Controlled trial to improve resident sign-out in a medical intensive care unit

Nanchal, Rahul; Aebly, Brian; Graves, Gabrielle; Truwit, Jonathon D.; Kumar, Gagan; Taneja, Amit; Dagar, Gaurav; Graf, Jeanette; Hubertz, Erin; Ramalingam, Vijaya Sivalingam; Fletcher, Kathlyn E.

doi:10.1136/bmjqs-2017-006657

Cited by 15 publications

(17 citation statements)

References 25 publications

(6 reference statements)

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“…However, the large effect sizes (a 2-day shorter ICU LOS and 7% lower rate of mortality) suggest lack of power may partially explain our null results. Similar to how Nanchal and others used structure to improve ICU shift handoffs,24 this novel intervention bundle holds promise to provide structure to service transitions in a meaningful way. Despite the lack of incentive as motivation or extra time to complete, resident and nursing adoption of the transition bundle was impressive with 98% of handoffs completed at the bedside, 72% including nurses, 81% including patients or families and 81% using the structured ICU transition checklist.…”

Section: Discussionmentioning

confidence: 96%

“…Similarly, patients transitioning between locations17 18 or to home from the hospital may be at risk related to ineffective handoffs 19–21. Evidence-based practices targeting these handoffs have been developed that may improve both communication and patient outcomes 4 5 22–25…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, this specific and substantial transition has not been investigated in the critically ill—a population often considered one of the most vulnerable to medical errors. Organised structure facilitates care in the intensive care unit (ICU), and recent work found that a structured ICU-specific handoff template may improve perceived outcomes during resident shift handoff at night,24 but interventions aimed at service handoff have not been tested.…”

Section: Introductionmentioning

confidence: 99%

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Improving end-of-rotation transitions of care among ICU patients

et al. 2019

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BackgroundHospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking.ObjectiveDevelop and implement a multidisciplinary patient-centred handoff intervention to improve outcomes for patients who are critically ill during end-of-rotation transitions.Design, setting and participantsSingle-centre, controlled pilot study of medical intensive care unit (ICU) patients whose resident team was undergoing end-of-rotation transition at a university hospital from June 2017 to February 2018.InterventionA 4-item intervention was implemented over two study periods. Intervention 1 included: (1) in-person bedside handoff between teams rotating off and on service, (2) handoff checklist, (3) nursing involvement in handoff, and (4) 30 min education session. Intervention 2 included the additional option to conduct bedside handoff via videoconferencing.Main outcome measuresImplementation was measured by repeated clinician surveys and direct observation. Patient outcomes included length of stay (LOS; ICU and hospital) and mortality (ICU, hospital and 30 days). Clinician perceptions were modelled over time using per cent positive responses in logistic regression. Patient outcomes were compared with matched control ‘transition’ patients from 1 year prior to implementation of the intervention.ResultsAmong 270 transition patients, 46.3% were female with a mean age of 55.9 years. Mechanical ventilation (64.1%) and in-hospital death (27.6%) rates were prevalent. Despite high implementation rates—handoff participation (93.8%), checklist utilisation (75.0%), videoconferencing (62.5%), nursing involvement (75.0%)—the intervention did not significantly improve LOS or mortality. Multidisciplinary survey data revealed significant improvement in acceptability by nursing staff, while satisfaction significantly declined for resident physicians.ConclusionsIn this controlled pilot study, a structured ICU end-of-rotation care transition strategy was feasible to implement with high fidelity. While mortality and LOS were not affected in a pilot study with limited power, the pragmatic strategy of this intervention holds promise for future trials.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving end-of-rotation transitions of care among ICU patients

et al. 2019

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“…Additionally, patients with critical illnesses in ICUs are known to be prone to rapid clinical degradation. 2 Although a disease is the primary cause of hospital admissions, this is not the case when we refer to admissions of young people to ICUs, as other factors that involve extreme or intrusive behaviors are often responsible. 3,4 According to studies, the most common causes of admission of young people to ICUs are social and financial reasons, such as poverty, unemployment, low level of education or even psychological reasons, like anxiety, low self-esteem, uncertainty and insecurity for the future, etc.…”

Section: Introductionmentioning

confidence: 99%

Causes of admission of patients 18-30 years old in intensive care units

et al. 2019

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Introduction: The causes that lead to the admission of young adults into Intensive Care Units (ICUs) are a multivariable phenomenon of modern times with a variety of social extensions.Aim: The purpose of this study was to investigate the causes of admission of young adult population aged 18-30 in Intensive Care Units.Method and material: The studied population consisted of people aged 18-30 years who were hospitalized in an Intensive Care Unit of Attica, Greece during the years 2016 and 2017. A specially formatted registration form was used to collect the data, which except for the demographic data, included variables related to the reasons of admission to ICU, the duration of the hospitalization, as well as the final outcome. The SPSS 23 statistical package and the x2 method were used to analyze the data.Results: The 71.1% of the study population were male and 28.9% female. Regarding nationality, 81.1% were Greeks, while 18.9% were foreigners. As a first cause of admission to ICU was the road traffic accidents with percentage of 41.2%, followed by pathological causes with 32%, postoperative monitoring with 16.2%, suicide attempts at 4.4%, drug abuse at 3.5%, and work-related accidents at 2.6%. The statistical analysis of the results showed that men were more frequently admitted into the ICUs compared to women with a statistically significant difference p <0,000. The marital status does not seem to be related to the frequency of admission, which also applies to nationality, comparing the percentage of foreigners in the sample with the percentage of the population, there was no statistically significant difference. By studying the other social and demographic characteristics, there was a statistically significant dependence of the causes of admission both with the profession (p = 0.001) and with the place of residence (p = 0,013). The overwhelming majority (87.5%) of drug addicts and 50% of those who attempting to commit suicide were unemployed.Conclusions: It is identified that demographic and social characteristics affect to a large extent the admission of young people into the ICU.

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“…In addition, there are tools developed to evaluate the quality of written handover documents, which have been tested in critical care settings. 18 Different mnemonics are also utilized for the same purpose. Neurosurgical procedure and the care provided during the perioperative period are more complex.…”

mentioning

confidence: 99%