scholarly journals Safety of transition from a routine to a selective intensive care admission pathway after elective open aneurysm repair

2021 ◽  
Vol 64 (1) ◽  
pp. E3-E8
Author(s):  
Danielle Dion ◽  
Laura Marie Drudi ◽  
Nathalie Beaudoin ◽  
Jean-François Blair ◽  
Stéphane Elkouri
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Perioperative Complications ◽  
Intermediate Care ◽  
Single Centre ◽  
Icu Admission ◽  
Intermediate Care Unit ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
Group B

Background: There is a growing trend to implement intermediate care units to avoid unnecessary costs associated with intensive care unit (ICU) admission and associated resources. We sought to evaluate the safety of transitioning from a routine to a selective policy of postoperative transfer to the ICU for elective open abdominal aortic aneurysm (AAA) repair. Methods: This retrospective study included consecutive open elective AAA repair procedures performed at a single centre from Aug. 8, 2010, to Dec. 1, 2014. Patients were identified through a prospectively maintained database, and electronic charts were reviewed. Patients with interventions before Mar. 13, 2012, were routinely sent to the ICU after operation (group A). Patients treated after this date were sent directly to an intermediate care unit (group B) unless preoperative or intraoperative factors deemed them suitable for ICU admission. The primary outcome was in-hospital death; secondary outcomes were perioperative complications and length of stay. We used logistic and linear regression to determine the association between the use of an intermediate care unit and the primary and secondary outcomes after adjusting for confounders and clinically relevant covariates. Results: The cohort comprised 310 patients (266 men, 44 women) with a mean age of 69.7 (standard deviation 10.1) years and a mean AAA diameter of 61.2 mm (SD 9.6 mm). Groups A and B included 118 and 192 patients, respectively. Admission to the ICU was spared in 149 patients (77.6%) in group B. Only 2 patients (1.3%) in group B were subsequently admitted to the ICU. There was no statistically significant difference in in-hospital mortality or perioperative complications between the 2 groups on multivariable logistic regression. There was a nonsignificant trend toward slightly shorter length of stay in group B. Conclusion: In this single-centre experience with the majority of patients sent directly to an intermediate care unit, there was no statistically significant difference in mortality or morbidity between routine and selective ICU admission. Our results confirm the safety of a selective ICU admission pathway.

scholarly journals Designing and Evaluating the Establishment of Admission Criteria for Patients in an Intensive Care Unit: A Descriptive Study in Iran

2021 ◽  
Author(s):  
Fariba Hosseinpour ◽  
Mahyar Sedighi ◽  
Fariba Hashemi ◽  
Sima Rafiei
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Statistical Tests ◽  
P Value ◽  
Admission Criteria ◽  
Total Cost ◽  
Icu Admission ◽  
Study Results ◽  
Significant Difference

Background: A few studies have reviewed and revised ICU admission criteria based on specific circumstances and local conditions. The aim was to develop ICU admission criteria and compare the cost, mortality, and length of stay among identified admission priorities. Methods: This was a cross-sectional study conducted in an intensive care unit of a training hospital in Qazvin, Iran. The study was conducted among 127 patients admitted to ICU from July to September 2019. The data collection tool was a self-designed checklist, which included items regarding patients' clinical data and their billing, type of diagnosis, level of consciousness at the time of hospitalization based on GCS scale or Glasgow Coma Scale, length of stay, and patient status at the time of discharge. Descriptive statistical tests were used to describe study variables, and in order to determine the relationship between study variables, ANOVA and Chi-square test were used. Results: A set of criteria were designed to prioritize patient admissions in ICU. Based on the defined criteria, patients were categorized into four groups based on patient's stability, hemodynamic, and respiration. Study findings revealed that a significant percentage of patients were admitted to the ward while in the second and third priorities of hospitalization (26.8 % and 32.3 %, respectively). There was a statistically significant difference in the four groups in terms of patients' age, total cost, and insurance share of the total cost (P-value < 0.05). Conclusion: Study results emphasize the necessity to classify patients based on defined criteria to efficiently use available resources.

scholarly journals Healthcare trajectories before and after critical illness: population-based insight on diverse patients clusters

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Youenn Jouan ◽  
Leslie Grammatico-Guillon ◽  
Noémie Teixera ◽  
Claire Hassen-Khodja ◽  
Christophe Gaborit ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Length Of Stay ◽  
Population Based ◽  
Hospital Length Of Stay ◽  
Healthcare Use ◽  
Icu Admission ◽  
Icu Discharge

Abstract Background The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients’ comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS—compared to pre-existing comorbidities—as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients’ healthcare use trajectories. Results Using discharge databases in a 2.5-million-people region in France, we retrieved, over 3 years, all adult patients admitted in ICU for septic shock or acute respiratory distress syndrome (ARDS), intubated at least 5 days and discharged alive from hospital: 882 patients were included. Median duration of mechanical ventilation was 11 days (interquartile ranges [IQR] 8;20), mean SAPS2 was 49, and median hospital length of stay was 42 days (IQR 29;64). Healthcare use (days spent in healthcare facilities) was analyzed 2 years before and 2 years after ICU admission. Prior to ICU admission, we observed, at the scale of the whole study population, a progressive increase in healthcare use. Healthcare trajectories were then explored at individual level, and patients were assembled according to their individual pre-ICU healthcare use trajectory by clusterization with the K-Means method. Interestingly, this revealed diverse trajectories, identifying patients with elevated and increasing healthcare use (n = 126), and two main groups with low (n = 476) or no (n = 251) pre-ICU healthcare use. In ICU, however, SAPS2, duration of mechanical ventilation and length of stay were not different across the groups. Analysis of post-ICU healthcare trajectories for each group revealed that patients with low or no pre-ICU healthcare (which represented 83% of the population) switched to a persistent and elevated healthcare use during the 2 years post-ICU. Conclusion For 83% of ARDS/septic shock survivors, critical illness appears to have a pivotal role in healthcare trajectories, with a switch from a low and stable healthcare use prior to ICU to a sustained higher healthcare recourse 2 years after ICU discharge. This underpins the hypothesis of long-term critical illness and PICS-related quantifiable consequences in healthcare use, measurable at a population level.

scholarly journals Risk factors for transfer from respiratory intermediate CARE unit to INTENSIVE CARE unit in COVID-19

2021 ◽  
Author(s):  
Enrico Buonamico ◽  
Vitaliano Nicola Quaranta ◽  
Esterina Boniello ◽  
Michela Dimitri ◽  
Valentina Di Lecce ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intermediate Care ◽  
Intermediate Care Unit

scholarly journals Anticipating pediatric patient transfers from intermediate to intensive care

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e14-e15
Author(s):  
Daryl Cheng ◽  
Caitlyn Hui ◽  
Kate Langrish ◽  
Carolyn Beck
Keyword(s):  
Heart Rate ◽  
Intensive Care ◽  
Length Of Stay ◽  
Respiratory Rate ◽  
Nursing Intervention ◽  
Admission Criteria ◽  
Close Monitoring ◽  
Paediatric Care ◽  
Significant Difference ◽  
Transferred Patients

Abstract BACKGROUND Paediatric intermediate care units (IC) function to provide a higher level of inpatient paediatric care such as frequent monitoring or nursing intervention compared to routine inpatient general paediatric care. A small subset of these patients in IC deteriorate further and require transfer to the paediatric intensive care unit (PICU). By identifying patient characteristics at the time of admission that predict secondary transfer, specific monitoring, resource allocation and early intervention may be implemented in order to improve quality of care. Appropriate and timely patient flow and length of stay (LOS) can also be optimized. DESIGN/METHODS The IC at our tertiary care institution admits predominantly general paediatric patients. Its admission criteria have been designed with input from stakeholders, and comprise a range of physiologic and resource based measures. Data were collected on patients who were admitted to IC, including those subsequently transferred to PICU, between July 2016 - June 2017. Patients whose index IC admission was from the PICU were excluded. Data included demographic and physiologic characteristics (heart rate, respiratory rate, temperature, oxygen therapy) and the bedside paediatric early warning system (BPEWS) score, a validated score based on vital signs. Quantitative and qualitative data were analyzed using Fisher and Mann-Whitney tests respectively. RESULTS 210 patient visits occurred in this time period, with 44 (20.95%) transferred to PICU (Table 1). Transferred patients showed no significant difference in age or sex. However, they had significantly higher median BPEWS, heart rate, respiratory rate and mean body temperature compared to non-transferred patients, as well as a significantly higher rate of respiratory support and shorter LOS on IC. There was a non-significant trend toward admission directly from the Emergency Department (ED) in transferred patients. Admission criteria and main organ systems affected were similar amongst both groups, with a predominance of respiratory conditions. PICU transfer was predicted by most physiological characteristics, including BPEWS. This coupled with a significantly shorter length of stay is a likely reflection of higher disease acuity in this group of patients and higher risk of deterioration and subsequent transfer to PICU. CONCLUSION The need for close monitoring of physiologic parameters remains paramount in predicting the need for transfer from the IC to PICU.

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 Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

scholarly journals Comparison of Dexmedetomidine versus Midazolam in weaning from mechanical ventilation and length of stay in ICU.

2020 ◽  
Vol 27 (11) ◽  
pp. 2309-2313
Author(s):  
Afia Arshed Dodhy
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Significant Relationship ◽  
Controlled Trial ◽  
Cost Study ◽  
Extubation Time ◽  
Group A ◽  
Surgical Icu ◽  
Group B

Objectives: To compare the role of dexmedetomidine versus midazolam as sedative in facilitating early mechanical ventilation weaning thereby decreasing ICU cost. Study Design: Randomized Controlled trial. Setting: Surgical ICU of Lahore General Hospital, Lahore. Period: December 2018 to July 2019. Material & Methods: Total of 60 adult postoperative patients (30 in each group) who required mechanical ventilation in the surgical ICU for minimum 24 hours postoperatively after major pelvi-abdominal operations were included. Patients of group “A” and “B” received midazolam infusion 20-100 mcg/kg/hr & dexmedetomidine infusion 0.2-0.7 μg/kg/hr respectively while being mechanically ventilated. The degree of sedation was measured by using the Richmond agitation sedation score (RASS) every 6 hourly. Extubation time (i.e. time from termination of drug to extubation) was recorded. The time of ICU length of stay was also recorded Results: Mean age of patients was 41.97 ±10.21 and 42.57±10.93 years in group-A and B, respectively. In group-A 18 patients (60%) and in group-B 16 patients (53.0%) were male while 12 patients (40%) in group-A and 14 patients (47.0%) were females. A significant decrease in extubation time was observed in Group-B when compared with the Group-A (p=0.046) along with odds ratio 0.938 while no significant relationship could be proved between length of stay at ICU between two groups. Stratification with regard to age, gender height, weight and type of surgery was carried out. Conclusion: Dexmedetomidine is more favourable than midazolam for sedation in intensive care patients by facilitating early exubation and decreasing the duration of invasive ventilation while no significant relationship could be proved in two groups between length of stay in intensive care unit.

scholarly journals Lactate Clearance as a Predictive Marker of Mortality in Adult Intensive Care Unit

2020 ◽  
Vol 5 (2) ◽  
pp. 32-38
Author(s):  
Shirish Raj Joshi ◽  
Renu Gurung ◽  
Subhash Prasad Acharya ◽  
Bashu Dev Parajuli ◽  
Navindra Raj Bista
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Lactate Clearance ◽  
Icu Mortality ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Significant Difference

Introduction: Lactate clearance has been widely investigated. Serial lactate concentrations can be used to examine disease severity and predict mortality in the intensive care unit. We investigated the diagnostic accuracy of lactate concentration and lactate clearance in predicting mortality in critically ill patients during the first 24 hours in Intensive Care Unit (ICU).Methods: It was a Prospective, observational study conducted in ICU. Sixty eight consecutive patients having blood lactate level >2 mmol/L were included irrespective of disease and postoperative status. We measured blood lactate concentration at ICU admission(H0), at six hours(H6), 12 hours(H12), and 24 hours(H24). Lactate clearance was measured for H0-H6, H0-H12 and H0-H24 time period.Results: ICU mortality was 33.8%. Lactate clearance was 15.80 ± 17.21% in survivors and 1.73±11% in non survivors for the H0-H6 (p = 0.001) and remained higher in survivors than in non survivors over the study period of 24 hours; 17.97±15 vs. -2.04±19.84% for H0-H12 and 27.40 ± 11.41% vs. -14.83 ± 26.84% for the H0-H24 period (p < 0.001 for each studied period). There was significant difference in lactate concentration (static) between survivors and non survivors during the course of initial 24 hours. The best predictor of ICU mortality was lactate clearance for the H0-H24 period (AUC =0.89; 95% CI 0.78-1.01). Logistic regression found that H0-H24 lactate clearance was independently correlated to a survival status (p = 0.005, OR = 0.922 and 95% CI 0.871-0.976).Conclusion: Blood lactate concentration and lactate clearance are both predictive for mortality during initial 24 hours of ICU admission.

scholarly journals Association of prescription opioid use on mortality and hospital length of stay in the intensive care unit

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250320
Author(s):  
Nicole Hardy ◽  
Fatima Zeba ◽  
Anaelia Ovalle ◽  
Alicia Yanac ◽  
Christelle Nzugang-Noutonsi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Icu Admission ◽  
Prescription Opioid Use

Objective Several studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases. However, the association of outpatient prescription opioid use on morbidity and mortality has not been adequately evaluated in a critical care setting. The purpose of this study was to determine if there is an association between chronic opioid use and mortality after an ICU admission. Design A single-center, longitudinal retrospective cohort study of all Intensive Care Unit (ICU) patients admitted to a tertiary-care academic medical center from 2001 to 2012 using the MIMIC-III database. Setting Medical Information Mart for Intensive Care III database based in the United States. Patients Adult patients 18 years and older were included. Exclusion criteria comprised of patients who expired during their hospital stay or presented with overdose; patients with cancer, anoxic brain injury, non-prescription opioid use; or if an accurate medication reconciliation was unable to be obtained. Patients prescribed chronic opioids were compared with those who had not been prescribed opioids in the outpatient setting. Interventions None. Measurements and main results The final sample included a total of 22,385 patients, with 2,621 (11.7%) in the opioid group and 19,764 (88.3%) in the control group. After proceeding with bivariate analyses, statistically significant and clinically relevant differences were identified between opioid and non-opioid users in sex, length of hospital stay, and comorbidities. Opioid use was associated with increased mortality in both the 30-day and 1-year windows with a respective odds ratios of 1.81 (95% CI, 1.63–2.01; p<0.001) and 1.88 (95% CI, 1.77–1.99; p<0.001), respectively. Conclusions Chronic opioid usage was associated with increased hospital length of stay and increased mortality at both 30 days and 1 year after ICU admission. Knowledge of this will help providers make better choices in patient care and have a more informed risk-benefits discussion when prescribing opioids for chronic usage.

scholarly journals Clinical characteristics and outcomes in diabetes patients admitted with COVID-19 in Dubai: a cross-sectional single centre study.

2020 ◽  
Author(s):  
Rahila Bhatti ◽  
Amar Omer ◽  
Samara Khattib ◽  
Seemin Shiraz ◽  
Glenn Matfin
Keyword(s):  
Length Of Stay ◽  
Clinical Characteristics ◽  
Single Centre ◽  
Cross Sectional ◽  
Centre Study ◽  
Icu Admission ◽  
Patients With Diabetes ◽  
Single Centre Study ◽  
D Dimer ◽  
Diabetes Patients

Aim: To describe the clinical characteristics and outcomes of hospitalised Coronavirus Disease 2019 (COVID-19) patients with diabetes. Methods: A cross-sectional observational study was conducted in patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates (UAE) from 30th March to 7th June 2020. They had laboratory and/or radiologically confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), known as COVID-19. Variation in characteristics, length of stay in hospital, diabetes status, comorbidities and outcomes were examined. Results: A total of 103 patients with confirmed COVID-19 presentations had diabetes. During the same timeframe, 410 patients overall were admitted with COVID-19 infection. This gives a total proportion of persons admitted with COVID-19 infection and coexistent diabetes/prediabetes of 25%. 67% (n=69) of the COVID-19 diabetes cohort were male. Patients admitted with COVID-19 and diabetes represented 17 different ethnicities. Of these, 59.2% (n=61) were Asians and 35% (n=36) were from Arab countries. Mean age (SD) was 54 (12.5) years. 85.4% (n=88) were known to have diabetes prior to admission, while 14.6% (n=15) were newly diagnosed with either diabetes or prediabetes during admission. Most patients in the study cohort had type 2 diabetes or prediabetes, with only 3% overall having type 1 diabetes (n=3). 46.9% of patients had evidence of good glycaemic control of their diabetes during the preceding 4-12 weeks prior to admission as defined arbitrarily by admission HbA1c <7.5%. 73.8% (n=76) had other comorbidities including hypertension, ischaemic heart disease, and dyslipidaemia. Laboratory data Mean(SD) on admission for those who needed ward-based care versus those needing intensive care unit (ICU) care: Fibrinogen 462.75 (125.16) mg/dl vs 660 (187.58) mg/dl ; D-dimer 0.66 (0.55) mcg/ml vs 2.3 (3.48) mcg/ml; Ferritin 358.08 (442.05) mg/dl vs 1762.38 (2586.38) mg/dl; and CRP 33.9 (38.62) mg/L vs 137 (111.72) mg/L were all statistically significantly higher for the ICU cohort (p<0.05). Average length of stay in hospital was 14.55 days. 28.2% of patients needed ICU admission. 4.9% (n=5) overall died during hospitalisation (all in ICU). Conclusions: In this single-centre study in Dubai, 25% of patients admitted with COVID-19 also had diabetes/prediabetes. Most diabetes patients admitted to hospital with COVID-19 disease were males of Asian origin. 14.6% had new diagnosis of diabetes/prediabetes on admission. The majority of patients with diabetes/prediabetes and COVID-19 infection had other important comorbidities (n=76; 73.8%). Only 4 patients had negative COVID-19 RT-PCR but had pathognomonic changes of COVID-19 radiologically. Our comprehensive laboratory analysis revealed distinct abnormal patterns of biomarkers that are associated with poor prognosis: Fibrinogen, D-dimer, Ferritin and CRP levels were all statistically significantly higher (p<0.05) at presentation in patients who subsequently needed ICU care compared with those patients who remained ward-based. 28.2% overall needed ICU admission, out of which 5 patients died. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region.

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