 2016 en portugués, inglés o español, en MEDLINE y CINAHL utilizando términos estandarizados (MeSH y CINAHL). Se leyeron Los títulos, resúmenes y textos en su totalidad de los artículos encontrados para aplicación de los criterios de elegibilidad y clasificación del nivel de evidencia. Se agruparon las complicaciones de la ECMO en hemorrágicas, infecciosas, renales, vasculares, mecánicas, neurológicas y otras. Resultados: se encontraron 666 estudios, de los cuales se incluyeron 45. Las principales complicaciones identificadas fueron: las hemorrágicas, encontradas en 747 individuos (21,23%), seguidas de las infecciosas (10,85%), renales (9,18%), vasculares (5,99%), mecánicas (4, 15%) y neurológicas (3,8%). Conclusión: se identificaron las principales complicaciones de la ECMO en pacientes adultos. Conocerlas subsidia la planificación del cuidado prestado, pudiendo evitarlas o diagnosticarlas precozmente, disminuyendo así, la morbimortalidad, costos y tiempo de internación. Descriptores: Adulto; Cardiología; Cuidados Críticos; Atención de Enfermería; Oxigenación por Membrana Extracorpórea; Neumología.

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.

Demand for Nursing Care for Patients in Intensive Care Units in Southeast Poland

2010 ◽  
Vol 19 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Mariusz Wysokinski ◽  
Anna Ksykiewicz-Dorota ◽  
Wieslaw Fidecki
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nursing Care ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Western Europe ◽  
The United States ◽  
Therapeutic Intervention Scoring System ◽  
Night And Day

Background The Therapeutic Intervention Scoring System is widely used in both Western Europe and the United States to assess the level of patients’ need for nursing care. Poland currently has 3 types of intensive care according to a territorial division of the country and the scope of medical treatment offered: poviat, voivodeship, and clinical. Objective To determine the need for nursing care for patients in the 3 types of intensive care units in southeastern Poland. Methods The investigation was conducted at 6 intensive care units in southeastern Poland in 2005 and 2006. Two units were randomly selected from each type of intensive care unit. A total of 155 patients from the units were categorized according to scores on the Therapeutic Intervention Scoring System 28. Results Among the 3 types of units, patients varied significantly with respect to age, length of hospitalization, and scores on the Therapeutic Intervention Scoring System 28. Nevertheless, demand for nursing care during night and day shifts was similar in all 3 types. On the basis of the patients’ scores, all 3 types of units provided appropriate staffing levels necessary to meet the demands for nursing care. Most patients required category III level of care. Conclusion Need or demand for nursing care in intensive care units in Poland varies according to the type of intensive care unit and can be determined on the basis of scores on the Therapeutic Intervention Scoring System 28.

Quantifying Nursing Care in Barbiturate-Induced Coma with the Therapeutic Intervention Scoring System

1995 ◽  
Vol 27 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Geraldine L. Myles ◽  
Anne G. Perry ◽  
Marc D. Malkoff ◽  
Bobbi J. Shatto ◽  
Mary C. Scott-Killmade
Keyword(s):  
Nursing Care ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Therapeutic Intervention Scoring System

Therapeutic Intervention Scoring System used in the care of patients in pentobarbital-induced coma to determine nurse-patient ratios

1996 ◽  
Vol 5 (1) ◽  
pp. 74-79 ◽  
Author(s):  
GL Myles ◽  
MD Malkoff ◽  
AG Perry ◽  
RD Bucholz ◽  
CR Gomez
Keyword(s):  
Critical Care ◽  
Intracranial Pressure ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Therapeutic Intervention Scoring System ◽  
Increased Intracranial Pressure ◽  
Barbiturate Coma ◽  
Care Nurse ◽  
Use Of Resources ◽  
Critical Care Patients

BACKGROUND: Critical care patients generally require extensive interventions, thereby consuming a large percentage of healthcare resources. Induced pentobarbital coma for the management of increased intracranial pressure is one such intervention, required to maintain patient stability. Quantification of these interventions, as well as the amount of nursing work required, has not been addressed in the literature. OBJECTIVE: To use the Therapeutic Intervention Scoring System to analyze and quantify how interventions affect nurse-patient ratios in the management of patients in pentobarbital coma for refractory increased intracranial pressure. METHODS: The medical records of patients with subarachnoid hemorrhage from aneurysmal rupture and subsequent increased intracranial pressure, in whom pentobarbital coma was salvage therapy, were reviewed retrospectively. The Therapeutic Intervention Scoring System was used to quantify the number of interventions required before, during, and after coma induction. The data were analyzed and daily Therapeutic Intervention Scoring System scores correlated with serum pentobarbital levels. Typically, a critical care nurse can manage a patient caseload of 40 to 50 Therapeutic Intervention Scoring System points. By quantifying the interventions, the score reflected the amount of care required to manage the patient in barbiturate coma. RESULTS: The intensity of interventions correlated with the level of coma, length of time in coma, and associated complications. CONCLUSIONS: The scores indicated the intensity of interventions used in pentobarbital coma and the use of resources. Nursing care and complications involved with this therapy were quantified and nurse-patient ratios were established.

scholarly journals Surge effects and survival to hospital discharge in critical care patients with COVID-19 during the early pandemic: a cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Christopher R. Dale ◽  
Rachael W. Starcher ◽  
Shu Ching Chang ◽  
Ari Robicsek ◽  
Guilford Parsons ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Multivariable Logistic Regression Analysis ◽  
Hospital Capacity ◽  
Multivariable Logistic Regression ◽  
Critical Care Patients ◽  
Over Time

Abstract Background The early months of the COVID-19 pandemic were fraught with much uncertainty and some resource constraint. We assessed the change in survival to hospital discharge over time for intensive care unit patients with COVID-19 during the first 3 months of the pandemic and the presence of any surge effects on patient outcomes. Methods Retrospective cohort study using electronic medical record data for all patients with laboratory-confirmed COVID-19 admitted to intensive care units from February 25, 2020, to May 15, 2020, at one of 26 hospitals within an integrated delivery system in the Western USA. Patient demographics, comorbidities, and severity of illness were measured along with medical therapies and hospital outcomes over time. Multivariable logistic regression models were constructed to assess temporal changes in survival to hospital discharge during the study period. Results Of 620 patients with COVID-19 admitted to the ICU [mean age 63.5 years (SD 15.7) and 69% male], 403 (65%) survived to hospital discharge and 217 (35%) died in the hospital. Survival to hospital discharge increased over time, from 60.0% in the first 2 weeks of the study period to 67.6% in the last 2 weeks. In a multivariable logistic regression analysis, the risk-adjusted odds of survival to hospital discharge increased over time (biweekly change, adjusted odds ratio [aOR] 1.22, 95% CI 1.04–1.40, P = 0.02). Additionally, an a priori-defined explanatory model showed that after adjusting for both hospital occupancy and percent hospital capacity by COVID-19-positive individuals and persons under investigation (PUI), the temporal trend in risk-adjusted patient survival to hospital discharge remained the same (biweekly change, aOR 1.18, 95% CI 1.00–1.38, P = 0.04). The presence of greater rates of COVID-19 positive/PUI as a percentage of hospital capacity was, however, significantly and inversely associated with survival to hospital discharge (aOR 0.95, 95% CI 0.92–0.98, P < 0.01). Conclusions During the early COVID-19 pandemic, risk-adjusted survival to hospital discharge increased over time for critical care patients. An association was also seen between a greater COVID-19-positive/PUI percentage of hospital capacity and a lower survival rate to hospital discharge.

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