Objective To reliably improve diagnostic fidelity and identify delays using a standardized approach applied to the electronic medical records of patients with emerging critical illness. Patients and Methods This retrospective observational study at Mayo Clinic, Rochester, Minnesota, conducted June 1, 2016, to June 30, 2017, used a standard operating procedure applied to electronic medical records to identify variations in diagnostic fidelity and/or delay in adult patients with a rapid response team evaluation, at risk for critical illness. Multivariate logistic regression analysis identified predictors and compared outcomes for those with and without varying diagnostic fidelity and/or delay. Results The sample included 130 patients. Median age was 65 years (interquartile range, 56-76 years), and 47.0% (52 of 130) were women. Clinically significant diagnostic error or delay was agreed in 23 (17.7%) patients (κ=0.57; 95% CI, 0.40-0.74). Median age was 65.4 years (interquartile range, 60.3-74.8) and 9 of the 23 (30.1%) were female. Of those with diagnostic error or delay, 60.9% (14 of 23) died in the hospital compared with 19.6% (21 of 107) without; P <.001. Diagnostic error or delay was associated with higher Charlson comorbidity index score, cardiac arrest triage score, and do not intubate/do not resuscitate status. Adjusting for age, do not intubate/do not resuscitate status, and Charlson comorbidity index score, diagnostic error or delay was associated with increased mortality; odds ratio, 5.7; 95% CI, 2.0-17.8. Conclusion Diagnostic errors or delays can be reliably identified and are associated with higher comorbidity burden and increased mortality.
BackgroundThe purpose of this study was to determine the ideal timing for providers to perform point-of-care ultrasound (POCUS) with the least increase in workload.MethodsWe conducted a pilot crossover study to compare 2 POCUS-assisted evaluation protocols for acutely ill patients: sequential (physical examination followed by POCUS) vs parallel (POCUS at the time of physical examination). Participants were randomly assigned to 2 groups according to which POCUS-assisted protocol (sequential vs parallel) was used during simulated scenarios. Subsequently, the groups were crossed over to complete assessment by using the other POCUS-assisted protocol in the same patient scenarios. Providers’ workloads, measured with the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and time to complete patient evaluation, were compared between the 2 protocols.ResultsSeven providers completed 14 assessments (7 sequential and 7 parallel). The median (IQR) total NASA-TLX score was 30 (30–50) in the sequential and 55 (50–65) in the parallel protocol (P = .03), which suggests a significantly lower workload in the sequential protocol. When individual components of the NASA-TLX score were evaluated, mental demand and frustration level were significantly lower in the sequential than in the parallel protocol (40 [IQR, 30–60] vs 50 [IQR, 40–70]; P = .03 and 25 [IQR, 20–35] vs 60 [IQR, 45–85]; P = .02, respectively). The time needed to complete the assessment was similar between the sequential and parallel protocols (8.7 [IQR, 6–9] minutes vs 10.1 [IQR, 7–11] minutes, respectively; P = .30).ConclusionsA sequential POCUS-assisted protocol posed less workload to POCUS operators than the parallel protocol.
cost between regular unit and ICU of $3200, and assuming a 1-day ICU stay after unwarranted transfer, the decrease in ICU transfers equates to a monthly saving of $48,000. Conclusions: Tele-ICU consultation via tablet devices can be used for immediate expert assessment during rapid response calls. Patient care, and allocation of limited ICU resources (personnel and beds), can be positively impacted by tele-ICU support during rapid response calls.Learning Objectives: Centenarians, who are 100 yr old and older, used be special people. Little fact about centenarians is known although an increase in centenarians will become the new global issue of medicine. Our aim is to describe characteristics of centenarians who are survived from OHCA in Japan. Methods: Our study is a nationwide population based observational design, which involved consecutive patients with OHCA in Japan from 2005 to 2010. We compared patient and EMS characteristics between patients with neurologicly favorable outcome and those with neurologicly unfavorable outcome in all centenarians with OHCA. We also stratified centenarians with OHCA who were performed CPR by witnessed bystanders. Results: There were 2,943 centenarians. Patients with neurologicly favorable outcome were more witnessed and performed bystander CPR than the others (P=0.014, P<0.01, respectively). They got return of spontaneous circulation (ROSC) more at pre-hospital (87.5% (14/16) vs 2.6% (75/2,925), P<0.01) in short durations (median 7 (5-8) min vs 19 (6-10) min, P<0.01). There was no bystander who was a familiar layperson in the group with neurologicly favorable outcome. They were less performed airway protection by EMS than the others (37.5% (6/16) vs 81.2% (2,374/2,925), P<0.01). Stratified analysis also showed similar results with all patients although stratified population become one fifth of all. Rate of one-month survival and neurologicly favorable outcome were 1.9% (56/2,941) and 0.5% (16/2,943), respectively in all and 4.0% (26/646) and 1.5% (10/646), respectively, after stratification. Among 16 centenarians neurologicly favorably survived from OHCA, at least nine patients had gotten ROSC before EMS arrival. They were not performed advanced prehospital treatment at all. Conclusions: Surprisingly, there were 16 centenarians with neurologicly favorable outcome one month after collapsed. To get pre-hospital ROSC in a very short period with basic life support by witnessed bystander who was not a familiar person is an associated factor to get neurologicly favorable outcome for centenarians with OHCA.
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