Accuracy of delirium risk factors in adult intensive care unit patients

Objective: To assess the accuracy measurements for predisposing and precipitating Risk Factors for delirium in an adult Intensive Care Unit. Method: Cohort, prospective study with patients over 18 who had been hospitalized for over 24 hours and were able to communicate. The patients were assessed once a day until the onset of delirium or permanence in the Intensive Care Unit. Instruments were employed to track delirium, characterize the sample, and identify the risk factors. Descriptive statistics was employed for sample characterization and accuracy tests for risk factors. Results: The included patients amounted to 102, 31 of which presented delirium. The predisposing predictive risk factors were hypoalbuminemia, American Society of Anesthesiology over three, severity, altered tissue perfusion, dehydration, and being a male, whereas precipitating predictive factors were physical restraint, infection, pharmacological agent, polypharmacy, anemia, altered renal function, dehydration, invasive devices, altered tissue perfusion and altered quality and quantity of sleep. Conclusion: An accurate identification of predisposing and precipitating risk factors may contribute to planning preventive measures against delirium.

The Effects of Introducing a Mobile Application-Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study (Preprint)

BACKGROUND To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs utilising a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile application (App) could provide the ideal platform for trainees in an adult intensive care unit (ICU). OBJECTIVE To compare trainee compliance with completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an App-based logbook. METHODS A retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a two-year period in the adult ICU of the John Hunter Hospital (JHH), Newcastle, NSW, Australia, participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in patients’ electronic medical records (EMR) appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor’s signature for the before and after periods. We also analysed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. RESULTS Of 2,987 CVC insertions documented in the EMR between April 7, 2019, and April 6, 2021, 2,161 (72%) were included and separated into cohorts before and after the app’s introduction. Following the introduction of the App-based logbook the percentage of CVC insertions appearing as logbook entries increased from 3.6% to 20.5% (P<.001). There was no difference in the proportion of supervisor approved entries containing a supervisor’s signature before and after the introduction of the app, with 76.3% and 83.2% respectively (P=.31). Following the introduction of the App there was an increase in the percentage of active logbook users from 15.1% to 62.4% (P<.001). Adherence to one’s logbook was similar in both groups with 75% of first-time users in the before group and 79.5% in the after group going on to log at least 3 or more CVCs during their time working in ICU. CONCLUSIONS The addition of an electronic, mobile, app-based logbook to a pre-existing paper-based logbook, was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in ICU.