Journal of critical care
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Journal of critical care · Aug 2012
Comparative StudyStaff satisfaction between 2 models of care for the chronically critically ill.
Chronically critically ill (CCI) patients are a growing population in intensive care units (ICUs), and evidence suggests that this patient group is perceived as demanding by healthcare professionals. However, information is scarce regarding organizational factors that affect staff satisfaction during the care of CCI patients. ⋯ Results from this study provide information about health-care professionals' perceived burden of care when treating CCI patients. Strategies promoting professional development have a potential to increase staff satisfaction when it comes to the care of this patient group.
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Journal of critical care · Aug 2012
A model to predict short-term death or readmission after intensive care unit discharge.
Early unplanned readmission to the intensive care unit (ICU) carries a poor prognosis, and post-ICU mortality may be related, in part, to premature ICU discharge. Our objectives were to identify independent risk factors for early post-ICU readmission or death and to construct a prediction model. ⋯ Among patients without treatment-limitation decisions and discharged alive from the ICU, 3.0% died or were readmitted within 7 days. Independent risk factors were indicators of patients' severity and discharge at night. Our prediction model should be evaluated in other ICU populations.
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Journal of critical care · Aug 2012
Predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy.
The purpose of the study was to identify the predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy (PDT). ⋯ Patients undergoing PDT have significant short-term mortality with 11% dying within 14 days and an in-hospital mortality rate of 30%. We identified an index diagnosis of ventilator-associated pneumonia and trauma to be associated with a higher survival rate, whereas older age, oncological diagnosis, cardiogenic shock, and ventricular-assist devices were associated with higher mortality. There is significant heterogeneity in both underlying diagnosis and patient outcomes, and these factors should be considered when deciding to perform this procedure and discussed with patients/family members to provide a realistic expectation of potential prognosis.
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Journal of critical care · Aug 2012
Prognostic models based on administrative data alone inadequately predict the survival outcomes for critically ill patients at 180 days post-hospital discharge.
There is interest in evaluating the quality of critical care by auditing patient outcomes after hospital discharge. Risk adjustment using acuity of illness scores, such as Acute Physiology and Chronic Health Evaluation (APACHE III) scores, derived from clinical databases is commonly performed for in-hospital mortality outcome measures. However, these clinical databases do not routinely track patient outcomes after hospital discharge. Linkage of clinical databases to administrative data sets that maintain records on patient survival after discharge can allow for the measurement of survival outcomes of critical care patients after hospital discharge while using validated risk adjustment methods. ⋯ The addition of APACHE III scores to administrative data substantially improved model performance to the level of the clinical model. Although linking data systems requires some investment, having the ability to evaluate case ascertainment and accurately risk adjust outcomes of intensive care patients after discharge will add valuable insights into clinical audit and decision-making processes.
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Journal of critical care · Aug 2012
Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units.
The reported actual compliance for severe sepsis bundles was very low, suggesting the presence of barriers to their implementation. The purpose of this study was to assess the influence of full-time intensivist and nurse-to-patient ratio in Korean intensive care units (ICUs) on the implementation of the severe sepsis bundles and clinical outcome. ⋯ The full-time intensivist and the nurse-to-patient ratio had a substantial influence on the implementation of severe sepsis bundles and the mortalities of patients with severe sepsis.