Survival outcomes after prolonged intensive care unit length of stay among trauma patients: The evidence for never giving up

Kisat, Mehreen; Latif, Asad; Zogg, Cheryl K.; Haut, Elliott R.; Zafar, Syed Nabeel; Hashmi, Zain G.; Oyetunji, Tolulope A.; Cornwell, Edward E.; Zafar, Hasnain; Haider, Adil H.

doi:10.1016/j.surg.2016.04.024

Cited by 29 publications

(28 citation statements)

References 32 publications

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“…Despite the fact that the performance of complex operative procedures on multimorbid patients has led to an increase of the ICU LOS in individual patients, we know little about the outcome of patients with a very long stay in an intensive care unit. The majority of recent studies focuses on ICU LOS between seven and twenty-one days [7–10] and less information is available on patients who stay in the ICU for over 30 days [20, 21]. …”

Section: Discussionmentioning

confidence: 99%

“…As shown by Kisat et al, the ICU mortality rates of trauma patients are high during the first 24 hours on the ICU reaching a value of about 10%. After the first day the mortality rates fall to 3.8% and then steadily increase reaching a maximum of 15% among trauma patients remaining in the intensive care unit from 41 to 90 days [21]. On the other hand, nontrauma patients admitted to a surgical ICU with an ICU LOS of at least 30 days had, compared to trauma patients, inferior outcomes with mortality rates of about 40% [16].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics and Outcomes of Surgical Patients with Intensive Care Unit Lengths of Stay of 90 Days and Greater

Martini

Lederer

Laessle

et al. 2017

Critical Care Research and Practice

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Background The aim of this study was to evaluate the influence of prolonged length of stay in an intensive care unit (ICU) on the mortality and morbidity of surgical patients. Methods We performed a monocentric and retrospective observational study in the surgical critical care unit of the department of surgery at the Medical Center of the University of Freiburg, Germany. Clinical data was collected from patients assigned to the ICU with a length of stay (LOS) of 90 days and greater. Results From the total of the 19 patients with ICU LOS over 90 days, ten patients died in the ICU whereas nine patients were discharged to the normal ward. The ICU mortality rate was 52%. The overall survival one year after ICU discharge was 32%. Regarding factors affecting mortality of the patients, significantly higher mortality was associated with age of the patients at the time point of the ICU admission and with postoperative need of renal replacement therapy. Conclusions We found a high but in our opinion acceptable mortality rate in surgical patients with ICU LOS of 90 days and greater. We identified age and the need of renal replacement therapy as risk factors for mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Surgical Patients with Intensive Care Unit Lengths of Stay of 90 Days and Greater

Martini

Lederer

Laessle

et al. 2017

Critical Care Research and Practice

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“…Decreasing LOS is an important focus of efforts to improve healthcare outcomes because the majority of patients, regardless of admission service, have been shown to have increased risk of mortality with increasing LOS. [20] The increased risk of mortality is most notably attributed to the correlation between LOS and hospital acquired bloodstream infections. [21] While the importance of structured hand-offs has been better characterized in medical fields, [22] there is limited data regarding Acute Care Surgery (ACS).…”

Section: Discussionmentioning

confidence: 99%

Morning report decreases length of stay in emergency general surgery patients

Gardner

Wolfe

Beck

et al. 2019

JHA

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Objective: Communication in the hospital setting is an easy target for quality improvement. Capturing this change via communication between providers during hand-offs is necessary to reduce delays and errors. While this process has been more widely characterized in medical specialties, we designed this study to address the knowledge gap in surgical specialties.Methods: Our institution’s division of Acute Care Surgery (ACS) implemented Morning Report (MR) in October of 2015. At MR, all admissions and service transfers were discussed from Trauma, Emergency General Surgery (EGS), and Surgical Critical Care services from the previous 24 hours. This study compared patients who underwent a surgical procedure during their hospital stay before and after protocol implementation.Results: 974 patients were included in this study. The average patient was 50.3 years of age, 65.4% were white, and 51.7% were male. The average length of stay (LOS) was 8.3 days with 1.75 days to procedure. The post-MR cohort LOS was 2.7 shorter and had 0.85 fewer days to procedure. In an adjusted regression analysis, days to procedure and LOS decreased by 33% (p < .01) and 17% (p < .01) respectively.Conclusions: Implementation of MR led to a decrease in the overall LOS and days to procedure for operative patients. Our results advocate for the standard use of structured hand-offs in surgical units.

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“…Although certain subsets of patients benefit from an extended stay in the ICU, the majority of both medicine and surgery patients are at an increased risk of mortality the longer they spend in the hospital. 9 This increased mortality can be attributed to many different factors; however, none have been more extensively studied than infection rates. Barnett et al 10 have described the significant correlation between an increased LOS and hospital-acquired bloodstream infections.…”

Section: Discussionmentioning

confidence: 99%

Morning report decreases length of stay in trauma patients

Wolfe

Gardner

Beck

et al. 2018

Trauma Surg Acute Care Open

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BackgroundModern acute care surgery (ACS) programs depend on consistent patient hand-offs to facilitate care, as most programs have transitioned to shift-based coverage. We sought to determine the impact of implementing a morning report (MR) model on patient outcomes in the trauma service of a tertiary care center.MethodsThe University of Arkansas for Medical Sciences (UAMS) Division of ACS implemented MR in October 2015, which consists of the trauma day team, the emergency general surgery day team, and a combined night float team. This study queried the UAMS Trauma Registry and the Arkansas Clinical Data Repository for all patients meeting the National Trauma Data Bank inclusion criteria from January 1, 2011 to April 30, 2018. Bivariate frequency statistics and generalized linear model were run using STATA V.14.2ResultsA total of 11 253 patients (pre-MR, n=6556; post-MR, n=4697) were analyzed in this study. The generalized linear model indicates that implementation of MR resulted in a significant decrease in length of stay (LOS) in trauma patients.DiscussionThis study describes an approach to improving patient outcomes in a trauma surgery service of a tertiary care center. The data show how an MR session can allow for patients to get out of the hospital faster; however, broader implications of these sessions have yet to be studied. Further work is needed to describe the decisions being made that allow for a decreased LOS, what dynamics exist between the attendings and the residents in these sessions, and if these sessions can show some of the same benefits in other surgical services.Level of evidenceLevel 4, Care Management.

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Survival outcomes after prolonged intensive care unit length of stay among trauma patients: The evidence for never giving up

Cited by 29 publications

References 32 publications

Clinical Characteristics and Outcomes of Surgical Patients with Intensive Care Unit Lengths of Stay of 90 Days and Greater

Clinical Characteristics and Outcomes of Surgical Patients with Intensive Care Unit Lengths of Stay of 90 Days and Greater

Morning report decreases length of stay in emergency general surgery patients

Morning report decreases length of stay in trauma patients

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