SummaryWe assessed the impact of a United Kingdom government‐recommended triage process, designed to guide the decision to admit patients to intensive care during an influenza pandemic, on patients in a teaching hospital intensive care unit. We found that applying the triage criteria to a current case‐mix would result in 116 of the 255 patients (46%) admitted during the study period being denied intensive care treatment they would have otherwise received, of which 45 (39%) survived to hospital discharge. In turn, 69% of those categorised as too ill to warrant admission according to the criteria survived. The sensitivity and specificity of the triage category at ICU admission predicting mortality was 0.29 and 0.84, respectively. If the need for intensive care beds is estimated to be 275 patients per week, the triage criteria would not exclude enough patients to prevent the need for further rationing. We conclude that the proposed triage tool failed adequately to prioritise patients who would benefit from intensive care.
surgery due to lack of level two facilities during the first year of operation.
MethodsWe audited the critical care database for booked admissions and cancellations to HDU and POSU of elective major surgery for the year prior to, and the year following the opening of a six-bedded POSU. Chi squared test was used to compare occurrences of events before and after the opening of POSU.
Introduction:Anaesthetists are among several health care practitioners responsible for neonatal resuscitation in Canada. The Neonatal resuscitation program (NRP) courses are the North American educational standard. NRP has been shown to be an effective way of learning skills and knowledge but retention has been found to be problematic [1]. The use of cognitive aids is mandatory in industries such as aviation, to avoid dependence on memory when decision making in critical situations. Visual cognitive aids have been studied retrospectively in resuscitation and performance was found to correlate to the frequency of use of the aid [2]. Cognitive aids have been found to be of benefit in an unblinded prospective study [3]. We aimed to conduct the first blinded study on the effect of a cognitive aid on the performance of simulated resuscitation. Methods: We conducted a single-blind randomized controlled trial to investigate whether the presence of a cognitive aid improved performance in a simulated neonatal resuscitation. After ethics board approval we recruited 32 anaesthesia residents who had previously passed the NRP. Subjects were randomized to an intervention group that had a poster detailing the NRP algorithm and a control group without the poster. The cognitive aid was positioned so that it could not be seen on the video recordings of the simulation that was used to assess performance. The scenario was piloted to confirm adequate blinding. Both groups had their performance in a simulated neonatal resuscitation recorded and subsequently analyzed by a peer, an expert anaesthetist and an expert neonatologist, using a previously validated checklist. A further rater observed the scenario in real time to examine frequency of use of the cognitive aid. Results: The inter-rater reliability of the checklist was excellent with an intraclass correlation coefficient of 0.88. Consequently the mean of the scores assigned by all three raters was used for analysis. The median checklist score in the control group 18.2 [15.0-20.5 (10.7-25.3)] was not significantly different from that in the intervention group 20. 3 [18.3-21.3 (15.0-24.3)] (P = 0.08). Retention of NRP skills and knowledge of was poor: when evaluated by the neonatologist none of the subjects correctly performed all life-saving interventions necessary to pass the checklist. Although only one subject in the intervention group did not use the aid at all, only 26.7% used the aid frequently and none used it extensively.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.