Critical care medicine
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Critical care medicine · Aug 2014
Comparative StudyAn Empirical Comparison of Key Statistical Attributes Among Potential ICU Quality Indicators.
Good quality indicators should have face validity, relevance to patients, and be able to be measured reliably. Beyond these general requirements, good quality indicators should also have certain statistical properties, including sufficient variability to identify poor performers, relative insensitivity to severity adjustment, and the ability to capture what providers do rather than patients' characteristics. We assessed the performance of candidate indicators of ICU quality on these criteria. Indicators included ICU readmission, mortality, several length of stay outcomes, and the processes of venous-thromboembolism and stress ulcer prophylaxis provision. ⋯ No indicator performed optimally across assessments. Future research should seek to define and operationalize quality in a way that is relevant to both patients and providers.
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Critical care medicine · Aug 2014
Use of a Daily Goals Checklist for Morning ICU Rounds: A Mixed-Methods Study.
To understand the perspectives and attitudes of ICU clinicians about use of a daily goals checklist on rounds. ⋯ The daily goals checklist was perceived to improve the management of critically ill patients by creating a systematic, comprehensive approach to patient care and by setting individualized daily goals. Reportedly improving interprofessional communication and practice, the daily goals checklist also enhanced patient safety and daily progress, encouraging momentum in recovery from critical illness. Daily goals checklist review prompted teaching opportunities for multidisciplinary learners on morning rounds.
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Critical care medicine · Aug 2014
Identifying Critically Ill Patients at Risk for Inappropriate Antibiotic Therapy: A Pilot Study of a Point-of-Care Decision Support Alert.
To develop an automated alert aimed at reducing inappropriate antibiotic therapy of serious healthcare-associated infections. ⋯ Our results suggest that a simple automated alert could identify more than 40% of critically ill patients prescribed inappropriate antibiotic therapy for healthcare-associated infections. These data suggest that an opportunity exists to employ hospital informatics systems to improve the prescription of antibiotic therapy in ICU patients with suspected healthcare-associated infections.
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Critical care medicine · Aug 2014
Observational StudyObesity and 1-Year Outcomes in Older Americans With Severe Sepsis.
Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index. ⋯ Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.
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Critical care medicine · Aug 2014
Comparative StudyThe Return on Investment of Implementing a Continuous Monitoring System in General Medical-Surgical Units.
To evaluate the cost savings attributable to the implementation of a continuous monitoring system in a medical-surgical unit and to determine the return on investment associated with its implementation. ⋯ Implementation of this monitoring system was associated with a highly positive return on investment. The magnitude and timing of these expected gains to the investment costs may justify the accelerated adoption of this system across remaining inpatient non-ICU wards of the community hospital.