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Wasniewski ABR, Ricachinevsky CP, Rezende RQ, Lorentz BT, Silveira EDS, Angeli VHR, de Oliveira MG, da Silveira TR. Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1. CRITICAL CARE SCIENCE 2023; 35:377-385. [PMID: 38265319 PMCID: PMC10802767 DOI: 10.5935/2965-2774.20230215-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events. METHODS This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical. RESULTS A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79). CONCLUSION Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.
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Affiliation(s)
- Ana Beatriz Ramos Wasniewski
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
| | - Claudia Pires Ricachinevsky
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
| | - Raíssa Queiroz Rezende
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
| | - Bruna Tomasi Lorentz
- Instituto do Coração, Hospital de Clínicas,
Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP),
Brazil
| | | | - Viviane Helena Rampon Angeli
- Pediatric Intensive Care Unit, Hospital da Criança Santo
Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto
Alegre (RS), Brazil
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Kiesel LM, Bertsche A, Kiess W, Siekmeyer M, Bertsche T, Neininger MP. Intensive care drug therapy and its potential adverse effects on blood pressure and heart rate in critically ill children. World J Pediatr 2023; 19:902-911. [PMID: 36854951 PMCID: PMC10423157 DOI: 10.1007/s12519-023-00683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/02/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Owing to complex treatment, critically ill children may experience alterations in their vital parameters. We investigated whether such hemodynamic alterations were temporally and causally related to drug therapy. METHODS In a university pediatric intensive care unit, we retrospectively analyzed hemodynamic alterations defined as values exceeding the limits set for heart rate (HR) and blood pressure (BP). For causality assessment, we used the World Health Organization-Uppsala Monitoring Center (WHO-UMC) system, which categorizes the probability of causality as "certain," "probable," "possible," and "unlikely." RESULTS Of 315 analyzed patients with 43,200 drug prescriptions, 59.7% experienced at least one hemodynamic alteration; 39.0% were affected by increased HR, 19.0% by decreased HR, 18.1% by increased BP, and 16.2% by decreased BP. According to drug information databases, 83.9% of administered drugs potentially lead to hemodynamic alterations. Overall, 88.3% of the observed hemodynamic alterations had a temporal relation to the administration of drugs; in 80.2%, more than one drug was involved. Based on the WHO-UMC system, a drug was rated as a "probable" causing factor for only 1.4% of hemodynamic alterations. For the remaining alterations, the probability ratings were lower because of multiple potential causes, e.g., several drugs. CONCLUSIONS Critically ill children were frequently affected by hemodynamic alterations. The administration of drugs with potentially adverse effects on hemodynamic parameters is often temporally related to hemodynamic alterations. Hemodynamic alterations are often multifactorial, e.g., due to administering multiple drugs in rapid succession; thus, the influence of individual drugs cannot easily be captured with the WHO-UMC system.
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Affiliation(s)
- Lisa Marie Kiesel
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstr. 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Division of Neuropediatrics, University Hospital for Children and Adolescents, Fleischmannstr. 8, 17475 Greifswald, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Manuela Siekmeyer
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstr. 32, 04103 Leipzig, Germany
| | - Martina Patrizia Neininger
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Bruederstr. 32, 04103 Leipzig, Germany
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Dillner P, Eggenschwiler LC, Rutjes AWS, Berg L, Musy SN, Simon M, Moffa G, Förberg U, Unbeck M. Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis. BMJ Qual Saf 2023; 32:133-149. [PMID: 36572528 PMCID: PMC9985739 DOI: 10.1136/bmjqs-2022-015298] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/08/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Adverse events (AEs) cause suffering for hospitalised children, a fragile patient group where the delivery of adequate timely care is of great importance. OBJECTIVE To report the incidence and characteristics of AEs, in paediatric inpatient care, as detected with the Global Trigger Tool (GTT), the Trigger Tool (TT) or the Harvard Medical Practice Study (HMPS) method. METHOD MEDLINE, Embase, Web of Science and Google Scholar were searched from inception to June 2021, without language restrictions. Studies using manual record review were included if paediatric data were reported separately. We excluded studies reporting: AEs for a specific disease/diagnosis/treatment/procedure, or deceased patients; study protocols with no AE outcomes; conference abstracts, editorials and systematic reviews; clinical incident reports as the primary data source; and studies focusing on specific AEs only. Methodological risk of bias was assessed using a tool based on the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Primary outcome was the percentage of admissions with ≥1 AEs. All statistical analyses were stratified by record review methodology (GTT/TT or HMPS) and by type of population. Meta-analyses, applying random-effects models, were carried out. The variability of the pooled estimates was characterised by 95% prediction intervals (PIs). RESULTS We included 32 studies from 44 publications, conducted in 15 countries totalling 33 873 paediatric admissions. The total number of AEs identified was 8577. The most common types of AEs were nosocomial infections (range, 6.8%-59.6%) for the general care population and pulmonary-related (10.5%-36.7%) for intensive care. The reported incidence rates were highly heterogeneous. The PIs for the primary outcome were 3.8%-53.8% and 6.9%-91.6% for GTT/TT studies (general and intensive care population). The equivalent PI was 0.3%-33.7% for HMPS studies (general care). The PIs for preventable AEs were 7.4%-96.2% and 4.5%-98.9% for GTT/TT studies (general and intensive care population) and 10.4%-91.8% for HMPS studies (general care). The quality assessment indicated several methodological concerns regarding the included studies. CONCLUSION The reported incidence of AEs is highly variable in paediatric inpatient care research, and it is not possible to estimate a reliable single rate. Poor reporting standards and methodological differences hinder the comparison of study results.
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Affiliation(s)
- Pernilla Dillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden .,Division of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Luisa C Eggenschwiler
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne W S Rutjes
- Department of Medical and Surgical Sciences SMECHIMAI, University of Modena and Reggio Emilia, Modena, Italy.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Lena Berg
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sarah N Musy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Ulrika Förberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Verlaat CW, Zegers M, Klein R, van Waardenburg D, Kuiper JW, Riedijk M, Kneyber M, Timmers B, van Heerde M, Hazelzet JA, van der Hoeven J, Lemson J. Adverse Events in Pediatric Critical Care Nonsurvivors With a Low Predicted Mortality Risk: A Multicenter Case Control Study. Pediatr Crit Care Med 2023; 24:4-16. [PMID: 36521013 PMCID: PMC9799043 DOI: 10.1097/pcc.0000000000003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Some patients with a low predicted mortality risk in the PICU die. The contribution of adverse events to mortality in this group is unknown. The aim of this study was to estimate the occurrence of adverse events in low-risk nonsurvivors (LN), compared with low-risk survivors (LS) and high-risk PICU survivors and nonsurvivors, and the contribution of adverse events to mortality. DESIGN Case control study. Admissions were selected from the national Dutch PICU registry, containing 53,789 PICU admissions between 2006 and 2017, in seven PICUs. PICU admissions were stratified into four groups, based on mortality risk (low/high) and outcome (death/survival). Random samples were selected from the four groups. Cases were "LN." Control groups were as follows: "LS," "high-risk nonsurvivors" (HN), and "high-risk survivors" (HS). Adverse events were identified using the validated trigger tool method. SETTING Patient chart review study. PATIENTS Children admitted to the PICU with either a low predicted mortality risk (< 1%) or high predicted mortality risk (≥ 30%). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In total, 419 patients were included (102 LN, 107 LS, 104 HN, and 106 HS). LN had more complex chronic conditions (93.1%) than LS (72.9%; p < 0.01), HN (49.0%; p < 0.001), and HS (48.1%; p < 0.001). The occurrence of adverse events in LN (76.5%) was higher than in LS (13.1%) and HN (47.1%) ( p < 0.001). The most frequent adverse events in LN were hospital-acquired infections and drug/fluid-related adverse events. LN suffered from more severe adverse events compared with LS and HS ( p < 0.001). In 30.4% of LN, an adverse event contributed to death. In 8.8%, this adverse event was considered preventable. CONCLUSIONS Significant and preventable adverse events were found in low-risk PICU nonsurvivors. 76.5% of LN had one or more adverse events. In 30.4% of LN, an adverse event contributed to mortality.
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Affiliation(s)
- Carin W Verlaat
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard Klein
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick van Waardenburg
- Department of Pediatric Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Willem Kuiper
- Department of Pediatric Intensive Care, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Maaike Riedijk
- Department of Pediatric Intensive Care, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martin Kneyber
- Department of Pediatric Intensive Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Brigitte Timmers
- Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc van Heerde
- Department of Pediatric Intensive Care, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Joris Lemson
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Inata Y, Nakagami-Yamaguchi E, Ogawa Y, Hatachi T, Takeuchi M. Quality Assessment of the Literature on Quality Improvement in PICUs: A Systematic Review. Pediatr Crit Care Med 2021; 22:553-560. [PMID: 33729730 DOI: 10.1097/pcc.0000000000002683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To synthesize the literature describing quality improvement in PICUs and to appraise the quality of extant research. DATA SOURCES We searched the PubMed, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials databases between May and June 2020. STUDY SELECTION Peer-reviewed articles in English that report quality improvement interventions in PICUs were included. Titles and abstracts were screened, and articles were reviewed to determine whether they met quality improvement criteria. DATA EXTRACTION Data were abstracted using a structured template. The quality of the included articles was assessed using the Quality Improvement Minimum Quality Criteria Set and scored on a scale of 0-16. DATA SYNTHESIS Of the 2,449 articles identified, 158 were included in the analysis. The most common targets of quality improvement interventions were healthcare-associated infections (n = 17, 10.8%), handoffs (n = 15, 9.5%), rounds (n = 13, 8.2%), sedation/pain/delirium (n = 13, 8.2%), medication safety (n = 11, 7.0%), and unplanned extubation (n = 9, 5.7%). Of the six domains of healthcare quality described by the Institute of Medicine, patient-centeredness and timeliness were infrequently addressed, and none of the studies addressed equity. The median quality score based on the Quality Improvement Minimum Quality Criteria Set was 11.0 (25-75th interquartile range, 9.0-13.0). Although the quantity and quality of articles have been increasing, only 17% of the studies were deemed "high quality," having a score between 14 and 16. Only eight articles (5%) cited Standards for QUality Improvement Reporting Excellence guidelines for reporting quality improvement works. CONCLUSIONS The number of publications, including high-quality publications, on quality improvement interventions in PICUs has been increasing. However, low-quality articles continue to be published, even in recent years. Therefore, there is room for improvement in the quality of reporting.
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Affiliation(s)
- Yu Inata
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Etsuko Nakagami-Yamaguchi
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuko Ogawa
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takeshi Hatachi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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Vollam S, Gustafson O, Young JD, Attwood B, Keating L, Watkinson P. Problems in care and avoidability of death after discharge from intensive care: a multi-centre retrospective case record review study. Crit Care 2021; 25:10. [PMID: 33407702 PMCID: PMC7789328 DOI: 10.1186/s13054-020-03420-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over 138,000 patients are discharged to hospital wards from intensive care units (ICUs) in England, Wales and Northern Ireland annually. More than 8000 die before leaving hospital. In hospital-wide populations, 6.7-18% of deaths have some degree of avoidability. For patients discharged from ICU, neither the proportion of avoidable deaths nor the reasons underlying avoidability have been determined. We undertook a retrospective case record review within the REFLECT study, examining how post-ICU ward care might be improved. METHODS A multi-centre retrospective case record review of 300 consecutive post-ICU in-hospital deaths, between January 2015 and March 2018, in 3 English hospitals. Trained multi-professional researchers assessed the degree to which each death was avoidable and determined care problems using the established Structured Judgement Review method. RESULTS Agreement between reviewers was good (weighted Kappa 0.77, 95% CI 0.64-0.88). Discharge from an ICU for end-of-life care occurred in 50/300 patients. Of the remaining 250 patients, death was probably avoidable in 20 (8%, 95% CI 5.0-12.1) and had some degree of avoidability in 65 (26%, 95% CI 20.7-31.9). Common problems included out-of-hours discharge from ICU (168/250, 67.2%), suboptimal rehabilitation (167/241, 69.3%), absent nutritional planning (76/185, 41.1%) and incomplete sepsis management (50/150, 33.3%). CONCLUSIONS The proportion of deaths in hospital with some degree of avoidability is higher in patients discharged from an ICU than reported in hospital-wide populations. Extrapolating our findings suggests around 550 probably avoidable deaths occur annually in hospital following ICU discharge in England, Wales and Northern Ireland. This avoidability occurs in an elderly frail population with complex needs that current strategies struggle to meet. Problems in post-ICU care are rectifiable but multi-disciplinary. TRIAL REGISTRATION ISRCTN14658054.
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Affiliation(s)
- Sarah Vollam
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
- National Institute for Health Research Biomedical Research Centre, Oxford, UK.
| | - Owen Gustafson
- National Institute for Health Research Biomedical Research Centre, Oxford, UK
- Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Benjamin Attwood
- Adult Intensive Care Unit, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Liza Keating
- Adult Intensive Care Unit, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- National Institute for Health Research Biomedical Research Centre, Oxford, UK
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Charyk Stewart T, Luong K, Alharfi I, McKelvie B, Fraser DD. Identification of adverse events in pediatric severe traumatic brain injury patients to target evidence-based prevention for increased performance improvement and patient safety. Injury 2020; 51:1568-1575. [PMID: 32446657 DOI: 10.1016/j.injury.2020.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma centres are required to continuously measure, evaluate and improve care. Severe traumatic brain injury (sTBI) patients are highly susceptible to adverse events (AE; unintended, potentially harmful events resulting from health care) due to their unstable condition requiring high risk interventions, multiple medications and invasive monitoring. Objectives were to describe: (1) a process for identifying AE in pediatric sTBI patients to identify safety risks, target and implement evidence-based prevention strategies; and (2) a tertiary care PICU's sTBI AE experience. METHODS Merging databases, Trauma Registry with Adverse Events Management System, identified AE in patients. Details on the event location, type and severity of harm were combined with patient demographics, injury data, costs and outcomes in a cohort of 193 PICU sTBI patients (2000-15). Descriptive statistics and multivariate logistic regression were undertaken to describe AE, and their association with risk factors and outcomes. RESULTS 103/193 sTBI patients (53%) suffered at least one AE. 238 AE occurred (1.23 AE/patient), with 30% of patients having 2+ AE. Most resulted in no harm (54%) with decubitus ulcers (15%) the most common AE. AE patients were more likely to be monitored for elevated ICP (p<0.001), with fewer ventilator-free days (p=0.015), longer LOS for PICU (11 vs. 3.5 days; p<0.001) and in-hospital (31 vs. 11 days; p<0.001) with higher median costs ($121,234 vs. $53,341; p=0.031). AE patients required a higher level of care on discharge (p=0.035). CONCLUSIONS Merging databases is an effective practice to identify AE and safety risks in trauma populations. Utilizing this method, a PICU AE rate of 1.23 events per patient was found with TBI severity the most important factor to increase the odds of AE. AE represent performance improvement events, opportunities to optimize care, decrease costs, as well as improve outcomes, to ultimately improve patient safety in this vulnerable population.
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Affiliation(s)
- Tanyak Charyk Stewart
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Children's Hospital at London Health Sciences Centre, London, ON, Canada.
| | - Kyle Luong
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Children's Hospital at London Health Sciences Centre, London, ON, Canada.
| | - Ibrahim Alharfi
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Children's Hospital at London Health Sciences Centre, London, ON, Canada.
| | - Brianna McKelvie
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Children's Hospital at London Health Sciences Centre, London, ON, Canada.
| | - Douglas D Fraser
- Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Children's Hospital at London Health Sciences Centre, London, ON, Canada; Translational Research Centre, London, ON, Canada; Children's Health Research Institute, London, ON, Canada; Physiology and Pharmacology, Western University, London, ON, Canada; Clinical Neurological Sciences, Western University, London, ON, Canada.
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8
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Sundberg F, Fridh I, Lindahl B, Kåreholt I. Associations between healthcare environment design and adverse events in intensive care unit. Nurs Crit Care 2020; 26:86-93. [DOI: 10.1111/nicc.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Fredrika Sundberg
- Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Ingemar Kåreholt
- School of Health and Welfare, Institute of Gerontology Jönköping University Jönköping Sweden
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