AimIntrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation.Design and implementationWe conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme.ResultsThe implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001).ConclusionThe implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.
Objective Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated factors of MV reinstitution. Methods We analyzed the clinical data and physiological measurements of tracheostomized patients with prolonged MV discharged from the weaning unit to general wards after successful weaning to compare between those with and without in-hospital MV reinstitution within 60 days. Results Of 454 patients successfully weaned, 116 (25.6%) reinstituted MV at general wards within 60 days; at hospital discharge, 42 (36.2%) of them were eventually liberated from MV, 51 (44.0%) remained MV dependent, and 33 (28.4%) died. Of the 338 patients without reinstitution within 60 days, only 3 (0.9%) were later reinstituted with MV before discharge (on day 67, 89 and 136 at general wards, respectively), and 322 (95.2%) were successfully weaned again at discharge, while 13 (3.8%) died. Patients with MV reinstitution had a significantly lower level of maximal expiratory pressure (P E max) before unassisted breathing trial compared to those without reinstitution. Multivariable Cox regression analysis showed fever at RCC discharge (hazard ratio [HR] 14.00, 95% confidence interval [CI] 3.2-61.9) chronic obstructive pulmonary disease (HR 2.37, 95% CI 1.34-4.18), renal replacement therapy at the ICU (HR 2.29, 95% CI 1.50-3.49) and extubation failure before tracheostomy (HR 1.76, 95% CI 1.18-2.63) were associated with increased risks of reinstitution, while P E max > 30 cmH 2 O (HR 0.51, 95% CI 0.35-0.76) was associated with a decreased risk of reinstitution.
Background: Higher prevalence rate of patients with prolonged mechanical ventilation, among them have ventilated at home. However, unplanned hospital readmission of home ventilated patients remains a critical issue. Therefore, to explore the characteristics and prognosis of unplanned readmissions of patients using a home ventilator and to analyze relevant pre-discharge factors that affect such unplanned readmissions.Methods: A retrospective study was conducted to collect medical record data for 2013–2017 on the readmission of home-ventilated patients in a medical center in northern Taiwan. In all, 127 cases were considered. Unplanned readmissions were divided by time intervals (≤ 30 days, 31–180 days, 181–365 days, ≥ 366 days) into an early readmission group (≤ 30 days) and a late readmission group (≥ 31 days). Statistical analysis, a chi-square test, and a multivariate logistic regression analysis model were used to verify the factors influencing the readmission of home-ventilated patients.Results: Patients’ populations according to the intervals of unplanned readmission (≤ 30 days, 31–180 days, 181–365 days, ≥ 366 days) were 42 (33.1%), 60 (47.2%), 17 (13.4%), and 8 (6.3%), respectively. The average intervals of home care for the early readmission group (≤ 30 days) and the late readmission group (≥ 31 days) were 15.1 ± 9.2 and 164.8 ± 143.2 days, respectively. Regarding risk factors of early and late unplanned hospital readmission, the odds ratio (OR) for patients with chronic cardiovascular disease compared with those without this disease was 4.535 (95% CI 1.253 -16.413). For maximum inspiratory pressure ≦ −30 cmH2O compared with > −30 cmH2O, the OR for early readmission was 0.207 (95% CI 0.056 - 0.767). For hemoglobin ≥ 10.1 g/dL compared with < 10.1 g/dL, the OR of early readmission was 0.280 (95% CI 0.082 - 0.958).Conclusion: Pre-discharge problems, including chronic cardiovascular disease, maximum inspiratory pressure, and reduced hemoglobin, are risk factors for unplanned early hospitalization readmission of patients using a ventilator at home. Therefore, attention should be paid to these risk factors during discharge planning.
Exploring the characteristics and prognosis of unplanned readmissions of patients using a home ventilator and analyzing relevant pre-discharge factors that affect such unplanned readmissions.A retrospective study was conducted to collect medical record data for 2013–2017 on the readmission of home-ventilated patients in a medical center in northern Taiwan. The average intervals of home care for the early readmission group (≤ 30 days) and the late readmission group (≥ 31 days) were 15.1 ± 9.2 and 164.8 ± 143.2 days, respectively. Regarding risk factors of early and late unplanned hospital readmission, the odds ratio (OR) for patients with chronic cardiovascular disease compared with those without this disease was 4.535 (95% CI 1.253 -16.413). For maximum inspiratory pressure ≦ −30 cmH2O compared with > −30 cmH2O, the OR for early readmission was 0.207 (95% CI 0.056 - 0.767). For hemoglobin ≥ 10.1 g/dL compared with < 10.1 g/dL, the OR of early readmission was 0.280 (95% CI 0.082 - 0.958). So, pre-discharge problems, including chronic cardiovascular disease, maximum inspiratory pressure, and reduced hemoglobin, are risk factors for unplanned early hospitalization readmission of patients using a ventilator at home. Therefore, attention should be paid to these risk factors during discharge planning.
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