Impact of intensive care unit discharge delay after medical clearance on outcomes after liver transplantation

Abstract Background For general intensive care unit (ICU) patients, ICU discharge delay (ICUDD) has been shown to be associated with increased hospital length of stay (LOS) and acquiring multi-resistant organism (MRO) infections. The impact of ICUDD in liver transplant (LT) recipients is unknown. Methods We retrospectively studied consecutive adults who underwent deceased-donor LT between 2011–2019. All patients went to ICU post-operatively then to a specific transplant ward. ICUDD was defined as > 8 hours between a patient being cleared by staff for discharge to ward and the patient leaving ICU. Results 550 received LT and survived to ward discharge. Median time between clearance for ward and the patient leaving ICU was 25.6 hours (interquartile range 6.6–38.6). The majority (68.4%) of patients experienced ICUDD. No donor or recipient variables were associated with ICUDD. However, patients cleared for discharge early in the week (Sunday-Tuesday) were more likely to experience ICUDD than those cleared on Wednesday-Saturday: 77.5% vs. 62.2% (P = 0.001), while patients cleared outside routine work hours were more likely to experience ICUDD than those cleared within working hours (93.6% vs. 66.2%, P < 0.001). The median hospital LOS were identical (18 days, P = 0.96) and there were no differences in other patient outcomes. Patients who became colonized with MRO in ICU spent longer time there compared to those who remained MRO-free (9 vs. 6 days, P < 0.001), however this was not due to ICUDD. Conclusions ICUDD post-LT is common and related to logistical factors. It does not prolong hospital LOS and is not associated with adverse patient outcomes or MRO colonization.

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Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

Medicinski pregled ◽

10.2298/mpns2104112p ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 112-116

Author(s):

Marina Pandurov ◽

Izabella Fabri-Galambos ◽

Andjela Opancina ◽

Anna Uram-Benka ◽

Goran Rakic ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Infections ◽

Hospital Length Of Stay ◽

Surgical Intensive Care Unit ◽

Negative Consequences ◽

Surgical Intensive Care ◽

Acinetobacter Baumanii ◽

Cross Sectional ◽

The Impact

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

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Glucose Disturbances and Atypical Antipsychotic Use in the Intensive Care Unit

Journal of Pharmacy Practice ◽

10.1177/0897190015579452 ◽

2016 ◽

Vol 29 (6) ◽

pp. 534-538 ◽

Cited By ~ 3

Author(s):

Amy Bishara ◽

Stephanie V. Phan ◽

Henry N. Young ◽

T. Vivian Liao

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Outcomes ◽

Atypical Antipsychotic ◽

Atypical Antipsychotics ◽

Apache Ii Score ◽

Icu Patients ◽

Acute Hyperglycemia ◽

The Impact ◽

Chronic Use

Purpose: Chronic use of atypical antipsychotics may lead to metabolic abnormalities including hyperglycemia. Although evidence supports acute hyperglycemic episodes associated with atypical antipsychotic use, the acute use of atypical antipsychotics in the intensive care unit (ICU) setting has not been studied. The purpose of this study is to evaluate the occurrence of hyperglycemia in ICU patients receiving newly prescribed atypical antipsychotic. Summary: Of the 273 patient charts reviewed, 50 patients were included in this study. Approximately 45% of patients experienced at least 1 hyperglycemic episode (blood glucose >180 mg/dL) after the initiation of an atypical antipsychotic in the ICU. Of the patients experiencing at least 1 hyperglycemic episode, 60% experienced multiple distinct hyperglycemic episodes. In this study, quetiapine was the most commonly used atypical antipsychotic, 19 (38%) patients were discharged from the ICU on the atypical antipsychotic, 6 (12%) patients died in the ICU, and 31 (62%) patients were treated with an antihyperglycemic agent. Logistic regression analysis showed that women and ICU patients with a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score were significantly more likely to have multiple hyperglycemic episodes. Conclusion: Patients admitted to the ICU and initiated on an atypical antipsychotic may develop hyperglycemia independent of other glucose-elevating factors. The direct correlation of these agents to resulting acute hyperglycemia is unknown. Further studies are needed to investigate the link between atypical antipsychotics and acute hyperglycemia and the clinical significance of the impact on patient outcomes.

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Medication Changes and Diagnosis of New Chronic Illnesses in COVID-19 Intensive Care Unit Survivors

Annals of Pharmacotherapy ◽

10.1177/10600280211063319 ◽

2022 ◽

pp. 106002802110633

Author(s):

Rima A. Mohammad ◽

Cynthia T. Nguyen ◽

Patrick G. Costello ◽

Janelle O. Poyant ◽

Siu Yan Amy Yeung ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Admission ◽

Hospital Discharge ◽

Medical Condition ◽

Hospital Length Of Stay ◽

Medical Conditions ◽

Medication Change ◽

The Impact ◽

Medication Changes

Background Currently, there is limited literature on the impact of the COVID-19 infection on medications and medical conditions in COVID-19 intensive care unit (ICU) survivors. Our study is, to our knowledge, the first multicenter study to describe the prevalence of new medical conditions and medication changes at hospital discharge in COVID-19 ICU survivors. Objective To determine the number of medical conditions and medications at hospital admission compared to at hospital discharge in COVID-19 ICU survivors. Methods Retrospective multicenter observational study (7 ICUs) evaluated new medical conditions and medication changes at hospital discharge in patients with COVID-19 infection admitted to an ICU between March 1, 2020, to March 1, 2021. Patient and hospital characteristics, baseline and hospital discharge medication and medical conditions, ICU and hospital length of stay, and Charlson comorbidity index were collected. Descriptive statistics were used to describe patient characteristics and number and type of medical conditions and medications. Paired t-test was used to compare number of medical conditions and medications from hospital discharge to admission. Results Of the 973 COVID-19 ICU survivors, 67.4% had at least one new medical condition and 88.2% had at least one medication change. Median number of medical conditions (increased from 3 to 4, P < .0001) and medications (increased from 5 to 8, P < .0001) increased from admission to discharge. Most common new medical conditions at discharge were pulmonary disorders, venous thromboembolism, psychiatric disorders, infection, and diabetes. Most common therapeutic categories associated with medication change were cardiology, gastroenterology, pain, hematology, and endocrinology. Conclusion and Relevance Our study found that the number of medical conditions and medications increased from hospital admission to discharge. Our results provide additional data to help guide providers on using targeted approaches to manage medications and diseases in COVID-19 ICU survivors after hospital discharge.

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The impact of critical care transition programs on outcomes after intensive care unit (ICU) discharge: can we get there from here?

Journal of Thoracic Disease ◽

10.21037/jtd.2016.05.30 ◽

2016 ◽

Vol 8 (7) ◽

pp. 1374-1376 ◽

Cited By ~ 3

Author(s):

Regis Goulart Rosa ◽

Juçara Gasparetto Maccari ◽

Ricardo Viegas Cremonese ◽

Tulio Frederico Tonietto ◽

Rafael Viegas Cremonese ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Transition Programs ◽

Care Transition ◽

Icu Discharge ◽

The Impact

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Development and Implementation of a Multicomponent Protocol to Promote Sleep and Reduce Delirium in a Medical Intensive Care Unit

Annals of Pharmacotherapy ◽

10.1177/10600280211043278 ◽

2021 ◽

pp. 106002802110432

Author(s):

Adrienne Darby ◽

Kalynn Northam ◽

C. Adrian Austin ◽

Lydia Chang ◽

Stacy Campbell-Bright

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Medical Intensive Care Unit ◽

Severity Of Illness ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Poor Sleep ◽

Medical Intensive Care ◽

The Impact

Background: Evidence suggests that poor sleep increases risk of delirium. Because delirium is associated with poor outcomes, institutions have developed protocols to improve sleep in critically ill patients. Objective: To assess the impact of implementing a multicomponent sleep protocol. Methods: In this prospective, preimplementation and postimplementation evaluation, adult patients admitted to the medical intensive care unit (ICU) over 42 days were included. Outcomes evaluated included median delirium-free days, median Richards-Campbell Sleep Questionnaire (RCSQ) score, median optimal sleep nights, duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and in-hospital mortality. Results: The preimplementation group included 78 patients and postimplementation group, 84 patients. There was no difference in median delirium-free days (1 day [interquartile range, IQR, = 0-2.5] vs 1 day [IQR = 0-2]; P = 0.48), median RCSQ score (59.4 [IQR = 43.2-71.6] vs 61.2 [IQR = 49.9-75.5]; P = 0.20), median optimal sleep nights (1 night [IQR = 0-2] vs 1 night [IQR = 0-2]; P = 0.95), and in-hospital mortality (16.7% vs 17.9%, P = 1.00). Duration of MV (8 days [IQR = 4-10] vs 4 days [IQR = 2-7]; P = 0.03) and hospital LOS (13 days [IQR = 7-22.3] vs 8 days [IQR = 6-17]; P = 0.05) were shorter in the postimplementation group, but both were similar between groups after adjusting for age and severity of illness. Conclusions and Relevance: This report demonstrates that implementation of a multicomponent sleep protocol in everyday ICU care is feasible, but limitations exist when evaluating impact on measurable outcomes. Additional evaluations are needed to identify the most meaningful interventions and best practices for quantifying impact on patient outcomes.

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The impact of delirium in the intensive care unit on hospital length of stay

Intensive Care Medicine ◽

10.1007/s00134-001-1132-2 ◽

2001 ◽

Vol 27 (12) ◽

pp. 1892-1900 ◽

Cited By ~ 619

Author(s):

E. Ely ◽

S. Gautam ◽

R. Margolin ◽

J. Francis ◽

L. May ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

The Impact

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Clinical and Economic Outcomes of Telemedicine Programs in the Intensive Care Unit: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066617726942 ◽

2017 ◽

Vol 33 (7) ◽

pp. 383-393 ◽

Cited By ~ 33

Author(s):

Jing Chen ◽

Dalong Sun ◽

Weiming Yang ◽

Mingli Liu ◽

Shufan Zhang ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Meta Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Icu Length Of Stay ◽

The Impact

Objective: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. Methods: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis. Results: Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], −0.63; 95% CI, −0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs. Conclusions: This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.

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The Impact of Medical Conditions on the Quality of Life of Survivors at Discharge From Intensive Care Unit

Medicina ◽

10.3390/medicina47050038 ◽

2011 ◽

Vol 47 (5) ◽

pp. 38 ◽

Cited By ~ 1

Author(s):

Andrius Klimašauskas ◽

Ieva Sereikė ◽

Aušra Klimašauskienė ◽

Gintautas Kėkštas ◽

Juozas Ivaškevičius

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Intensive Care ◽

Organ System ◽

Therapeutic Interventions ◽

Prolonged Stay ◽

Role Physical ◽

Icu Discharge ◽

The Impact

Background and Objective. Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU discharge. The objective of the study was to identify whether health state on discharge from prolonged stay in the ICU has any influence on survivors’ HRQOL 6 months after intensive care. Material and Methods. A prospective study of patients with the prolonged length of stay (exceeding 7 days) in the ICU was conducted. The study covered the impact of organ system dysfunction (SOFA score), number of therapeutic interventions (TISS-28 score), and critical illness neuromuscular abnormalities (CINMA) on discharge from the ICU on HRQOL 6 months following ICU discharge. Results. In total, 137 patients were included in the study. The SOFA score on the last day in the ICU was 2.91 (SD, 1.57); the TISS-28 score on the last day in the ICU was 21.79 (SD, 4.53). Decreased physical functioning (PF) and role physical (RP) were identified. Circulatory impairment on discharge from the ICU had an impact on decreased PF (P=0.016), role physical (P=0.066), and role emotional (P=0.001). Patients with dysfunction in more than one organ system on ICU discharge had decreased role emotional (P=0.016). Severe CINMA was diagnosed in 18 patients. They had decreased PF (P=0.007) and RP (P=0.019). Patients with the TISS-28 score above or equal to 20 points showed lower HRQOL in the PF domain (P=0.077) and general health (P=0.038). Conclusions. HRQOL in patients with prolonged stay in the ICU is particularly impaired in the domains of physical functioning and role physical. It is associated with circulatory impairment, CINMA, and greater number of therapeutic interventions on discharge from the ICU.

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Impact of Sepsis Identification and Treatment Time on In-Hospital Mortality, Length of Stay, and Hours in the Intensive Care Unit

10.1101/2021.05.26.21257894 ◽

2021 ◽

Author(s):

Sylvia EK Sudat

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Length Of Stay ◽

Mortality Reduction ◽

Sepsis Screening ◽

The Impact

Objective: The objective of this study was to examine the impact of timely treatment and identification of sepsis on patient outcomes at Sutter Health, a mixed-payer healthcare system in northern California, US. Methods: This observational, retrospective analysis considered electronic health record (EHR) data for individuals who presented with sepsis during 2016-17 at any of Sutter Health's 22 emergency departments (ED). Impacts were assessed for the timing of broad-spectrum antibiotic and intravenous (IV) fluid initiation, first vital signs, sepsis screening, and lactate results. Outcomes were in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) hours for patients discharged alive. Results: The final sample size was 35,847 (N=9,638 severe sepsis, N=5,309 septic shock). Early fluid initiation had the largest estimated impacts: a mortality reduction of 2.85%[2.03%,3.68%] overall and 2.94%[1.44%,4.48%] for severe sepsis (within 1 hour of sepsis presentation), and 14.66%[9.23%,20.07%] for septic shock (within 3 hours); reduced LOS (days) 1.39[1.08,1.71] overall, 2.30[1.31,3.21] severe sepsis, 3.07[1.21,4.94] septic shock; and fewer ICU hours 25.93[16.95,34.66] overall, 35.06[14.7,56.99] severe sepsis, 41.99[15.70,70.68] septic shock (within 3 hours). Sepsis screening within 30 minutes was also associated with mortality reductions (3.88%[2.96%,4.90%] overall, 1.74%[0.08%,3.50%] severe sepsis, 6.78%[3.12%,10.33%] septic shock). The greatest improvement opportunity was estimated for joint initiation of antibiotics and IV fluids, with a modest additional mortality reduction of 0.80%[0.47%,1.17%] overall, 0.77%[0.34%,1.19%] severe sepsis, 2.94%[1.83%,3.97%] septic shock; LOS reduction of 0.37[0.28,0.46] overall, 0.29[0.17,0.43] severe sepsis, 0.25[0.01,0.51] septic shock (within 1 hour); ICU hours reduction of 4.85[3.26,6.57] overall, 5.07[2.55,7.67] severe sepsis, 3.85[1.69,6.24] septic shock (within 3 hours).

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Impact of Intensive Care Unit Readmissions on Patient Outcomes and the Evaluation of the National Early Warning Score to Prevent Readmissions: Literature Review

JMIR Perioperative Medicine ◽

10.2196/13782 ◽

2020 ◽

Vol 3 (1) ◽

pp. e13782

Author(s):

Heidi Mcneill ◽

Saif Khairat

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Literature Review ◽

Hospital Mortality ◽

Patient Outcomes ◽

Early Warning ◽

Early Warning Score ◽

Risk Stratification Tool ◽

National Early Warning Score ◽

The Impact

Background Intensive care unit (ICU) readmissions have been shown to increase a patient’s in-hospital mortality and length of stay (LOS). Despite this, no methods have been set in place to prevent readmissions from occurring. Objective The aim of this literature review was to evaluate the impact of ICU readmission on patient outcomes and to evaluate the effect of using a risk stratification tool, the National Early Warning Score (NEWS), on ICU readmissions. Methods A database search was performed on PubMed, Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and ProQuest. In the initial search, 2028 articles were retrieved; after inclusion and exclusion criteria were applied, 12 articles were ultimately used in this literature review. Results This literature review found that patients readmitted to the ICU have an increased mortality rate and LOS at the hospital. The sample sizes in the reviewed studies ranged from 158 to 745,187 patients. Readmissions were most commonly associated with respiratory issues about 18% to 59% of the time. The NEWS has been shown to detect early clinical deterioration in a patient within 24 hours of transfer, with a 95% CI of 0.89 to 0.94 (P<.001), a sensitivity of 93.6% , and a specificity of 82.2%. Conclusions ICU readmissions are associated with worse patient outcomes, including hospital mortality and increased LOS. Without the use of an objective screening tool, the provider has been solely responsible for the decision of patient transfer. Assessment with the NEWS could be helpful in decreasing the frequency of inappropriate transfers and ultimately ICU readmission.

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