1
|
McLean B, Thompson D. MRI and the Critical Care Patient: Clinical, Operational, and Financial Challenges. Crit Care Res Pract 2023; 2023:2772181. [PMID: 37325272 PMCID: PMC10264715 DOI: 10.1155/2023/2772181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/03/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Neuroimaging in conjunction with a neurologic examination has become a valuable resource for today's intensive care unit (ICU) physicians. Imaging provides critical information during the assessment and ongoing neuromonitoring of patients for toxic-metabolic or structural injury of the brain. A patient's condition can change rapidly, and interventions may require imaging. When making this determination, the benefit must be weighed against possible risks associated with intrahospital transport. The patient's condition is assessed to decide if they are stable enough to leave the ICU for an extended period. Intrahospital transport risks include adverse events related to the physical nature of the transport, the change in the environment, or relocating equipment used to monitor the patient. Adverse events can be categorized as minor (e.g., clinical decompensation) or major (e.g., requiring immediate intervention) and may occur in preparation or during transport. Regardless of the type of event experienced, any intervention during transport impacts the patient and may lead to delayed treatment and disruption of critical care. This review summarizes the commentary on the current literature on the associated risks and provides insight into the costs as well as provider experiences. Approximately, one-third of patients who are transported from the ICU to an imaging suite may experience an adverse event. This creates an additional risk for extending a patient's stay in the ICU. The delay in obtaining imaging can negatively impact the patient's treatment plan and affect long-term outcomes as increased disability or mortality. Disruption of ICU therapy can decrease respiratory function after the patient returns from transport. Because of the complex care team needed for patient transport, the staff time alone can cost $200 or more. New technologies and advancements are needed to reduce patient risk and improve safety.
Collapse
Affiliation(s)
- Barbara McLean
- Division of Emergency Services and Critical Care, Grady Health System, Atlanta, GA, USA
| | | |
Collapse
|
2
|
Salih S, Nordin MN, Alkatheeri A, Nasser A, Saif M, Abdallah Z, Alderei A, Faisal LA, Alhasan M, Hasaneen M. Assessment of Nursing Students' Awareness toward Ionizing Radiation: Cross-Sectional Study. NURSING REPORTS 2023; 13:855-864. [PMID: 37368342 DOI: 10.3390/nursrep13020075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Among healthcare workers, nurses are considered the core of healthcare auth-info services in healthcare facilities because of their responsibilities and duties toward patients. All healthcare professionals, especially nurses, must be completely knowledgeable about the hazards of ionizing radiation, and the most effective radiation protection techniques. This study assessed the attitude and awareness toward radiation protection among final-year nursing students in the Fatima College of Health Sciences (FCHS) campuses. An online cross-sectional survey was conducted between March and April 2022. A total of 200 out of 224 female participants ranging from 18 to 30 years old agreed to participate in the study. The highest percentage of final-year nursing students did not attend any radiation protection course (52%). The results of the last section of the survey indicate a lack of awareness of basic radiation protection knowledge among final-year nursing students in FCHS campuses (less than 80%). The results showed a lack of knowledge and poor attitude toward radiation hazards and radiation protection from final-year nursing students in the FCHS. Formal education about basic radiation and radiation is recommended in the nursing program for safe clinical practice.
Collapse
Affiliation(s)
- Suliman Salih
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
- National Cancer Institute, University of Gezira, Wad Madani 2667, Sudan
| | - Mohd Nazmi Nordin
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| | - Ajnas Alkatheeri
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| | - Alanoud Nasser
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| | - Mezna Saif
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| | - Zuwaina Abdallah
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| | - Aljazi Alderei
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| | - Laila Ali Faisal
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| | - Mustafa Alhasan
- Faculty of Applied Medical Sciences, Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohamed Hasaneen
- Department of Radiography and Medical Imaging, Fatima College of Health Sciences, Abu Dhabi 3798, United Arab Emirates
| |
Collapse
|
3
|
Sainbhi AS, Gomez A, Froese L, Slack T, Batson C, Stein KY, Cordingley DM, Alizadeh A, Zeiler FA. Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research. Front Neurol 2022; 13:872731. [PMID: 35557627 PMCID: PMC9087842 DOI: 10.3389/fneur.2022.872731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
The process of cerebral vessels regulating constant cerebral blood flow over a wide range of systemic arterial pressures is termed cerebral autoregulation (CA). Static and dynamic autoregulation are two types of CA measurement techniques, with the main difference between these measures relating to the time scale used. Static autoregulation looks at the long-term change in blood pressures, while dynamic autoregulation looks at the immediate change. Techniques that provide regularly updating measures are referred to as continuous, whereas intermittent techniques take a single at point in time. However, a technique being continuous or intermittent is not implied by if the technique measures autoregulation statically or dynamically. This narrative review outlines technical aspects of non-invasive and minimally-invasive modalities along with providing details on the non-invasive and minimally-invasive measurement techniques used for CA assessment. These non-invasive techniques include neuroimaging methods, transcranial Doppler, and near-infrared spectroscopy while the minimally-invasive techniques include positron emission tomography along with magnetic resonance imaging and radiography methods. Further, the advantages and limitations are discussed along with how these methods are used to assess CA. At the end, the clinical considerations regarding these various techniques are highlighted.
Collapse
Affiliation(s)
- Amanjyot Singh Sainbhi
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Amanjyot Singh Sainbhi
| | - Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Logan Froese
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Trevor Slack
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Carleen Batson
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kevin Y. Stein
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dean M. Cordingley
- Applied Health Sciences Program, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada
| | - Arsalan Alizadeh
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A. Zeiler
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
4
|
Bae JG, Kim YH, Kim JY, Lee MS. The Feasibility and Safety of Temporary Transcatheter Balloon Occlusion of Bilateral Internal Iliac Arteries during Cesarean Section in a Hybrid Operating Room for Placenta Previa with a High Risk of Massive Hemorrhage. J Clin Med 2022; 11:jcm11082160. [PMID: 35456251 PMCID: PMC9031967 DOI: 10.3390/jcm11082160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the feasibility and safety of temporary transcatheter balloon occlusion of bilateral internal iliac arteries (TBOIIA) during cesarean section in a hybrid operating room (OR) for placenta previa (PP) with a high risk of massive hemorrhage. This retrospective study analyzed the medical records of 62 patients experiencing PP with a high risk of massive hemorrhage (mean age, 36.2 years; age range 28-45 years) who delivered a baby via planned cesarean section with TBOIIA in a hybrid OR between May 2019 and July 2021. Operation time, estimated blood loss (EBL), amount of intra- and postoperative blood transfusion, perioperative hemoglobin level, hospital stay after operation, balloon time, fluoroscopy time, radiation dose, rate of uterine artery embolization (UAE) and hysterectomy, and complication-related TBOIIA were assessed. The mean operation time was 122 min, and EBL was 1290 mL. Nine out of sixty-two patients (14.5%) received a blood transfusion. The mean hemoglobin levels before surgery, immediately after surgery and within 1 week after surgery were 11.3 g/dL, 10.4 g/dL and 9.2 g/dL, respectively. In terms of radiation dose, the mean dose area product (DAP) and cumulative air kerma were 0.017 Gy/cm2 and 0.023 Gy, respectively. Ten out of sixty-two patients (16.1%) underwent UAE postoperatively in the hybrid OR. One out of sixty-two patients had been diagnosed with placenta percreta with bladder invasion based on preoperative ultrasound, and thus underwent cesarean hysterectomy following TBOIIA and UAE. While intra-arterial balloon catheter placement for managing PP with a high risk of hemorrhage remains controversial, a planned cesarean section with TBOIIA in a hybrid OR is effective in eliminating the potential risk of intra-arterial balloon catheter displacement, thus reducing intraoperative blood loss, ensuring safe placental removal and conserving the uterus.
Collapse
Affiliation(s)
- Jin-Gon Bae
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Young Hwan Kim
- Department of Radiology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea; (Y.H.K.); (J.Y.K.)
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea; (Y.H.K.); (J.Y.K.)
| | - Mu Sook Lee
- Department of Radiology, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea; (Y.H.K.); (J.Y.K.)
- Correspondence: ; Tel.: +82-53-258-7862
| |
Collapse
|
5
|
Concannon E, Fitzgerald L, Canniff E, Birrane J, Harbison J, Shelley O. Neuroimaging provides relevant clinical information in patients with burn injuries. Burns 2019; 46:552-560. [PMID: 31787472 DOI: 10.1016/j.burns.2019.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/05/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neurological assessment of patients with burn injuries may be complicated by a variety of factors including artificial ventilation and sedation, cerebral hypoxia and intoxication. Medically unstable intubated patients present logistical challenges for radiological imaging. The role of neuroimaging as an adjunct to clinical assessment of burn injured patients has not yet been determined. AIM This study aims to investigate the indications, findings and outcomes of neuroimaging studies performed for burn injured patients. METHODS A retrospective case series study of adult burn patients admitted over an 8 year period was completed in the National Burns Centre at St James's Hospital, Dublin. Neuroimaging studies carried out for patients admitted during the study period were reviewed by a Consultant Radiologist and Consultant Stroke Physician. Outcomes included neuroimaging findings, prevalence of white matter disease (Fazekas scale), length of stay, discharge destination, predicted and observed mortality. RESULTS 1328 consecutive patients with burn injuries were admitted during the study period. 56 patients underwent neuroimaging studies with computerised tomography, magnetic resonance imaging or both. 46 out of 56 neuroimaged patients (82.1%) had significant radiological findings, including 14 patients (25%) with acute findings. There was a high prevalence of white matter disease (mean total Fazekas score: 3.59) and acute cerebral infarction (7 patients). Patients with radiological findings required additional in-patient rehabilitation and had increased length of stay (Median 47.0 days vs. 27.5 days, p < 0.027). Patients with resuscitation burns or associated inhalation injury were significantly more likely to undergo neuroimaging (p < 0.0001) and to have positive radiological findings. Predicted mortality was higher in patients with positive neuroimaging findings compared to patients with normal neuroimaging studies, although there was no significant difference in observed mortality between these two groups. CONCLUSION Neuroimaging is used appropriately in patients admitted with burns and provides valuable applicable clinical information when indicated.
Collapse
Affiliation(s)
- Elizabeth Concannon
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| | - Louise Fitzgerald
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| | - Emma Canniff
- Department of Radiology, St James's Hospital, Dublin, Ireland.
| | - John Birrane
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| | - Joseph Harbison
- Department of Medicine for the Elderly, St James's Hospital, Dublin, Ireland.
| | - Odhran Shelley
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| |
Collapse
|
6
|
Stout DE, Cortes MX, Aiyagari V, Olson DM. Management of External Ventricular Drains During Intrahospital Transport for Radiographic Imaging. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jradnu.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Meller CH, Garcia-Monaco RD, Izbizky G, Lamm M, Jaunarena J, Peralta O, Otaño L. Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study. Cardiovasc Intervent Radiol 2018; 42:365-370. [DOI: 10.1007/s00270-018-2113-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/01/2018] [Indexed: 11/24/2022]
|
8
|
|
9
|
Tierney DM, Boland LL, Overgaard JD, Huelster JS, Jorgenson A, Normington JP, Melamed RR. Pulmonary ultrasound scoring system for intubated critically ill patients and its association with clinical metrics and mortality: A prospective cohort study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:14-22. [PMID: 28984373 DOI: 10.1002/jcu.22526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Pulmonary ultrasound (PU) examination at the point-of-care can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of PU abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, PU scoring system that would allow for standardized documentation, have high interprovider agreement, and correlate with clinical metrics. METHODS In this prospective study of 250 adults intubated for ARF, a PU examination was performed at intubation, 48-hours later, and at extubation. A total lung score (TLS) was calculated. Clinical metrics and final diagnosis were extracted from the medical record. RESULTS TLS correlated positively with mortality (P = .03), ventilator hours (P = .003), intensive care unit, and hospital length of stay (P = .003, P = .008), and decreasing PaO2 /FiO2 (P < .001). Agreement of PU findings was very good (kappa = 0.83). Baseline TLS and subscores differed significantly between ARF categories (nonpulmonary, obstructive, and parenchymal disease). CONCLUSIONS A quick, scored, PU examination was associated with clinical metrics, including mortality among a diverse population of patients intubated for ARF. In addition to diagnostic and prognostic information at the bedside, a standardized and quantifiable approach to PU provides objectivity in serial assessment and may enhance communication of findings between providers.
Collapse
Affiliation(s)
- David M Tierney
- Department of Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Lori L Boland
- Division of Applied Research, Allina Health, Minneapolis, Minnesota
| | - Josh D Overgaard
- Department of Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Joshua S Huelster
- Department of Critical Care, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ann Jorgenson
- Division of Applied Research, Allina Health, Minneapolis, Minnesota
| | | | - Roman R Melamed
- Department of Critical Care, Abbott Northwestern Hospital, Minneapolis, Minnesota
| |
Collapse
|
10
|
Xu J, Sisniega A, Zbijewski W, Dang H, Stayman JW, Mow M, Wang X, Foos DH, Koliatsos VE, Aygun N, Siewerdsen JH. Technical assessment of a prototype cone-beam CT system for imaging of acute intracranial hemorrhage. Med Phys 2017; 43:5745. [PMID: 27782694 DOI: 10.1118/1.4963220] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE A cone-beam CT scanner has been developed for detection and monitoring of traumatic brain injury and acute intracranial hemorrhage (ICH) at the point of care. This work presents a technical assessment of imaging performance and dose for the scanner in phantom and cadaver studies as a prerequisite to clinical translation. METHODS The scanner incorporates a compact, rotating-anode x-ray source and a flat-panel detector (43 × 43 cm2) on a mobile U-arm gantry with source-axis distance = 550 mm and source-detector distance = 1000 mm. Central and peripheral doses were measured in 16 cm diameter CTDI phantoms using a 0.6 cm3 Farmer ionization chamber for various scan techniques and as a function of longitudinal position, including out of field. Spatial resolution, contrast, noise, and image uniformity were assessed in quantitative and anthropomorphic head phantoms. Two reconstruction protocols were evaluated, including filtered backprojection (FBP) for high-resolution bone imaging and penalized weighted least squares (PWLS) reconstruction for low-contrast soft tissue (ICH) visualization. A fresh cadaver was imaged with and without simulated ICH using the scanner as well as a diagnostic multidetector CT (MDCT) scanner using a standard head protocol. Images were interpreted by a fellowship-trained neuroradiologist for imaging tasks of ICH detection, gray-white-CSF differentiation, detection of midline shift, and fracture detection. RESULTS The nominal scan protocol involved 720 projections acquired over a 360° orbit at 100 kV and 216 mAs, giving a dose (weighted CTDI) of 22.8 mGy (∼1.2 mSv effective dose). Out-of-field dose decreased to <10% within 6 cm of the field edge (approximate to the thyroid position). Image uniformity demonstrated <1% variation between the edge of the field (near the cranium) and center of the image. The high-resolution FBP reconstruction protocol showed ∼0.9 mm point spread function (PSF) full-width at half-maximum (FWHM). The smooth PWLS reconstruction protocol yielded ∼1.2 mm PSF FWHM and contrast-to-noise ratio exceeding 5.7 in ∼50 HU spherical ICH, resulting in conspicuous depiction of ICH down to ∼2 mm (the smallest diameter investigated). Cadaver images demonstrated good differentiation of brain and CSF (sufficient, but inferior to MDCT, recognizing that the CBCT dose was one-third that of MDCT), excellent visualization of cranial sutures and fracture (potentially superior to MDCT), clear detection of midline shift, and conspicuous detection of ICH. CONCLUSIONS Technical assessment of the prototype demonstrates dose characteristics and imaging performance consistent with point-of-care detection and monitoring of head injury-most notably, conspicuous detection of ICH-and supports translation of the system to clinical studies.
Collapse
Affiliation(s)
- Jennifer Xu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Alejandro Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Hao Dang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Michael Mow
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | | | | | | | - Nafi Aygun
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21205
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205; Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21205; Department of Computer Science, Johns Hopkins University, Baltimore, Maryland 21205; Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland 21205; and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland 21205
| |
Collapse
|
11
|
Comeau OY, Armendariz-Batiste J, Woodby SA. Safety First! Using a Checklist for Intrafacility Transport of Adult Intensive Care Patients. Crit Care Nurse 2017; 35:16-25. [PMID: 26427972 DOI: 10.4037/ccn2015991] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adult critical care patients in an academic medical center experienced adverse events during intrafacility transport resulting from lack of preparation. An intervention was needed to help keep patients safe during intrafacility transport. OBJECTIVE To develop a checklist for transport that is easy to use and effective in preparing patients for transport. METHOD A checklist was developed and implemented. Elements of the checklist include preparation of the patient before transport, screening of patients for criteria that may place them at higher risk during transport, and a checklist for the procedural site. RESULTS From May 2011 through July 2014, 2506 transports were conducted. Of these, 97.6% (n = 2445) involved no reported complications. CONCLUSION This tool is suitable for bedside clinicians to use when preparing patients for transport.
Collapse
Affiliation(s)
- Odette Y Comeau
- Odette Y. Comeau is an adult critical care clinical nurse specialist at University of Texas Medical Branch (UTMB) in Galveston, Texas.Josette Armendariz-Batiste is the director of patient care and assistant chief nursing officer for adult medical-surgical and critical care units at UTMB Galveston.Scott A. Woodby is a nurse clinician in the medical intensive care unit/cardiac care unit at UTMB Galveston.
| | - Josette Armendariz-Batiste
- Odette Y. Comeau is an adult critical care clinical nurse specialist at University of Texas Medical Branch (UTMB) in Galveston, Texas.Josette Armendariz-Batiste is the director of patient care and assistant chief nursing officer for adult medical-surgical and critical care units at UTMB Galveston.Scott A. Woodby is a nurse clinician in the medical intensive care unit/cardiac care unit at UTMB Galveston
| | - Scott A Woodby
- Odette Y. Comeau is an adult critical care clinical nurse specialist at University of Texas Medical Branch (UTMB) in Galveston, Texas.Josette Armendariz-Batiste is the director of patient care and assistant chief nursing officer for adult medical-surgical and critical care units at UTMB Galveston.Scott A. Woodby is a nurse clinician in the medical intensive care unit/cardiac care unit at UTMB Galveston
| |
Collapse
|
12
|
Jia L, Wang H, Gao Y, Liu H, Yu K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Crit Care 2016; 20:12. [PMID: 26781179 PMCID: PMC4717618 DOI: 10.1186/s13054-016-1183-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/06/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the incidence of adverse events (AEs) during intra-hospital transport (IHT) of critically ill patients and evaluate the risk factors associated with these events. METHODS This prospective multicenter observational study was performed in 34 intensive care units in China during 20 consecutive days from 5 November to 25 November 2012. All consecutive patients who required IHT for diagnostic testing or therapeutic procedures during the study period were included. All AEs that occurred during IHT were recorded. The incidence of AEs was defined as the rate of transports with at least one AE. The statistical analysis included a description of demographic and clinical characteristics of the cohort as well as identification of risk factors for AEs during IHT by univariate and multivariate logistic regression analyses. RESULTS In total, 441 IHTs of 369 critically ill patients were analyzed. The overall incidence of AEs was 79.8% (352 IHTs). The proportion of equipment- and staff-related adverse events was 7.9% (35 IHTs). The rate of patient-related adverse events (P-AEs) was 79.4% (349 IHTs). The rates of vital sign-related P-AEs and arterial blood gas analysis-related P-AEs were 57.1% (252 IHTs) and 46.9% (207 IHTs), respectively. The incidence of critical P-AEs was 33.1% (146 IHTs). The rates of vital sign-related critical P-AEs and arterial blood gas analysis-related critical P-AEs were 22.9% (101 IHTs) and 15.0% (66 IHTs), respectively. All data collected in our study were considered potential risk factors. In the multivariate analysis, predictive factors for P-AEs were pH, partial pressure of carbon dioxide in arterial blood, lactate level, glucose level, and heart rate before IHT. Furthermore, the Acute Physiology and Chronic Health Evaluation II score, partial pressure of oxygen in arterial blood, lactate level, glucose level, heart rate, respiratory rate, pulse oximetry, and sedation before transport were independent influential factors for critical P-AEs during IHT. CONCLUSIONS The incidence of P-AEs during IHT of critically ill patients was high. Risk factors for P-AEs during IHT were identified. Strategies are needed to reduce their frequency. TRIAL REGISTRATION Chinese Clinical Trial Register identifier ChiCTR-OCS-12002661. Registered 5 November 2012.
Collapse
Affiliation(s)
- Liu Jia
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yang Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Haitao Liu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Kaijiang Yu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| |
Collapse
|
13
|
Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries. Eur Radiol 2015; 26:1620-30. [DOI: 10.1007/s00330-015-4001-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/24/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
|
14
|
Wells JL, Murphy PS. Clearing the Runway: An Innovative Approach to Preparing an Intensive Care Unit Patient for a Magnetic Resonance Imaging Scan. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jradnu.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
Clark A, Farber MK, Sviggum H, Camann W. Cesarean Delivery in the Hybrid Operating Suite. Anesth Analg 2013; 117:1187-9. [DOI: 10.1213/ane.0b013e3182a00aff] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
16
|
Ott LK, Pinsky MR, Hoffman LA, Clarke SP, Clark S, Ren D, Hravnak M. Medical emergency team calls in the radiology department: patient characteristics and outcomes. BMJ Qual Saf 2012; 21:509-18. [PMID: 22389020 PMCID: PMC3630458 DOI: 10.1136/bmjqs-2011-000423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to identify the characteristics of patients who experience medical emergency team calls in the radiology department (MET-RD) and the relationship between these characteristics and patient outcomes. DESIGN/PARTICIPANTS Retrospective review of 111 inpatient MET-RD calls (May 2008-April 2010). SETTING Academic medical centre with a well established MET system. MEASUREMENTS The characteristics of patients before, during and after transport to radiology were extracted from medical records and administrative databases. These characteristics were compared between patients with good and poor outcomes. MAIN RESULTS The majority of patients who experience MET-RD calls had a Charlson Comorbidity Index ≥4 and were from non-intensive care units (60%). Almost half (43%) of MET-RD calls occurred during patients' first day in hospital. Patients commonly arrived with nasal cannula oxygen (38%), recent tachypnoea (28%) and tachycardia (34%). A minority (16%) fulfilled MET call criteria in the 12 h before the MET-RD. MET-RD etiologies were cardiac (41%), respiratory (29%) or neurological (25%), and occurred most frequently during CT (44%) and MRI (22%) testing. Post MET-RD, the majority of patients (70%) required a higher level of care. Death before discharge (25%) was associated with need for cardiovascular support prior to RD transport (p=0.02), need for RD monitoring (p=0.02) and need for heightened RD surveillance (p=0.04). CONCLUSIONS The majority of patients who experienced MET-RD calls came from non-intensive care units, with comorbidities and vital sign alterations prior to arrival at the RD. Risk appeared to be increased for those requiring CT and MRI. These findings suggest that prior identification of a subset of patients at risk of instability in the RD may be possible.
Collapse
Affiliation(s)
- Lora K Ott
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | |
Collapse
|