scholarly journals Do Digital Handover Checklists Influence the Clinical Outcome Parameters of Intensive Care Unit Patients? A Randomized Controlled Pilot Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Nina Verholen ◽  
Lina Vogt ◽  
Martin Klasen ◽  
Michelle Schmidt ◽  
Stefan Beckers ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pilot Study ◽  
Clinical Outcome ◽  
Sofa Score ◽  
Time Window ◽  
Outcome Parameters ◽  
Treatment Errors ◽  
Randomized Controlled ◽  
Failure Assessment

Background: Clinical handovers have been identified as high-risk situations for medical treatment errors. It has been shown that handover checklists lead to a reduced rate of medical errors and mortality. However, the influence of handover checklists on essential patient outcomes such as prevalence of sepsis, mortality, and length of hospitalization has not yet been investigated in a randomized controlled trial (RCT).Objectives: The aim of the present pilot study was to estimate the effect of two different handover checklists on the 48 h sepsis-related organ failure assessment (SOFA) score and the feasibility of a respective clinical RCT.Methods: Outcome parameters and feasibility were investigated implementing and comparing an intervention with a control checklist.Design: Single center two-armed cluster randomized prospective crossover pilot study.Setting: The study took place over three 1-month periods in an intensive care unit (ICU) setting at the University Hospital Aachen.Patients/Participants: Data from 1,882 patients on seven ICU wards were assessed, of which 1,038 were included in the analysis.Intervention: A digital standardized handover checklist (ISBAR3) was compared to a control checklist (VICUR).Main Outcome Measures: Primary outcome was the 2nd 24 h time window sepsis-related organ failure assessment (SOFA) score. Secondary outcomes were SOFA scores on the 3rd and 5th 24 h time window, mortality, reuptake, and length of stay; handover duration, degree of satisfaction, and compliance as feasibility-related outcomes.Results: Different sepsis scores were observed only for the 1st 24 h time window after admission to the ICU, with higher values for ISBAR3. With respect to the patient-centered outcomes, both checklists achieved similar results. Average handover duration was shorter for VICUR, whereas satisfaction and compliance were higher for ISBAR3. However, overall compliance was low (25.4% for ISBAR3 and 15.8% for VICUR).Conclusions: Based on the results, a stratified randomization procedure is recommended for following RCTs, in which medical treatment errors should also be investigated as an additional variable. The use of control checklists is discouraged due to lower acceptance and compliance among healthcare practitioners. Measures should be undertaken to increase compliance with the use of checklists. Clinical outcome parameters should be carefully selected.Trial Registration:ClinicalTrials.gov, Identifier [NCT03117088]. Registered April 14, 2017.

scholarly journals Establishment of a prognostic model based on the Sequential Organ Failure Assessment score for patients with first-time acute myocardial infarction

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110119
Author(s):  
Shuai Zheng ◽  
Jun Lyu ◽  
Didi Han ◽  
Fengshuo Xu ◽  
Chengzhuo Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Cardiovascular Events ◽  
Failure Assessment ◽  
First Time

Objective This study aimed to identify the prognostic factors of patients with first-time acute myocardial infarction (AMI) and to establish a nomogram for prognostic modeling. Methods We studied 985 patients with first-time AMI using data from the Multi-parameter Intelligent Monitoring for Intensive Care database and extracted their demographic data. Cox proportional hazards regression was used to examine outcome-related variables. We also tested a new predictive model that includes the Sequential Organ Failure Assessment (SOFA) score and compared it with the SOFA-only model. Results An older age, higher SOFA score, and higher Acute Physiology III score were risk factors for the prognosis of AMI. The risk of further cardiovascular events was 1.54-fold higher in women than in men. Patients in the cardiac surgery intensive care unit had a better prognosis than those in the coronary heart disease intensive care unit. Pressurized drug use was a protective factor and the risk of further cardiovascular events was 1.36-fold higher in nonusers. Conclusion The prognosis of AMI is affected by age, the SOFA score, the Acute Physiology III score, sex, admission location, type of care unit, and vasopressin use. Our new predictive model for AMI has better performance than the SOFA model alone.

Sequential Organ Failure Assessment (SOFA) Score As a Predictor of Outcome in Sepsis in Pediatric Intensive Care Unit

2020 ◽  
Author(s):  
A.V. Lalitha ◽  
J.K. Satish ◽  
Mounika Reddy ◽  
Santu Ghosh ◽  
Jiny George ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Pediatric Intensive Care Unit ◽  
Sofa Score ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Inotropic Support ◽  
Discriminative Power ◽  
Failure Assessment

AbstractSequential organ failure assessment (SOFA) score is used as a predictor of outcome of sepsis in the pediatric intensive care unit. The aim of the study is to determine the application of SOFA scores as a predictor of outcome in children admitted to the pediatric intensive care unit with a diagnosis of sepsis. The design involved is prospective observational study. The study took place at the multidisciplinary pediatric intensive care unit (PICU), tertiary care hospital, South India. The patients included are children, aged 1 month to 18 years admitted with a diagnosis of sepsis (suspected/proven) to a single center PICU in India from November 2017 to November 2019. Data collected included the demographic, clinical, laboratory, and outcome-related variables. Severity of illness scores was calculated to include SOFA score day 1 (SF1) and day 3 (SF3) using a pediatric version (pediatric SOFA score or pSOFA) with age-adjusted cutoff variables for organ dysfunction, pediatric risk of mortality III (PRISM III; within 24 hours of admission), and pediatric logistic organ dysfunction-2 or PELOD-2 (days 1, 3, and 5). No intervention was observed during the period of study. A total of 240 patients were admitted to the PICU with septic shock during the study period. The overall mortality rate was 42 of 240 patients (17.5%). The majority (59%) required mechanical ventilation, while only 19% required renal replacement therapy. The PRISM III, PELOD-2, and pSOFA scores correlated well with mortality. All three severity of illness scores were higher among nonsurvivors as compared with survivors (p < 0.001). pSOFA scores on both day 1 (area under the curve or AUC 0.84) and day 3 (AUC 0.87) demonstrated significantly higher discriminative power for in-hospital mortality as compared with PRISM III (AUC, 0.7), and PELOD-2 (day 1, [AUC, 0.73]), and PELOD-2 (day 3, [AUC, 0.81]). Utilizing a cutoff SOFA score of >8, the relative risk of prolonged duration of mechanical ventilation, requirement for vasoactive infusions (vasoactive infusion score), and PICU length of stay were all significantly increased (p < 0.05), on both days 1 and 3. On multiple logistic regression, adjusted odds ratio of mortality was elevated at 8.65 (95% CI: 3.48–21.52) on day 1 and 16.77 (95% confidence interval or CI: 4.7–59.89) on day 3 (p < 0.001) utilizing the same SOFA score cutoff of 8. A positive association was found between the delta SOFA ([Δ] SOFA) from day 1 to day 3 (SF1–SF3) and in-hospital mortality (chi-square for linear trend, p < 0.001). Subjects with a ΔSOFA of ≥2 points had an exponential mortality rate to 50%. Similar association was—observed between ΔSOFA of ≥2 and—longer duration of inotropic support (p = 0.0006) with correlation co-efficient 0.2 (95% CI: 0.15–0.35; p = 0.01). Among children admitted to the PICU with septic shock, SOFA scores on both days 1 and 3, have a greater discriminative power for predicting in-hospital mortality than either PRISM III score (within 24 hours of admission) or PELOD-2 score (days 1 and 3). An increase in ΔSOFA of >2 adds additional prognostic accuracy in determining not only mortality risk but also duration of inotropic support as well.

scholarly journals A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

2010 ◽  
Vol 4 (4) ◽  
pp. 277-284 ◽  
Author(s):  
Colin K. Grissom ◽  
Samuel M. Brown ◽  
Kathryn G. Kuttler ◽  
Jonathan P. Boltax ◽  
Jason Jones ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Confidence Interval ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Laboratory Measurement ◽  
Receiver Operating Curve ◽  
Failure Assessment

ABSTRACTObjective: The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score.Methods: After a retrospective derivation in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during the 2008 calendar year and compared the ability to predict mortality and the need for mechanical ventilation.Results: A total of 1770 patients (56% male patients) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% confidence interval 0.81-.85) and 0.84 (95% confidence interval 0.82-.85), respectively (P = .33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the intensive care unit with an AUC of 0.78 and 0.79, respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted the need for mechanical ventilation on day 3, with an AUC of 0.83 and 0.82, respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58%, respectively.Conclusions: The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.(Disaster Med Public Health Preparedness. 2010;4:277-284)

scholarly journals Predictors of maternal outcome in women on mechanical ventilation in an obstetric intensive care unit: an observational study

2019 ◽  
Vol 8 (2) ◽  
pp. 721
Author(s):  
Tanu Soni ◽  
Priyadarshini Tiwari
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Coagulation System ◽  
P Value ◽  
Failure Assessment

Background: Present study was designed to note the indications for and the complications and outcome of women on mechanical ventilation in our obstetric intensive care unit, and in addition to look for the applicability and correlation of Sequential Organ Failure Assessment (SOFA) scores for the prediction of outcome in these women.Methods: A prospective observational study was conducted in the obstetric intensive care unit of our teaching hospital which included all women requiring mechanical ventilation in the study period. The diagnosis of the woman on admission, the clinical course and outcome along with total maximum sequential organ failure assessment (SOFA) score and SOFA score for each system were noted. Women were divided into two groups, survivors and non-survivors. Student t test and chi square test were used for analysis.Results: The foremost indication for mechanical ventilation was hypertension in pregnancy namely eclampsia and pre-eclampsia, followed by obstetric hemorrhage and then by hepatic failure. Maternal mortality rose significantly as the number of days of mechanical ventilation increased (p value <0.05). The total SOFA score correlated highly significantly with the outcome (p<0.0001).Conclusions: In women with eclampsia and pre-eclampsia suffering from respiratory failure, survival is inversely correlated with the number of days of mechanical ventilation. The total SOFA score is highly predictive of the woman’s outcome and all individual organ system scores also significantly correlate with outcome except for the score of coagulation system.

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