Documentation of Crucial Information Relating to Critically Ill Patients

2017 ◽  
Vol 33 (1) ◽  
pp. 5-8 ◽  
Author(s):  
Alexandria Bear ◽  
Elizabeth Thiel
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Medical Decision ◽  
Care Providers ◽  
Significant Difference ◽  
Review Study

Background: Medical decision-making has evolved to the modern model of shared decision-making among patients, surrogate decision-makers, and medical providers. As such, informed consent discussions with critically ill patients often should include larger discussions relating to values and goals of care. Documentation of care options and prognosis serves as an important component of electronic communication relating to patient preferences among care providers. Objective: This retrospective chart review study sought to evaluate the prevalence of documentation of critical data, care options, prognosis, and medical plan, within primary team and palliative care consult team documentation. Results: Three hundred two electronic medical records were reviewed. There was a significant difference in documentation between palliative care and primary teams for prognosis (83% vs 32%, P < .001), care options (82% vs 50%, P < .001), and care plan (82% vs 46%, P < .001). Conclusions: Our retrospective chart review study demonstrated a significant difference in documentation between primary and palliative care teams. We acknowledge that review of documentation cannot be extrapolated to the presence or absence of conversations between providers and patients and/or surrogates. Additional studies to evaluate this connection would be advantageous.

scholarly journals 970: EVALUATION OF THE USE OF MODAFINIL IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE CHART REVIEW

2021 ◽  
Vol 50 (1) ◽  
pp. 482-482
Author(s):  
Lindsey Branstetter ◽  
Jolie Gallagher ◽  
Kayla Nichols ◽  
Subir Goyal ◽  
Ayesha Mukhtar
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Retrospective Chart Review

Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States

2018 ◽  
Vol 35 (10) ◽  
pp. 1080-1094 ◽  
Author(s):  
Kartikeya Rajdev ◽  
Nina Loghmanieh ◽  
Maria A. Farberov ◽  
Seleshi Demissie ◽  
Theodore Maniatis
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
The United States ◽  
Care Providers ◽  
Strongly Agree ◽  
Eol Care

It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers’ self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Our study identified several deficiencies in the self-reported EOL care competencies among health-care providers. Around 34% of the participants either disagreed (strongly disagree or disagree) or were neutral when asked whether they feel well prepared for delivering EOL care. Around 30% of the participants did not agree (agree and strongly agree) that they were well prepared to determine when to refer patients to hospice. 51% of the participants, did not agree (agree and strongly agree) that clear and accurate information is delivered by team members to patients/family. The most common barrier to providing EOL care in the intensive care unit was family not accepting the patient’s poor prognosis. Nursing staff (registered nurse) had higher knowledge and attitudes mean competency scores than the medical staff. Attending physicians reported stronger knowledge competencies when compared to residents and fellows. More than half of the participants denied having received any previous training in EOL care. 82% of the participants agreed that training should be mandatory in this field. Most of the participants reported that the palliative care team is involved in EOL care when the patient is believed to be terminally ill. Apart from a need for a stronger training in the field of EOL care for health-care providers, the overall policies surrounding EOL and palliative care delivery require further evaluation and improvement to promote better outcomes in caring patients at the EOL.

Survival, Outcomes, and Use of Acuity Scoring Systems Following Tracheotomy in Veteran Patients

2020 ◽  
Vol 37 (11) ◽  
pp. 890-896
Author(s):  
Carol M. Bier-Laning ◽  
Jeffrey Hotaling ◽  
W. Jeffrey Canar ◽  
Aziz A. Ansari
Keyword(s):  
General Population ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Scoring Systems ◽  
Survival Outcomes ◽  
Logistic Organ Dysfunction ◽  
Failure Assessment

Objectives: To determine whether established prognosis tools used in the general population of critically ill patients will accurately predict tracheotomy-related outcomes and survival outcomes in critically ill patients undergoing tracheotomy. Methods: Retrospective chart review of 94 consecutive critically ill patients undergoing isolated tracheotomy. Results: Logistic Organ Dysfunction System (LODS) and sepsis-related organ failure assessment (SOFA) scores, 2 validated measures of acuity in critically ill patients, were calculated for all patients. The only tracheotomy-related outcome of significance was the finding that patients with an LODS score ≤6 were more likely to become ventilator independent ( P < .015). Higher LODS or SOFA scores were associated with in-house death (LODS, P = .001, SOFA, P = .008) and death within 90 days (LODS, P = .009, SOFA, P = .031), while death within 180 days was associated only with a higher LODS score (LODS, P = .018). When controlling for age, there was an association between both LODS ( P = .015) and SOFA ( P = .019) scores and death within 90 days of tracheotomy. Conclusions: The survival outcome for critically ill patients undergoing tracheotomy seems accurately predicted based on scoring systems designed for use in the general population of critically ill patients. Logistic Organ Dysfunction System may also be useful to predict the likelihood of the tracheotomy-related outcome of ventilator independence. This suggests that LODS scores may be helpful to palliative care clinicians as part of a shared decision-making aid in critically ill, ventilated patients for whom tracheotomy is being considered.

Examination and Analysis of After-Hours Calls in Hospice

2020 ◽  
Vol 37 (5) ◽  
pp. 324-328
Author(s):  
Masako Mayahara ◽  
Louis Fogg
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Shortness Of Breath ◽  
Medication Refill ◽  
Effective Care ◽  
Significant Difference ◽  
After Hours ◽  
Review Study ◽  
Care At Home ◽  
Using Data

To ensure safe and effective care at home, most hospice agencies provide 24-hour call services to patients and their families. However, responding to such calls can be very extensive since so many calls occur after hours when staff are fewer. The purpose of the current study was to better understand the types of after-hours calls and differences across patient teams. By understanding why these calls are made, we might be able to reduce the number of avoidable after-hours calls. This descriptive retrospective chart review study was conducted using data from 9 patient care teams within a single hospice agency. During the 6-month study period, the hospice agency received 1596 after-hours calls. The number of calls averaged 10.3 per night. Common clinical-related calls included consultations about the shortness of breath (10.2%) and pain (9.5%). A total of 37.7% of the calls were nonclinical, nonemergency in nature, including requests for supplies (29.6%) and medication refills (8.1%). There were statistically significant differences ( P < .05) between teams in the numbers of supply request calls, medication refill request calls, and calls associated with clinical-related issues. Also, there was a statistically significant difference in the after-hours calls across teams that resulted in dispatching staff to a home ( P < .05). These findings suggest that many after-hours calls would be more appropriately addressed during regular daytime hours. There are significant across-team differences that are not yet well understood. Further studies are needed to determine how to reduce the number of after-hours calls.

Comparative effectiveness of everolimus (EVE) and axitinib (AXI) for second-line treatment of metastatic renal cell carcinoma (mRCC) in the United States: A retrospective chart review.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 500-500 ◽  
Author(s):  
Nicholas J. Vogelzang ◽  
Sumanta Kumar Pal ◽  
James E. Signorovitch ◽  
William M. Reichmann ◽  
Pooja Chopra ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Chart Review ◽  
Proportional Hazards ◽  
Performance Status ◽  
Retrospective Chart Review ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
Review Study

500 Background: EVE and AXI are approved as 2nd-line TTs for mRCC. This study compares OS and PFS among mRCC patients treated with EVE and AXI following 1st TKI. The extent to which the duration of 1st TKI can inform optimal selection of a 2nd-line TT is of interest. Methods: A retrospective patient chart review study was conducted. Medical oncologists or hematologists/oncologists who treated ≥3 mRCC patients in the past year were recruited from a national panel. Patient eligibility criteria included: 1) aged ≥18 years; 2) initiated and discontinued 1st TKI (sunitinib or pazopanib) for medical reasons; 3) initiated 2nd TT between 2/1/2012 and 1/31/2013. OS was defined as time from initiation of 2nd TT to death. PFS was defined as time from initiation of 2nd TT to physician/chart reported progression or death, whichever occurred first. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) for OS and PFS between EVE and AXI, adjusting for age, gender, type and duration of 1st TKI, response to 1st TKI, duration of mRCC at 2nd TT, disease profile, performance status, sites of metastases, and years of physician practice. Comparative effectiveness was also analyzed by the type and duration (<6, 6-12, >12 months) of 1st TKI. Results: A total of 298 and 122 patients received 2nd TT with EVE and AXI. After adjusting for baseline characteristics, there was no statistically significant difference between EVE and AXI in OS [HR (95% CI): 1.10 (0.69-1.75)] or PFS [HR (95% CI): 1.12 (0.81-1.54)]. When stratified by subgroups defined by type and duration of 1st TKI, there was no statistically significant difference in OS between EVE and AXI in all subgroups, except for patients with <6 months on sunitinib as 1st TKI in which AXI had longer OS (HR =3.95). There was no statistically significant difference in PFS between EVE and AXI in all subgroups. Conclusions: In this large, retrospective chart review study, there was no significant difference in OS or PFS between EVE and AXI. Subgroup analyses stratified by duration of 1st TKI did not suggest that longer duration of 1st TKI was associated with better efficacy for 2nd-line AXI vs. EVE.

scholarly journals Pediatric Palliative Care: A Five-Year Retrospective Chart Review Study

2017 ◽  
Vol 20 (10) ◽  
pp. 1104-1111 ◽  
Author(s):  
Susan E. Thrane ◽  
Scott H. Maurer ◽  
Susan M. Cohen ◽  
Carol May ◽  
Susan M. Sereika
Keyword(s):  
Palliative Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Pediatric Palliative Care ◽  
Review Study

scholarly journals Impact of an Extended Infusion Β-lactam Strategy on Outcomes in Critically Ill Patients with Pseudomonas Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S299-S299
Author(s):  
Kenneth Klinker ◽  
Veena Venugopalan ◽  
Andrea Carnley ◽  
Stacy Voils ◽  
Jessica Cope ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Cure ◽  
Chart Review ◽  
Additional Data ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Drug Concentrations ◽  
Secondary Endpoints ◽  
Extended Infusion

Abstract Background Pseudomonas aeruginosa (PSA) is frequently associated with nosocomial infections resulting in significant morbidity and mortality. High MICs in MDR strains highlights the need to maximize antibiotic exposure with the goal of improving patient outcomes. For β-lactams, optimal efficacy is achieved when free drug concentrations are above the MIC for ~ 40–60% of the dosing interval. Unfortunately, due to significant pharmacokinetic variability in the critically ill, achieving this target with standard intermittent infusions (II) is challenging, resulting in preference for extended (EI) or continuous infusion strategies. Additional data in patients with PSA infections are needed to understand the association between infusion strategy and clinical outcome. Methods A single-center, retrospective chart review. Adult patients with positive respiratory or blood cultures for PSA treated with cefepime or piperacillin/tazobactam managed in an ICU from January 2012 to May 2016 were included. Primary endpoint was clinical cure (CC) at end of therapy (EOT) between patients receiving EI or II. Secondary endpoints included microbiologic eradication (ME), 28-day mortality, length of ICU and hospital stay, and effect of baseline kidney function on clinical cure. Results Eighty-three patients were included in the analysis. Patient characteristics were well matched except for a higher frequency of malignancy in the EI arm (P = 0.02). CC was achieved in an overwhelming majority of EI patients compared with II (89.2% vs. 69.6%, P = 0.031). Further, patients with normal renal function (CrCL ≥ 60; P = 0.02) or APACHE II ≥ 17 (P = 0.04) receiving II experienced higher failure rates. In multivariate analysis, use of II associated with 4-fold higher incidence of clinical failure (OR 4.5 [1.3–16.3]). For other secondary endpoints, ME was observed in 73% of EI vs. 65% of II (P = 0.44) and 28-day mortality was observed in 13% of patients in both arms (P = 0.94). No significant differences were observed with other secondary variables. Conclusion Use of an EI strategy in critically ill patients with PSA infections improves CC. Further, EI benefitted those patients with normal to augmented renal clearance suggesting that improved exposure may play a role in clinical outcomes. Disclosures K. Klinker, The Medicines Company: Scientific Advisor, Consulting fee.

Sign in / Sign up

Export Citation Format

Share Document