scholarly journals Admission patterns in a psychiatric intensive care unit in Ireland: a longitudinal follow-up

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S281-S282
Author(s):  
Shaeraine Raaj ◽  
Sujesha Navanathan ◽  
Basil Matti ◽  
Anisha Bhagawan ◽  
Pauline Twomey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Psychotic Disorder ◽  
Clinical Care ◽  
Bipolar Affective Disorder ◽  
Categorical Variables ◽  
Care Centre ◽  
The Mean ◽  
The Phoenix

AimsThis observational study aims to describe the course of the admission and clinical characteristics of admissions to the PICUs in the Phoenix Care Centre, Dublin, Ireland. The authors hypothesised that the length of stay (LOS) would be shorter in male patients as compared to females.MethodThis retrospective cohort study was carried out at the Phoenix Care Centre Dublin, Ireland. Informed consent was not sought as this was a retrospective chart study involving anonymised clinical data which was collected as part of routine clinical care and no items of information were reported that would enable the identification of any subject. We described primary outcomes using frequencies, percentages, mean and standard deviations, median and interquartile ranges (IQR). Between groups comparisons were made using x2 tests for categorical variables; t-tests, ANOVA tests, or Kruskal-Wallis tests, for continuous variables; All analyses were two-tailed, and a P-value ≤ 0.05 was considered statistically significantResultOver the study period from Jan 2014 to Jan 2017 inclusive, there were 96 admission episodes to the PICU. The mean age of admitted cases was 37.1 (SD = 11.3) years (range 18–63 years). The mean length of stay (LOS) was 59.3 (SD = 61.0) days (median 39.5 days). All patients were admitted under the Mental Health Act legislation. We identified assault as the primary risk factor for pre-admission 62% (n = 62) to the PICU. Antipsychotic polypharmacy was used in 61% (n = 55) of the admission. The mean daily antipsychotic dosage was 139.4 % (SD = 65.1) of BNF maximum daily dose. A diagnosis of acute psychotic disorder (B= -1.027, p = 0.003, 95% CI: –1.691 to –0.363) was associated with reduced LOS in PICU. Majority of admissions 43% (n = 39) had a diagnosis of schizophrenia, followed by Bipolar affective disorder BPAD 21% (n = 21), schizoaffective disorder 18% (n = 18), and acute psychotic disorder 9% (n = 9).ConclusionPsychiatric Intensive Care Unit is an essential service for the severely ill psychiatric patients and is a progressively developing sub-speciality. An important finding from our study describes the cohort of patients admitted being predominantly male, younger-aged, single, with a diagnosis of schizophrenia, legally detained, and from an Irish background. The primary indication for a referral is the risk of assault, showing the need for the intensive and secure treatment model that a PICU can provide.

scholarly journals Admission patterns in a psychiatric intensive care unit in Ireland: a longitudinal follow-up

2021 ◽  
pp. 1-8
Author(s):  
S. Raaj ◽  
S. Navanathan ◽  
B. Matti ◽  
A. Bhagawan ◽  
P. Twomey ◽  
...  
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Characteristics ◽  
Treatment Model ◽  
Care Centre ◽  
Primary Indication ◽  
The Mean ◽  
The Phoenix

Objective: This study aims to describe the course of admission and clinical characteristics of admissions to a psychiatric intensive care unit (PICU) in the Phoenix Care Centre (PCC), Dublin, Ireland. Methods: This retrospective chart study was conducted at the PCC, Dublin, Ireland. The cohort included all admission episodes (n = 91 complete data) over a three-year study period between January 2014 and January 2017. Results: The mean age of admitted cases was 37.1 (s.d. = 11.3; range 18–63). The mean length of stay (LOS) was 59.3 days (s.d. = 61.0; median 39.5 days). All patients were admitted under Mental Health Act legislation. Antipsychotic polypharmacy was used in 61% (n = 55) of the admissions. A diagnosis of acute psychotic disorder (B = −1.027, p = 0.003, 95% CI: −1.691, −0.363) was associated with reduced LOS in PICU. Conclusion: Our study describes the cohort of patients admitted as being predominantly male, younger-aged, single, having a diagnosis of schizophrenia and being legally detained. The primary indication for referral is risk of assault, which highlights the need for the intensive and secure treatment model that a PICU can provide.

scholarly journals 1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S713-S713
Author(s):  
Carlo Fopiano Palacios ◽  
Eric Lemmon ◽  
James Campbell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Linear Regression ◽  
Length Of Stay ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
P Value ◽  
Fisher Exact Test ◽  
The Mean ◽  
Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

scholarly journals (P2-94) How One Group of Physicians Helped a Busy Emergency Department

2011 ◽  
Vol 26 (S1) ◽  
pp. s167-s167
Author(s):  
J. Hu ◽  
J. Xu ◽  
J. Botler ◽  
S. Haydar
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Medical Center ◽  
Hospital Medicine ◽  
Intermediate Care ◽  
Physician Time ◽  
The Mean ◽  
Medical Telemetry

A pilot admission leadership physician (ALP) program was experimented within a 693-bed, tertiary medical center with a 60-bed emergency department. This trial was intended to investigate whether having a physician triage potential patients would shorten patients' length-of-stay in the emergency department. After a emergency physician evaluated patients, ALP triaged them. The ALP ordered the appropriate bed for the patients if they qualified for the inpatient criteria, choosing among medical, medical telemetry, cardiac telemetry, intermediate care, or intensive care bed. The mean patient door-to-bed order time (time between patients reaching the emergency department to time to bed ordered by ALP) is 330.7 minutes (n = 234, SD = 151.68, 95% CI = 310.21–351.28) with ALP involvement. Compared with the mean door-to-bed order time of 337.8 minutes (n = 827, SD = 149.71, 95%CI = 326.98–348.57) without ALP, ALP shortened the waiting time by 7.09 minutes. During the same period, the door-to-physician time was 41.38 minutes (SD = 38.87 95%CI = 36.38–46.39), compared with 39.52 minutes (SD = 40.32, 95%CI = 36.77–42.27) before ALP. The time for patients waiting in the emergency department for other services such as surgery, psychiatry, and pediatrics also have decreased accordingly. Incorrect medical admissions such as scrambling to get the patient to the intensive care unit right after seeing patients has decreased (data not provided). Identifying physicians as physicians in the emergency department who triage potential admissions also has improved efficiencies within the hospital medicine group and bonding with ER physicians.

scholarly journals The assessment of clinical evaluation and treatment results of high-energy blunt polytrauma patients

Medicina ◽  
2007 ◽  
Vol 43 (2) ◽  
pp. 137 ◽  
Author(s):  
Algimantas Pamerneckas ◽  
Andrei Pijadin ◽  
Giedrius Pilipavičius ◽  
Gintaras Tamulaitis ◽  
Vytautas Toliušis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Ventilation Time ◽  
Polytrauma Patients ◽  
The Mean

The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome. Materials and methods. Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively. Results. The mean age of multiple trauma patients was 43.9±1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17–64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5±0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5±0.7, 7.0±0.8, and 23.6±1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died. Conclusions. Working-age male pedestrians (17–64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common.

scholarly journals The Effects of Early Rehabilitation in the Intensive Care Unit for Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study

2022 ◽  
Vol 11 (2) ◽  
pp. 357
Author(s):  
Tokio Kinoshita ◽  
Yukihide Nishimura ◽  
Yasunori Umemoto ◽  
Yasuhisa Fujita ◽  
Ken Kouda ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Small Sample ◽  
Icu Length Of Stay ◽  
The Mean ◽  
Mean Time

This retrospective cohort study aimed to examine the rehabilitation effect of patients with coronavirus disease 2019 (COVID-19) in the intensive care unit (ICU) under mechanical ventilation and included ICU patients from a university hospital who received rehabilitation under ventilator control until 31 May 2021. Seven patients were included, and three of them died; thus, the results of the four survivors were examined. The rehabilitation program comprised the extremity range-of-motion training and sitting on the bed’s edge. The Sequential Organ Failure Assessment score (median (25–75th percentiles)) at admission was 7.5 (5.75–8.5), and the activities of daily living (ADLs) were bedridden, the lowest in the Functional Independence Measure (FIM) and Barthel Index (BI) surveys. Data on the mean time to extubation, ICU length of stay, and ADLs improvement (FIM and BI) during ICU admission were obtained. Inferential analyses were not performed considering the small sample size. The mean time to extubation was 4.9 ± 1.1 days, and the ICU length of stay was 11.8 ± 5.0 days. ΔFIM was 36.5 (28.0–40.5), and the ΔBI was 22.5 (3.75–40.0). Moreover, no serious adverse events occurred in the patients during rehabilitation. Early mobilization of patients with COVID-19 may be useful in ADLs improvement during ICU stay.

scholarly journals Use of Penalized Count Regression to Determine Factors Affecting the Length of Stay of Trauma Patients in the Intensive Care Unit

2021 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Variable Selection ◽  
Oxygen Saturation ◽  
Chest Trauma ◽  
Trauma Patients ◽  
Selection Methods ◽  
Factors Affecting ◽  
The Mean

Background: Trauma is considered an important issue in most countries. Identification of the factors affecting the length of stay (LOS) in the intensive care unit (ICU) plays a crucial role in controlling the costs and complications of prolonged hospitalization. Objectives: This study aimed to identify the factors affecting the LOS of trauma patients in the ICU using stepwise and new penalized variable selection methods in count data regression. Methods: The patients’ information was evaluated in Emtiaz Hospital and Shahid Rajaee trauma center in Shiraz from March 2016 to September 2017. Count regression model was used to determine the factors affecting the LOS of patients in the ICU using penalized variable selection including, Enet, Snet, and Mnet. Results: The mean age of the patients (n=382) was obtained at 36.7±16.7 years, and the majority (88.4%) of the patients were male. The mean LOS in the ICU was determined at 6.2±6.6 days. Mnet with a negative binomial distribution outperformed the other penalized variable selection methods. A Glasgow Coma Scale (GCS) of less than 9 (IRR=1.7), blunt brain trauma (IRR=1.8), chest trauma (IRR=2.2), and oxygen saturation of less than 90 (IRR=1.2) increased the LOS of trauma patients in the ICU. Conclusions: Penalized variable selection methods effectively ignore or control the existing correlations between predictors. Amongst the penalized models, Mnet provided more acceptable results with smaller Akaike information criterion and fewer predictors. According to this penalty, the most important factors affecting the length of stay were chest trauma, blunt brain trauma, GCS, and oxygen saturation rate. Most clinical studies on trauma have also shown the importance of these factors.

Factors Associated with Recovery of Acinetobacter baumannii in a Combat Support Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 664-666 ◽  
Author(s):  
Matthew E. Griffith ◽  
Russell S. Gonzalez ◽  
John B. Holcomb ◽  
Duane R. Hospenthal ◽  
Glenn W. Wortmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Acinetobacter Baumannii ◽  
Retrospective Review ◽  
Hospital Records ◽  
Us Army ◽  
Factors Associated ◽  
The Mean ◽  
Host Nation

A retrospective review of hospital records for Acinetobacter baumannii infection at a US Army combat support hospital revealed a monthly infection rate ranging from 20.5 to 0 cases per 1,000 patients admitted. The rate correlated with the mean census of host-nation patients in the intensive care unit, the mean census of host-nation patients on the wards, and length of stay in the intensive care unit.

scholarly journals A Retrospective Analysis and Comparison of Prisoners and Community-Based Patients with COVID-19 Requiring Intensive Care During the First Phase of the Pandemic in West Texas

2020 ◽  
Vol 11 ◽  
pp. 215013272095468
Author(s):  
Kiran Ali ◽  
Sanjana Rao ◽  
Gilbert Berdine ◽  
Victor Test ◽  
Kenneth Nugent
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Medical Intensive Care Unit ◽  
Prison Population ◽  
Community Based ◽  
Increased Risk ◽  
Gi Symptoms ◽  
Medical Intensive Care ◽  
The Mean

Background: COVID-19 is a highly infectious disease which usually presents with respiratory symptoms. This virus is disseminated through respiratory droplets, and, therefore, individuals residing in close quarters are at a higher risk for the acquisition of infection. The prison population is at a significantly increased risk for infection. Methods: Prisoners from the Montford Correctional facility in Lubbock, Texas, hospitalized in the medical intensive care unit at University Medical Center between March 1, 2020 and May 15, 2020 were compared to community-based patients hospitalized in the same medical intensive care unit. Clinical information, laboratory results, radiographic results, management requirements, and outcomes were compared. Results: A total of 15 community-based patients with a mean age of 67.4 ± 15.5 years were compared to 5 prisoners with a mean age of 56.0 ± 9.0 years. All prisoners were men; 10 community-based patients were men. Prisoners presented with fever, dyspnea, and GI symptoms. The mean number of comorbidities in prisoners was 2.4 compared to 1.8 in community-based patients. Prisoners had significantly lower heart rates and respiratory rates at presentation than community-based patients. The mean length of stay in prisoners was 12.6 ± 8.9 days; the mean length of stay in community-based patients was 8.6 ± 6.5. The case fatality rate was 60% in both groups. Conclusions: Prisoners were younger than community-based patients but required longer lengths of stay and had the same mortality rate. This study provides a basis for comparisons with future studies which could involve new treatment options currently under study.

Favorable Outcomes After Implementing a Nurse-Driven Sedation Protocol

2021 ◽  
Vol 41 (6) ◽  
pp. 29-35
Author(s):  
Samantha Green ◽  
Beth A. Staffileno
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Improvement Project ◽  
Sedation Protocol ◽  
Continuous Sedation ◽  
The Mean

Background In patients receiving mechanical ventilation, prolonged exposure to sedative and analgesic medications contributes to negative clinical outcomes. Objective To reduce exposure to sedative and analgesic medications among patients receiving mechanical ventilation by implementing a nurse-driven sedation protocol. Methods This quality improvement project followed a plan-do-study-act cycle. Nurses were educated on the protocol, and 30 patient medical records were reviewed both before and after protocol implementation. Data were extracted on intensive care unit length of stay, duration of mechanical ventilation, duration of continuous sedation, presence of delirium, pain, level of sedation, and performance and documentation of spontaneous awakening trials. Data were analyzed using descriptive statistics, the χ2 test, and calculated percent change. Results Forty-four nurses completed protocol education. The mean (SD) duration of mechanical ventilation decreased by 26% (from 5 [3.7] days to 3.7 [3.2] days), and the mean (SD) intensive care unit length of stay decreased by 27% (from 6.3 [4.3] days to 4.6 [3.7] days). The mean (SD) duration of continuous sedation decreased by 35% (from 6419 [7241] minutes to 4178 [4507] minutes). Spontaneous awakening trials documented increased by 35% (from 57% to 77%), and spontaneous awakening trials performed increased by 92% (from 40% to 77%), a statistically significant change (P = .004). Conclusion These preliminary data suggest that implementation of a nurse-driven sedation protocol resulted in favorable outcomes by decreasing duration of mechanical ventilation, intensive care unit length of stay, and duration of continuous sedation and increasing the number of spontaneous awakening trials performed.

scholarly journals Predictors and Incidence of Extubation Failure Post Modified Blalock Taussig Shunt in Infants

2021 ◽  
Author(s):  
Mohammed Al Ghafri ◽  
Safa Al Hadhrami ◽  
Hamid Al Badi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Prolonged Mechanical Ventilation ◽  
Unit Length ◽  
Extubation Failure ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Royal Hospital ◽  
Blalock Taussig Shunt

Abstract Objectives: To identify the characteristics of infants with extubation failure post Modified Blalock-Taussig Shunt (MBTS) and to determine the incidence and predictors of extubation failure in this group of infants and to compare it with the international figures.Methods: A single-center retrospective cohort study of infants < 1 year of age who underwent MBTS at the pediatric cardiac intensive care unit at Royal Hospital, Oman, from January 2010 to December 2019. We excluded infants who died before extubation, infants with missing data, and infants who underwent another surgical intervention before extubation. Ethical approval was obtained from the scientific research committee at the Royal Hospital. All categorical variables were presented as numbers and percentages. Analyses were performed using SPSS version 25. Results: A total of 146 infants were included in the study. Extubation failure occurred in 27 (18.5%) patients. Among those who failed extubation, 18 (66.7%) patients were ventilated before the surgery with statistically significant p-value of 0.019. A systolic blood pressure (SBP) ≤ 50th percentile was associated with extubation failure. Infants with extubation failure had longer intensive care unit length of stay and longer hospital length of stay. Severe respiratory distress and hemodynamic instability were the two main reasons for re-intubation.Conclusions: The lower incidence rate (18.5%) for extubation failure might indicate higher quality performance of our institution. Prolonged mechanical ventilation, requirements for escalation of inotropes, and SBP ≤ 50th percentile might be as predictors for extubation failure in infants post MBTS. Extubation failure is associated with longer intensive care unit and hospital admission.

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