Format
Sort by
Items per page

Send to

Choose Destination

Search results

Items: 1 to 20 of 710

1.
PLoS One. 2019 Jan 15;14(1):e0210875. doi: 10.1371/journal.pone.0210875. eCollection 2019.

The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review.

Author information

1
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
2
Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
3
Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
4
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.

Abstract

BACKGROUND:

Vital signs, i.e. respiratory rate, oxygen saturation, pulse, blood pressure and temperature, are regarded as an essential part of monitoring hospitalized patients. Changes in vital signs prior to clinical deterioration are well documented and early detection of preventable outcomes is key to timely intervention. Despite their role in clinical practice, how to best monitor and interpret them is still unclear.

OBJECTIVE:

To evaluate the ability of vital sign trends to predict clinical deterioration in patients hospitalized with acute illness.

DATA SOURCES:

PubMed, Embase, Cochrane Library and CINAHL were searched in December 2017.

STUDY SELECTION:

Studies examining intermittently monitored vital sign trends in acutely ill adult patients on hospital wards and in emergency departments. Outcomes representing clinical deterioration were of interest.

DATA EXTRACTION:

Performed separately by two authors using a preformed extraction sheet.

RESULTS:

Of 7,366 references screened, only two were eligible for inclusion. Both were retrospective cohort studies without controls. One examined the accuracy of different vital sign trend models using discrete-time survival analysis in 269,999 admissions. One included 44,531 medical admissions examining trend in Vitalpac Early Warning Score weighted vital signs. They stated that vital sign trends increased detection of clinical deterioration. Critical appraisal was performed using evaluation tools. The studies had moderate risk of bias, and a low certainty of evidence. Additionally, four studies examining trends in early warning scores, otherwise eligible for inclusion, were evaluated.

CONCLUSIONS:

This review illustrates a lack of research in intermittently monitored vital sign trends. The included studies, although heterogeneous and imprecise, indicates an added value of trend analysis. This highlights the need for well-controlled trials to thoroughly assess the research question.

PMID:
30645637
DOI:
10.1371/journal.pone.0210875
Free full text
Icon for Public Library of Science Icon for South & East Metropolitan Health Service Library, Australia

Conflict of interest statement

Dr. John Kellett is a major shareholder, director and chief medical officer of Tapa Healthcare DAC. The authors confirm that this does not alter their adherence to PLOS ONE policies on sharing data and materials.

2.
Acta Anaesthesiol Scand. 2019 Jan 8. doi: 10.1111/aas.13310. [Epub ahead of print]

Prehospital National Early Warning Score predicts early mortality.

Author information

1
Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
2
Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Abstract

BACKGROUND:

National Early Warning Score (NEWS) has been shown to be the best early warning score to predict in-hospital mortality but there is limited information on its predictive value in a prehospital setting. The aim of the current study was to investigate the diagnostic accuracy of NEWS in a prehospital setting using large population-based databases in terms of short-term mortality.

METHODS:

We calculated the NEWS scores from retrospective prehospital electronic patient record data and analysed their possible relationship to mortality. We included all patient records for patients 18 years or older with sufficient prehospital data to calculate NEWS from 17 August 2008 to 18 December 2015 encountered by the emergency medical services (EMS) in the Hospital District of Helsinki and Uusimaa, Finland. The primary outcome measure was death within 1 day of EMS dispatch.

RESULTS:

35 800 patients were included. Their mean (SD) age was 65.8 (19.9) years. The median value of NEWS was 3 (IQR 1-6). The primary outcome of death within 1 day of EMS dispatch occurred in 378 (1.1%) cases. Area under receiver operating characteristic curve (AUROC) for primary outcome of death within 1 day was 0.840 (95% CI 0.823-0.858). AUROC for 1 day mortality in trauma subgroup was 0.901 (95% CI 0.859-0.942).

CONCLUSION:

Prehospital NEWS predicts mortality within 1 day of EMS dispatch with good diagnostic accuracy.

PMID:
30623422
DOI:
10.1111/aas.13310
Icon for Wiley Icon for South & East Metropolitan Health Service Library, Australia
3.
J Nurses Prof Dev. 2019 Jan/Feb;35(1):18-24. doi: 10.1097/NND.0000000000000507.

The Impact of Hospital-Based In Situ Simulation on Nurses' Recognition and Intervention of Patient Deterioration.

Author information

1
Corinne Lee, DNP, RN-BC, ACNS-BC, is Educational Nurse Specialists, Michigan Medicine, Department of Professional Development and Education, Ann Arbor. Jolé L. Mowry, MS, RN, is Educational Nurse Specialists, Michigan Medicine, Department of Professional Development and Education, Ann Arbor. Susan E. Maycock, DNP, RN-BC, CNS-BC, is Educational Nurse Specialists, Michigan Medicine, Department of Professional Development and Education, Ann Arbor. Marie E. Colaianne-Wolfer, MSN, RN-BC, CCRN, is Educational Nurse Specialists, Michigan Medicine, Department of Professional Development and Education, Ann Arbor. Suzanne W. Knight, DNP, RN, is Educational Nurse Specialists, Michigan Medicine, Department of Professional Development and Education, Ann Arbor. Diane M. Wyse, MSN, RN-BC, is Educational Nurse Specialists, Michigan Medicine, Department of Professional Development and Education, Ann Arbor.

Abstract

Preparing nurses to recognize the signs and symptoms of a deteriorating patient and to provide appropriate initial interventions is essential. Hospital-based in situ simulation education is an effective evidence-based method that supports adult learning in a safe environment. The purpose of this article is to discuss the development, implementation, and evaluation of an in situ simulation program and the positive impact on nurses' confidence level in the recognition and initiation of interventions for a deteriorating patient.

4.
Eur J Emerg Med. 2018 Dec 24. doi: 10.1097/MEJ.0000000000000589. [Epub ahead of print]

Superior performance of National Early Warning Score compared with quick Sepsis-related Organ Failure Assessment Score in predicting adverse outcomes: a retrospective observational study of patients in the prehospital setting.

Author information

1
Anaesthetic and Critical Care Department, Queen Elizabeth University Hospital.
2
Emergency Department, Royal Alexandra Hospital.
3
ScotSTAR, Scottish Ambulance Service.
4
Institute for Research in Healthcare Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Paisley, UK.

Abstract

BACKGROUND:

Early intervention and response to deranged physiological parameters in the critically ill patient improve outcomes. A National Early Warning Score (NEWS) based on physiological observations has been developed for use throughout the National Health Service in the UK. The quick Sepsis-related Organ Failure Assessment Score (qSOFA) was developed as a simple bedside criterion to identify adult patients outwith the ICU with suspected infection who are likely to have a prolonged ICU stay or die in hospital. We aim to compare the ability of NEWS and qSOFA to predict adverse outcomes in a prehospital population.

PATIENTS AND METHODS:

All clinical observations taken by emergency ambulance crews transporting patients to a single hospital were collated along with information relating to mortality over a 2-month period. The performance of the NEWS and qSOFA in identifying the endpoints of 30-day mortality, ICU admission and a combined endpoint of 48 h. ICU admission or 30-day mortality was analysed.

RESULTS:

Complete data were available for 1713 patients. For the primary outcome of ICU admission within 48 h or 30-day mortality, the odds ratio for a qSOFA score of 3 compared with 0 was 124.1 [95% confidence interval (CI): 13.5-1137.7] and the odds ratio for a high NEWS category, compared with the low NEWS category was 9.82 (95% CI: 5.74-16.81). Comparison of qSOFA and NEWS performance was assessed using receiver operating characteristic curves. The area under the receiver operating characteristic curve for the primary outcome for qSOFA was 0.679 (95% CI: 0.624-0.733), for NEWS category was 0.707 (95% CI: 0.654-0.761) and for NEWS total score was 0.740 (95% CI: 0.685-0.795). Comparison of the receiver operating characteristic curves between NEWS total score and qSOFA using DeLong's test showed NEWS total score to be superior to qSOFA at predicting combined ICU admission within 48 h of presentation or 30-day mortality (P=0.011).

CONCLUSION:

Our study shows qSOFA can identify patients at risk of adverse outcomes in the prehospital setting. However, NEWS is superior to qSOFA in a prehospital environment at identifying patients at risk of adverse outcomes.

5.
Expert Rev Med Devices. 2018 Dec 22. doi: 10.1080/17434440.2019.1563480. [Epub ahead of print]

Wearable sensors to improve detection of patient deterioration.

Author information

1
a Department of Surgery and Cancer , Imperial College London , London , UK.
2
b West Middlesex University Hospital , Twickenham Road, Isleworth , UK.

Abstract

Monitoring a patient's vital signs forms a basic component of care, enabling the identification of deteriorating patients and increasing the likelihood of improving patient outcomes. Several paper-based track and trigger warning scores have been developed to allow clinical evaluation of a patient and guidance on escalation protocols and frequency of monitoring. However, evidence suggests that patient deterioration on hospital wards is still missed, and that patients are still falling through the safety net. Wearable sensor technology is currently undergoing huge growth, and the development of new light-weight wireless wearable sensors has enabled multiple vital signs monitoring of ward patients continuously and in real time. Areas covered: In this paper, we aim to closely examine the benefits of wearable monitoring applications that measure multiple vital signs; in the context of improving healthcare and delivery. A review of the literature was performed. Expert commentary: Findings suggest that several sensor designs are available with the potential to improve patient safety for both hospital patients and those at home. Larger clinical trials are required to ensure both diagnostic accuracy and usability.

KEYWORDS:

Continuous monitoring; Hospital; Patient deterioration; Vital signs; Ward patients; Wearable sensors

6.
Clin Exp Emerg Med. 2018 Dec;5(4):219-229. doi: 10.15441/ceem.17.268. Epub 2018 Dec 31.

Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding.

Author information

1
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
2
National Cancer Control Institute, National Cancer Center, Goyang, Korea.

Abstract

OBJECTIVE:

We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score (GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB).

METHODS:

We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours.

RESULTS:

Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59-0.73, P=0.004), but not to GBS (0.70, 0.64-0.77, P=0.141) and AIMS65 (0.76, 0.70-0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%.

CONCLUSION:

The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB.

KEYWORDS:

Bleeding; Gastrointestinal; Lactate; Mortality; Risk

7.
Niger J Clin Pract. 2018 Dec;21(12):1590-1595. doi: 10.4103/njcp.njcp_58_18.

The prognastic efficiencies of modified early warning score and mainz emergency evaluation score for emergency department patients.

Author information

1
Department of Emergency Medicine, Maltepe University Faculty of Medicine, Istanbul, Turkey.
2
Department of Emergency Medicine, Izmir Medicalpark Hospital, Izmir, Turkey.
3
Department of Emergency Medicine, Inönü University Faculty of Medicine, Malatya, Turkey.

Abstract

Background:

Recently, there is an increasing interest for scoring systems to evaluate the critically ill patients by means of the severeness of their disease and their availibility for discharge in the emergency departments and intensive care units. Our aim in this study is to evaluate the efficiency of the mEWS and MEES scoring systems in assessing the severeness of the disease and predicting the mid term prognosis of the patients hospitalized following their emergency care in our emergency room.

Material and Method:

Patients, who attended to Inonu University Department of Emergency Medicine and hospitalized following their emergency care were included to our study. The effects of age, sex, triage categories, mEWS and MEES scores on the site of hospitalization and mortality was evaluated. Statistical analyses were performed by SPSS for Windows version 16.0. The data was summarized as means, standart deviation and percents. Univariate and multiavriate analyses were performed for risk factor calculations.

Results:

The mean age of the patients was 58±19 and 584 (56%) were male. Triage group 1 patients accounted for 21 of all (2%), while 646 (61%) were in group 2 and 384 (37%) were in triage group 3. Of all patients, 341 (32%) were hospitalized to ICU. While discharged patients accounted for 89% (935 patients) of the study group, 116 patients (11%) died at the hospital. The GCS, AVPU and mEWS values were statistically significant by means of patient mortality (P < 0.0001), but the delta MEES value was not (P < 0.127).

Conclusion:

The results of our stuy suggests that mEWS evaluation is an effective and reliable tool for predicting outcome and hospitalization areas of ED patients. Our results also displayed that the easily available GCS and AVPU scales are reliable guides in patient management. MEES values, on the other hand, are not convenient for ED use.

KEYWORDS:

AVPU; Glasgow Coma Scale; Modified Early Warning Score; critical patient; emergency department; mainz emergency evaluation scoring; prognosis

PMID:
30560822
DOI:
10.4103/njcp.njcp_58_18
Free full text
Icon for Medknow Publications and Media Pvt Ltd Icon for South & East Metropolitan Health Service Library, Australia

Conflict of interest statement

There are no conflicts of interest

8.
BMJ Open. 2018 Dec 14;8(12):e024120. doi: 10.1136/bmjopen-2018-024120.

Prognostic value of Modified Early Warning Score generated in a Chinese emergency department: a prospective cohort study.

Author information

1
Department of Nursing, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
2
Department of Nursing, The People's Hospital of Longhua, Shenzhen, China.
3
School of Nursing, Guangdong Medical University, Zhanjiang, China.
4
Emergency Department, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
5
Department of Intensive Care Unit, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
6
Reproductive Medicine Center, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
7
School of Nursing, Guangzhou Medical University, Guangzhou, China.
8
School of Nursing, Anhui Medical University, Hefei, China.
9
Research Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Abstract

OBJECTIVES:

This study aimed to validate the performance of the Modified Early Warning Score (MEWS) in a Chinese emergency department and to determine the best cut-off value for in-hospital mortality prediction.

DESIGN:

A prospective, single-centred observational cohort study.

SETTING:

This study was conducted at a tertiary hospital in South China.

PARTICIPANTS:

A total of 383 patients aged 18 years or older who presented to the emergency department from 17 May 2017 through 27 September 2017, triaged as category 1, 2 or 3, were enrolled.

OUTCOMES:

The primary outcome was a composite of in-hospital mortality and admission to the intensive care unit. The secondary outcome was using MEWS to predict hospitalised and discharged patients.

RESULTS:

A total of 383 patients were included in this study. In-hospital mortality was 13.6% (52/383), and transfer to the intensive care unit was 21.7% (83/383). The area under the receiver operating characteristic curve of MEWS for in-hospital mortality prediction was 0.83 (95% CI 0.786 to 0.881). When predicting in-hospital mortality with the cut-off point defined as 3.5, 158 patients had MEWS >3.5, with a specificity of 66%, a sensitivity of 87%, an accuracy of 69%, a positive predictive value of 28% and a negative predictive value of 97%, respectively.

CONCLUSION:

Our findings support the use of MEWS for in-hospital mortality prediction in patients who were triaged category 1, 2 or 3 in a Chinese emergency department. The cut-off value for in-hospital mortality prediction defined in this study was different from that seen in many other studies.

KEYWORDS:

("emergency") and "triage"; ("modified early warning score") or "mews"; emergency department

Conflict of interest statement

Competing interests: None declared.

9.
Jt Comm J Qual Patient Saf. 2018 Dec 3. pii: S1553-7250(18)30354-4. doi: 10.1016/j.jcjq.2018.10.005. [Epub ahead of print]

Reasons for Repeat Rapid Response Team Calls, and Associations with In-Hospital Mortality.

Abstract

BACKGROUND:

Previous publications noted increased mortality risk in patients subject to repeat rapid response team (RRT) calls. These patients were examined as a homogenous group, but there may be many reasons for repeat calls. Those potentially preventable by the rapid response system have not been investigated.

METHODS:

In a retrospective cohort study, patients with potentially preventable repeat calls were classified into two categories: type 1 (patients who had a repeat call following an initial call that ended despite the patient still triggering RRT calling criteria [T1-PRC]) and type 2 (patients with a repeat call within 24 hours of an initial call and for the same reason [T2-PRC]). In-hospital mortality for these patients and for those with repeat calls for all other reasons (ORC), were compared to patients with only a single call during their admission (SC).

RESULTS:

Mortality occurred in 31 (43.7%) T1-PRC, 13 (15.1%) T2-PRC, 56 (28.9%) ORC, and 289 (13.9%) SC patients. Univariate odds ratios (ORs), in comparison to SC patients, were 4.81 (95% confidence interval [CI]: 2.96-7.81; p < 0.001), 1.10 (95% CI: 0.60-2.02; p = 0.75), and 2.52 (95% CI: 1.80-3.52; p < 0.001), respectively. Mortality effects persisted for the T1-PRC and ORC groups after adjustment for patient, admission, and initial call characteristics with ORs of 4.07 (95% CI: 2.36-7.01; p < 0.001) and 2.29 (95% CI: 1.57-3.34; p < 0.001), respectively.

CONCLUSION:

This study found that repeat calls following an initial call that ended with ongoing breach of predefined calling criteria were strongly associated with increased mortality. This highlights the risk to patients when the RRT leaves reversible clinical deterioration unresolved at the end of a call.

10.
J Clin Nurs. 2018 Dec 5. doi: 10.1111/jocn.14728. [Epub ahead of print]

The National Early Warning Score predicts mortality in hospital ward patients with deviating vital signs: A retrospective medical record review study.

Author information

1
Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Faculty of Medicine, Lund University, Lund, Sweden.
2
Department of Anaesthesiology & Intensive Care, Hospital of Kristianstad, Region Skane, Sweden.
3
Department of Anaesthesiology, Copenhagen University Hospital, Hvidovre, Denmark.
4
Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden.
5
Department of Anesthesiology, Holbaek University Hospital, Zealand Region, Denmark.
6
Department of Health Sciences, Lund University, Lund, Sweden.

Abstract

AIMS AND OBJECTIVES:

To evaluate whether the scale used for assessment of hospital ward patients could predict in-hospital and 30-day mortality amongst those with deviating vital signs; that is, that patients classified as medium or high risk would have increased risk of in-hospital and 30-day mortality compared to patients with low risk.

BACKGROUND:

The National Early Warning Score (NEWS) is a widely adopted scale for assessing deviating vital signs. A clinical risk scale that comes with the NEWS divides the risk for critical illness into three risk categories, low, medium and high.

DESIGN:

Retrospective analysis of vital sign data.

METHODS:

Logistic regression models for age-adjusted in-hospital and 30-day mortality were used for analyses of 1,107 patients with deviating vital signs.

RESULTS:

Patients classified as medium or high risk by NEWS experienced a 2.11 or 3.40 increase, respectively, in odds of in-hospital death (95% CI: 1.27-3.51, p = 0.004% and 95% CI: 1.90-6.01, p < 0.001) compared to low-risk patients. Moreover, those with NEWS medium or high risk were associated with a 1.98 or 3.19 increase, respectively, in odds of 30-day mortality (95% CI: 1.32-2.97, p = 0.001% and 95% CI: 1.97-5.18, p < 0.001).

CONCLUSION:

The NEWS risk classification seems to be a reliable predictor of mortality on patients in hospital wards.

RELEVANCE TO CLINICAL PRACTICE:

The NEWS risk classification offers a simple way to identify deteriorating patients and can aid the healthcare staff to prioritise amongst patients.

KEYWORDS:

Early Warning Score; Medical Emergency Team; National Early Warning Score; critical care; critical care outreach; hospital mortality; in-hospital cardiac arrest; vital signs

11.
Appl Ergon. 2019 Feb;75:230-242. doi: 10.1016/j.apergo.2018.10.005. Epub 2018 Nov 12.

Eye-tracking reveals how observation chart design features affect the detection of patient deterioration: An experimental study.

Author information

1
School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, 4072, Australia.
2
School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, 4072, Australia; Clinical Skills Development Service, Metro North Hospital and Health Service, Herston, Brisbane, Queensland, 4006, Australia. Electronic address: Andrew.Hill@health.qld.gov.au.
3
School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, 4072, Australia; Clinical Skills Development Service, Metro North Hospital and Health Service, Herston, Brisbane, Queensland, 4006, Australia; School of Medicine, The University of Queensland, Herston, Brisbane, Queensland, 4006, Australia.

Abstract

Particular design features intended to improve usability - including graphically displayed observations and integrated colour-based scoring-systems - have been shown to increase the speed and accuracy with which users of hospital observation charts detect abnormal patient observations. We used eye-tracking to evaluate two potential cognitive mechanisms underlying these effects. Novice chart-users completed a series of experimental trials in which they viewed patient data presented on one of three observation chart designs (varied within-subjects), and indicated which observation was abnormal (or that none were). A chart that incorporated both graphically displayed observations and an integrated colour-based scoring-system yielded faster, more accurate responses and fewer, shorter fixations than a graphical chart without a colour-based scoring-system. The latter, in turn, yielded the same advantages over a tabular chart (which incorporated neither design feature). These results suggest that both colour-based scoring-systems and graphically displayed observations improve search efficiency and reduce the cognitive resources required to process vital sign data.

KEYWORDS:

Clinical deterioration; Human factors; Patient safety

12.
Medicine (Baltimore). 2018 Nov;97(48):e13490. doi: 10.1097/MD.0000000000013490.

Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team: A cohort study.

Author information

1
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine.
2
Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea.

Abstract

Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions.The median age of the 184 subjects included was 72 (inter quartile range, 62-75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 ± 6.0 vs 32.4 ± 7.7, P = .002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P = .001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P = .228).In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.

PMID:
30508979
PMCID:
PMC6283106
DOI:
10.1097/MD.0000000000013490
[Indexed for MEDLINE]
Free PMC Article
Icon for Wolters Kluwer Icon for PubMed Central Icon for South & East Metropolitan Health Service Library, Australia
13.
J Crit Care. 2019 Feb;49:187-192. doi: 10.1016/j.jcrc.2018.09.002. Epub 2018 Oct 26.

Rapid response team review of hemodynamically unstable ward patients: The accuracy of cardiac index assessment.

Author information

1
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
2
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; ANZIC Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: glenn.eastwood@austin.org.au.
3
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia. Electronic address: helen.young@austin.org.au.
4
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia. Electronic address: leah.peck@austin.org.au.
5
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; ANZIC Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: daryl.jones@austin.org.au.
6
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Intensive Care Research, Austin Hospital, Melbourne, Victoria, Australia; Co-director ANZICS Research Centre, Monash University, Melbourne, Australia; Intensive Care, The University of Melbourne, Melbourne, Australia; Medicine, Monash University, Melbourne, Australia. Electronic address: rinaldo.bellomo@austin.org.au.

Abstract

PURPOSE:

Intensive care doctors commonly attend rapid response team (RRT) reviews of hospital-ward patients with hemodynamic instability and estimate the patient's likely cardiac index (CI). We aimed to non-invasively measure the CI of such patients and assess the level of agreement between such measurements and clinically estimated CI categories (low <2L/min/m2, normal 2-2.99L/min/m2 or high ≥3L/min/m2).

MATERIALS AND METHODS:

A prospective, observational study of non-invasive measurement and clinical estimation of CI categories in 50 adult hospital-ward patients who activated the RRT for 'hemodynamic instability' (tachycardia > 100BPM or hypotension < 90mmHg or both).

RESULTS:

The CI was measured in 47/50(94%) patients and the mean CI was 3.5(95% CI 3.2-3.7) L/min/m2. Overall, 30(64%) patients had a high CI, 13(28%) and 4(9%) had a normal and a low CI, respectively. The level of agreement between measured and clinically estimated CI categories was low(19.2%). Sensitivity and positive predictive values of clinical estimation were low(0% and 3.3% for high CI, and 0% and 50% for low CI, respectively).

CONCLUSIONS:

Non-invasive CI measurement was possible in almost all hospital-ward patients triggering RRT review for hemodynamic instability. In such patients, the CI was high, and intensive care clinicians were unable to identify a low or a high CI state.

KEYWORDS:

Cardiac index; Cardiac output; Hemodynamic monitoring; Medical emergency team; Non-invasive; Rapid response team

14.
Aust Crit Care. 2018 Nov 20. pii: S1036-7314(18)30120-6. doi: 10.1016/j.aucc.2018.09.006. [Epub ahead of print]

Nurses' recognition and response to clinical deterioration in the cardiac catheterisation laboratory.

Author information

1
School of Nursing and Midwifery, Deakin University, Geelong, Australia; MonashHeart, Clayton, Victoria, Australia. Electronic address: kevin.white@monashhealth.org.
2
School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Eastern Health Partnership, Box Hill, Victoria, Australia.
3
School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia.

Abstract

BACKGROUND:

Patients presenting to the cardiac catheter laboratory for treatment of unstable acute coronary syndromes (ACS) experience a mismatch in myocardial oxygen supply and demand, causing vital sign abnormalities prior to neurological, cardiac and respiratory deterioration. Delays in detecting clinical deterioration and escalating care increases risk of adverse events, unplanned intensive care (ICU) admission, cardiac arrest, and in-hospital mortality.

OBJECTIVES:

The objective of the study was to explore how nurses in the cardiac catheter laboratory (CCL) recognise and respond to clinical deterioration in patients with unstable ACS undergoing primary percutaneous coronary intervention (PCI).

METHODS:

A prospective exploratory descriptive design was used with 30 participants completing 10 written clinical scenarios. Participants scored their level of concern for each physiological cue and then then ranked their preferred immediate response based on the deterioration identified.

RESULTS:

Hypotension and the presence of pain were the physiological cues of highest concern. The most common responses to clinical deterioration were to increase vital sign assessment to 5-minutely intervals, administer pain relief or provide reassurance. Despite the presence of clinical deterioration fulfilling organisational escalation of care criteria, calling cardiac arrest or rapid response team (RRT) were not commonly selected responses.

CONCLUSION:

Nurses most commonly use hypotension and the presence of pain to recognise clinical deterioration in patients presenting to the CCL with an unstable ACS. Once clinical deterioration is identified, interventional cardiac nurses delay the escalation of care to the RRT or cardiac arrest team, preferring to implement local nurse initiated interventions.

KEYWORDS:

Acute coronary syndrome; Cardiac nursing; Nursing; Patient safety; Percutaneous coronary intervention

15.
Crit Care Med. 2018 Dec;46(12):e1229-e1230. doi: 10.1097/CCM.0000000000003404.

In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample: Does Telemetry Monitoring Have a Role to Play?

Author information

1
Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, and Grady Memorial Hospital, Atlanta, GA.
16.
Eur J Pediatr. 2019 Feb;178(2):229-234. doi: 10.1007/s00431-018-3285-9. Epub 2018 Nov 9.

Recognizing critically ill children with a modified pediatric early warning score at the emergency department, a feasibility study.

Author information

1
Department of Pediatrics, Maasstad Hospital, Room 1F2042, PO box 9100, 3007 AC, Rotterdam, The Netherlands.
2
Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, dr. Molenwaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
3
Department of Pediatrics, Maasstad Hospital, Room 1F2042, PO box 9100, 3007 AC, Rotterdam, The Netherlands. verhoevenjj@maasstadziekenhuis.nl.

Abstract

Pediatric Early Warning Scores were developed to monitor clinical deterioration of children admitted to the hospital. Pediatric Early Warning Scores could also be useful in the Emergency Department to quickly identify critically ill patients so treatment can be started without delay. To determine if a newly designed, fast, and easy to use Modified Pediatric Early Warning Score can identify critically ill children in the Emergency Department. We conducted a retrospective observational study in the Emergency Department of an urban district hospital in Rotterdam, the Netherlands. Patients < 16 years attending the Emergency Department with an internal medical problem were included. Immediate intensive care unit admission was used as a measure for critically ill children. During the study period 2980 children attended the Emergency Department, ten (0.4%) of them required immediate intensive care unit admission. The Modified Pediatric Early Warning Score can identify critically ill children in the general pediatric Emergency Department population (area under the ROC curve 0.82). A sensitivity of 80% and specificity of 85% show potential to rule out critical illness in children visiting the Emergency Department when these results are validated in a larger population. A model containing both the Modified Pediatric Early Warning Score and the Manchester Triage System did not perform significantly better than the Manchester Triage System alone but did show a positive tendency in favor of the model containing the Modified Pediatric Early Warning Score and Manchester Triage System, area under the ROC curve 0.89 [95% CI 0.77-1.00] versus area under the ROC curve 0.82 [95% CI 0.68-0.95].Conclusions: In this feasibility study, the Modified Pediatric Early Warning Score could be a fast and easy to use tool to identify critically ill children in the general pediatric Emergency Department population. The effectiveness of the Modified Pediatric Early Warning Score may be optimized if combined with triage systems such as the Manchester Triage System. A larger prospective study is needed to confirm our results. What is known: • Pediatric Early Warning Scores can identify children who are in need for immediate intensive care unit admission at the Emergency Department. • Pediatric Early Warning Scores can be time-consuming, contain subjective parameters or parameters which are difficult to obtain in a reliable and standardized method. What is new: • We introduce a simplified, manageable and smartly designed Pediatric Early Warning Score on a pocket card based on an existing and previously investigated Pediatric Early Warning Score. • In this feasibility study the diagnostic performance of the Modified Pediatric Early Warning Score to predict immediate intensive care unit admission in the Emergency Department is in line with the original Pediatric Early Warning Scores but has to be validated on a larger scale.

KEYWORDS:

Emergency department; Intensive care; Pediatric early warning scores; Referral and consultation; Triage

17.
Hosp Pract (1995). 2018 Nov 8:1-4. doi: 10.1080/21548331.2019.1546529. [Epub ahead of print]

The impact of proactive rounding on rapid response team calls: an observational study.

Author information

1
a Assistant Professor of Clinical Medicine, IU School of Medicine , Indiana University Health Physicians , Indianapolis , IN , USA.
2
b Fellow Division of Nephrology , IU School of Medicine , Indianapolis , IN , USA.
3
c Department of Biostatistics , IU School of Medicine and Richard M. Fairbanks School of Public Health , Indianapolis , IN , USA.
4
d Regenstrief Institute , Indiana University School of Medicine , Indianapolis , IN , USA.

Abstract

BACKGROUND:

Rapid response teams (RRTs) improve mortality by intervening in the hours preceding arrest. Implementation of these teams varies across institutions.

SETTING AND DESIGN:

Our health-care system has two different RRT models at two hospitals: Hospital A does not utilize a proactive rounder while Hospital B does. We studied the patterns of RRT calls at each hospital focusing on the differences between night and day and during nursing shift transitions.

RESULTS:

The presence of proactive surveillance appeared to be associated with an increased total number of RRT calls with more than twice as many calls made at the smaller Hospital B than Hospital A. Hospital B had more calls in the daytime compared to the nighttime. Both hospitals showed a surge in the night-to-day shift transition (7-8am) compared to the preceding nighttime. Hospital A additionally showed a surge in calls during the day-to-night shift transition (7-8pm) compared to the preceding daytime.

CONCLUSIONS:

Differences in the diurnal patterns of RRT activation exist between hospitals even within the same system. As a continuously learning system, each hospital should consider tracking these patterns to identify their unique vulnerabilities. More calls are noted between 7-8am compared to the overnight hours. This may represent the reestablishment of the 'afferent' arm of the RRT as the hospital returns to daytime staffing and activity. Factors that influence the impact of proactive rounding on RRT performance may deserve further study.

KEYWORDS:

Hospital rapid response team; diurnal variations; emergency treatment; hospital

18.
Pediatr Crit Care Med. 2018 Nov 1. doi: 10.1097/PCC.0000000000001796. [Epub ahead of print]

Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility.

Author information

1
Department of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
2
Department of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
3
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

Abstract

OBJECTIVES:

Satellite inpatient facilities of larger children's hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children's hospital. Herein, we compare this model with our in-person model at our main campus.

DESIGN:

Cross-sectional.

SETTING:

A tertiary pediatric center and its satellite facility.

PATIENTS:

Patients admitted to the satellite facility.

INTERVENTIONS:

Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support.

MEASUREMENTS AND MAIN RESULTS:

We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model.

MAIN RESULTS:

Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45-55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation.

CONCLUSIONS:

Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities.

19.
BMJ Open. 2018 Nov 3;8(11):e023749. doi: 10.1136/bmjopen-2018-023749.

Team talk and team decision processes: a qualitative discourse analytical approach to 10 real-life medical emergency team encounters.

Author information

1
Department of Circulation and Medical Imaging, The Norwegian University of Science and Technology, Trondheim, Norway.
2
Department of Anaesthesia and Intensive Care Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
3
Department of Language and Literature, The Norwegian University of Science and Technology, Trondheim, Norway.
4
Department of Anaesthesiology and Intensive Care, Finnmarkssykehuset, Hammerfest, Norway.
5
Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.

Abstract

OBJECTIVES:

Explore the function of three specific modes of talk (discourse types) in decision-making processes.

DESIGN:

Ten real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.

SETTING:

Interdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).

PARTICIPANTS:

All emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.

RESULTS:

The three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.

CONCLUSION:

A discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.

KEYWORDS:

qualitative research; quality In health care

Conflict of interest statement

Competing interests: None declared.

20.
Crit Care. 2018 Oct 30;22(1):286. doi: 10.1186/s13054-018-2194-7.

Multicenter derivation and validation of an early warning score for acute respiratory failure or death in the hospital.

Author information

1
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
2
Department of Anesthesiology, HCL CHU Croix-Rousse, Lyon, France.
3
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
4
Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
5
Department of Systems & Computational Biology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, USA.
6
Division of Critical Care Medicine, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Main Floor, Gold Zone, 111 East 210th Street, Bronx, NY, 10467, USA. mgong@montefiore.org.

Abstract

BACKGROUND:

Acute respiratory failure occurs frequently in hospitalized patients and often starts before ICU admission. A risk stratification tool to predict mortality and risk for mechanical ventilation (MV) may allow for earlier evaluation and intervention. We developed and validated an automated electronic health record (EHR)-based model-Accurate Prediction of Prolonged Ventilation (APPROVE)-to identify patients at risk of death or respiratory failure requiring >= 48 h of MV.

METHODS:

This was an observational study of adults admitted to four hospitals in 2013 or a fifth hospital in 2017. Clinical data were extracted from the EHRs. The 2013 patients were randomly split 50:50 into a derivation/validation cohort. The qualifying event was death or intubation leading to MV >= 48 h. Random forest method was used in model derivation. APPROVE was calculated retrospectively whenever data were available in 2013, and prospectively every 4 h after hospital admission in 2017. The Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS) were calculated at the same times as APPROVE. Clinicians were not alerted except for APPROVE in 2017cohort.

RESULTS:

There were 68,775 admissions in 2013 and 2258 in 2017. APPROVE had an area under the receiver operator curve of 0.87 (95% CI 0.85-0.88) in 2013 and 0.90 (95% CI 0.84-0.95) in 2017, which is significantly better than the MEWS and NEWS in 2013 but similar to the MEWS and NEWS in 2017. At a threshold of > 0.25, APPROVE had similar sensitivity and positive predictive value (PPV) (sensitivity 63% and PPV 21% in 2013 vs 64% and 16%, respectively, in 2017). Compared to APPROVE in 2013, at a threshold to achieve comparable PPV (19% at MEWS > 4 and 22% at NEWS > 6), the MEWS and NEWS had lower sensitivity (16% for MEWS and NEWS). Similarly in 2017, at a comparable sensitivity threshold (64% for APPROVE > 0.25 and 67% for MEWS and NEWS > 4), more patients who triggered an alert developed the event with APPROVE (PPV 16%) while achieving a lower false positive rate (FPR 5%) compared to the MEWS (PPV 7%, FPR 14%) and NEWS (PPV 4%, FPR 25%).

CONCLUSIONS:

An automated EHR model to identify patients at high risk of MV or death was validated retrospectively and prospectively, and was determined to be feasible for real-time risk identification.

TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02488174 . Registered on 18 March 2015.

KEYWORDS:

Acute respiratory failure; Early warning scores; Electronic health records; Prediction; Random forest

Supplemental Content

Loading ...
Support Center