A ‘Shock Room’ for Early Management of the Acutely Ill

Our 850-bed, academic, tertiary care hospital uses a four-bed dedicated ‘shock room situated between the Departments of Emergency Medicine and Intensive Care to stabilise all acutely ill patients from outside or inside the hospital before transfer to the intensive care unit or other department. Admitted patients stay a maximum of four hours in the shock room. In this article we describe our experiences using this shock room by detailing the demographic data, including time and source of admission, diagnosis and outcome, for the 2514 patients admitted to the shock room in 2006. The most common reasons for admission were cardiac (33%) and neurological (21%) diagnoses. After diagnosis and initial treatment, 54% of patients were transferred to an intensive care unit or a coronary care unit; 2.5% of patients died in the shock room. The shock room provides a useful area of collaboration between emergency department and intensive care unit staff and enables acutely ill patients to be assessed and treated rapidly to optimise outcomes.

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Paradox of Predictors in Critically ill COVID-19 Patients: Outcome of a COVID-dedicated Intensive Care Unit

10.1101/2021.04.23.21256009 ◽

2021 ◽

Author(s):

Morshed Nasir ◽

Rawshan Ara Perveen ◽

Rumana Nazneen ◽

Tahmina Zahan ◽

Sonia Nasreen Ahmad ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Tertiary Care ◽

Predictive Biomarkers ◽

Nasopharyngeal Swab ◽

Treatment Schedule ◽

Care Hospital ◽

Icu Stay ◽

Significant Difference

Background: The study aimed to analyze the demographic, comorbidities, biomarkers, pharmacotherapy, and ICU-stay with the mortality outcome of COVID-19 patients admitted in the intensive care unit of a tertiary care hospital in a low-middle income country, Bangladesh. Methods: The retrospective cohort study was done in Holy Family Red Crescent Medical College Hospital from May to September 2020. All 112 patients who were admitted to ICU as COVID-19 cases (confirmed by RT-PCR of the nasopharyngeal swab) were included in the study. Demographic data, laboratory reports of predictive biomarkers, treatment schedule, and duration of ICU-stay of 99 patients were available and obtained from hospital records (non-electronic) and treatment sheets, and compared between the survived and deceased patients. Results: Out of 99 patients admitted in ICU with COVID-19, 72 were male and 27 were female. The mean age was 61.08 years. Most of the ICU patients were in the 60 - 69 years of age group and the highest mortality rates (35.89%) were observed in this age range. Diabetes mellitus and hypertension were the predominant comorbidities in the deceased group of patients. A significant difference was observed in neutrophil count, creatinine and, NLR, d-NLR levels that raised in deceased patients. There was no significant difference as a survival outcome of antiviral drugs remdesivir or favipiravir, while the use of cephalosporin was found much higher in the survived group than the deceased group (46.66% vs 20.51%) in ICU. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males aged more than 60 years. There were wide variations of the biomarkers in critical COVID-19 patients in a different population, which put the healthcare workers into far more challenge to minimize the mortality in ICU in Bangladesh and around the globe during the peak of the pandemic.

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Drug utilization pattern in an intensive care unit of a teaching hospital in South India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20192633 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1527

Author(s):

Suraj B. ◽

Srikanth . ◽

Somashekara S. C. ◽

Sandeep B. ◽

Tanuja .

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Drug Utilization ◽

Demographic Data ◽

Tertiary Care ◽

Care Hospital ◽

Antibiotic Policy ◽

Inappropriate Use ◽

Icu Stay ◽

Bed Days

Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively. Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics.Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively.Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics. Keywords: Antibiotics, Daily defined doses, Drug utilization, Intensive care unit

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A Prospective Study on the Outcome of Semi-Closed Neurointensive Care in A Tertiary Care Hospital Located in A Rural Area of Eastern Nepal: A Lower-Income Developing Country

Eastern Green Neurosurgery ◽

10.3126/egn.v2i3.31445 ◽

2020 ◽

Vol 2 (3) ◽

pp. 7-13

Author(s):

Niraj Kumar Keyal ◽

Pankaj Raj Nepal ◽

Karuna Tamrakar ◽

Robin Bhattarai ◽

Dinesh Kumar Thapa ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care Hospital ◽

Demographic Data ◽

Tertiary Care ◽

Care Hospital ◽

Full Time ◽

Do Not Resuscitate ◽

Neurological Patient ◽

Common Diagnosis

Background: High mortality and morbidity in neurological patients are found due to lack of closed ICU (Intensive Care Unit), neurointensivist, and training in neurocritical care in most of the developing countries. Therefore, this study was conducted to evaluate the outcome of the neurological patient managed by neurointensivist in a semi-closed ICU. Materials and methods: It was a prospective, descriptive observational cross-sectional study in a level three Neuro-intensive care unit of a tertiary care hospital of Eastern Nepal, for one year in 191 patients. All patients above 18 years admitted to the Neuro-intensive care unit were included in this study. Demographic data was collected for all patients at the time of presentation to the ICU. The outcome of the patient was defined as transferred to Neuro-Ward, leave against medical advice (LAMA), do not resuscitate (DNR) and death. Statistical analysis was done by using SPSS. The result was presented as frequency and percentage. Results: Out of 191 patients, Males (71.7%) was more common than females (28.2%). There were 107 (56%) patients were admitted after 24 hours of injury or illness. 28.2% of patients had a hemorrhagic stroke and was the most common diagnosis for admission in the ICU. This study showed that 58(82.72%) patients survived and were discharged, 23(12%) expired, 7(3.66%) went in LAMA) and 3(1.57%) gave do not resuscitate orders (DNR). Mean days on a mechanical ventilator was 3.17 ± 2.12 days. Mortality in the intubated patient was 19%. Conclusion: A semi-closed Neuro-intensive care unit that includes full-time neurointensivist may have a better outcome than the open ICU.

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Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Clinical Pediatrics ◽

10.1177/00099228211047242 ◽

2021 ◽

pp. 000992282110472

Author(s):

Andrew Brown ◽

Mary Quaile ◽

Hannah Morris ◽

Dmitry Tumin ◽

Clayten L. Parker ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Discharge ◽

Care Coordination ◽

Chronic Conditions ◽

Tertiary Care ◽

Care Hospital ◽

Icu Admission ◽

Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

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Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

BMJ Open Quality ◽

10.1136/bmjoq-2017-000239 ◽

2018 ◽

Vol 7 (2) ◽

pp. e000239 ◽

Cited By ~ 2

Author(s):

Krishna Aparanji ◽

Shreedhar Kulkarni ◽

Megan Metzke ◽

Yvonne Schmudde ◽

Peter White ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Tertiary Care ◽

Care Hospital ◽

Icu Patients ◽

Quality Metric ◽

Risk Of Mortality ◽

Simulation Based ◽

Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

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