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Mercader Alarcón M, Miralles Sancho J, Pérez Carbonell A, Nolasco Guirao V, Antón Latour MA, Miras García MM. Result of the implementation of a quality management system based on the ISO 9001:2015 standard in a surgical intensive care unit. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:26-36. [PMID: 36621569 DOI: 10.1016/j.redare.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/22/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The implementation of Quality Management Systems (QMS) is one of the fundamental and future-oriented elements for the improvement of modern health systems. The objective of implementing a QMS in accordance with the requirements of the ISO 9001: 2015 Standard is to effectively carry out its activities, covering both technical and management aspects, guaranteeing the satisfaction of the needs and expectations of all its stakeholders, as well as compliance with legal and regulatory requirements. It must contemplate all those aspects that have an impact on the final quality of the product or service provided by the organization. OBJECTIVE The main objective is to describe the process of implementing a QMS under the ISO 9001: 2015 Standard in the Surgical Intensive Care Unit of the General University Hospital of Elche and evaluate its results. METHODOLOGY Carrying out and implementing a QMS in the Surgical Intensive Care Unit of the General University Hospital of Elche applying the points of the ISO 9001: 2015 Standard. The SGC has followed the benchmark of management by processes, identifying from its strategic core of mission, vision and values, the different processes involved and their interrelation reflected in the process map. Based on it, the necessary documents have been developed to describe the operation of the Unit both at an operational level through the key processes (admission and initial assessment of the patient, stabilization, follow-up, complementary tests, interconsultations, transfers and discharge) as well as which refers to procedures of a strategic or support type. RESULTS The strategic lines that marked the beginning of the deployment of our QMS were defined with the drafting of 7 objectives, achieving 100% compliance. The key processes (7) that described the functioning of our organization were elaborated, as well as those of a strategic type (14) and support or support (5), complemented with 55 medical and nursing protocols. 20 monitoring indicators were analyzed: 6 organizational and planning type, and 14 clinical. 46 incidents were detected in the first year of implementation of the QMS that were analyzed by the Quality Commission, emerging 7 corrective actions. 14 improvement actions were developed after the application of the AMFE methodology for key processes, achieving an average of greater than 70% effectiveness after reassessment. From the analysis of patient and family satisfaction through SAIP case management, 41 of a total of 52 cases were acknowledgments in writing. CONCLUSIONS Implementing a QMS in our Surgical Intensive Care Unit has made it possible to define the strategic lines of our organization, develop objectives, establish monitoring indicators, standardize the work of the Unit through procedures and protocols, increase safety at work through the use of lists of verification, initiate improvement actions to strengthen the weak points of the QMS itself, as well as know the degree of satisfaction and needs of our patients and the personnel who work in it.
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Affiliation(s)
- M Mercader Alarcón
- Servicio de Anestesiología y UCI Quirúrgica, Hospital General Universitario de Elche, Elche, Alicante, Spain.
| | - J Miralles Sancho
- Servicio de Anestesiología y UCI Quirúrgica, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - A Pérez Carbonell
- Servicio de Anestesiología y UCI Quirúrgica, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - V Nolasco Guirao
- UCI Quirúrgica, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - M A Antón Latour
- UCI Quirúrgica, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - M M Miras García
- UCI Quirúrgica, Hospital General Universitario de Elche, Elche, Alicante, Spain
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Fernández Trujillo A, Vallverdú Cartié H, Roman Maestre B, Lema Vazquez J, Berrade Zubiri J. Validation of "the patient evaluation of emotional care during hospitalisation" questionnaire in intensive care unit patients. PLoS One 2022; 17:e0277172. [PMID: 36383600 PMCID: PMC9668114 DOI: 10.1371/journal.pone.0277172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/23/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To validate the "Patient Evaluation of Emotional Care During Hospitalization" (PEECH) questionnaire, which assesses hospitalised patients' emotional experiences, in patients admitted to the intensive care unit (ICU). INTERVENTIONS Prospective study. The PEECH consists of three sections and four sub-scales: "level of security", "level of knowing", "level of personal value", and "level of connection". The questionnaire was completed by 253 hospitalised patients. Expert judgement was used to analyse the content validity and factor analysis was performed to confirm construct validity. Cronbach's alpha was used to measure the internal consistency of the four sub-scales. RESULTS In the confirmatory factor analysis of the four sub-scales, the weights of all questions were found to be significant (>1). The internal consistency of the PEECH questionnaire was 0.86 (Cronbach's alpha) and the homogeneity index was high (>0.50). CONCLUSION The PEECH questionnaire is a valid and reliable tool to evaluate the perception of emotional care in ICU patients. The information gathered can help provide more comprehensive care for patients in the ICU and in other hospitalised patients.
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Affiliation(s)
| | | | | | - Jorge Lema Vazquez
- Intensive care unit, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain
- * E-mail:
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García-Diez R, Martín-Delgado M, Merino-de Cos P, Aranaz-Andrés J. Herramientas para fomentar la seguridad en pacientes críticos. ENFERMERÍA INTENSIVA 2022. [DOI: 10.1016/j.enfi.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2021; 46:14-22. [PMID: 34802990 DOI: 10.1016/j.medine.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Madrid, Spain.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Medicina, Universidad de Vic-Central de Cataluña, Spain
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Deffland M, Spies C, Weiss B, Keller N, Jenny M, Kruppa J, Balzer F. Effects of pain, sedation and delirium monitoring on clinical and economic outcome: A retrospective study. PLoS One 2020; 15:e0234801. [PMID: 32877411 PMCID: PMC7467321 DOI: 10.1371/journal.pone.0234801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/02/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Significant improvements in clinical outcome can be achieved by implementing effective strategies to optimise pain management, reduce sedative exposure, and prevent and treat delirium in ICU patients. One important strategy is the monitoring of pain, agitation and delirium (PAD bundle). We hypothesised that there is no sufficient financial benefit to implement a monitoring strategy in a Diagnosis Related Group (DRG)-based reimbursement system, therefore we expected better clinical and decreased economic outcome for monitored patients. METHODS This is a retrospective observational study using routinely collected data. We used univariate and multiple linear analysis, machine-learning analysis and a novel correlation statistic (maximal information coefficient) to explore the association between monitoring adherence and resulting clinical and economic outcome. For univariate analysis we split patients in an adherence achieved and an adherence non-achieved group. RESULTS In total 1,323 adult patients from two campuses of a German tertiary medical centre, who spent at least one day in the ICU between admission and discharge between 1. January 2016 and 31. December 2016. Adherence to PAD monitoring was associated with shorter hospital LoS (e.g. pain monitoring 13 vs. 10 days; p<0.001), ICU LoS, duration of mechanical ventilation shown by univariate analysis. Despite the improved clinical outcome, adherence to PAD elements was associated with a decreased case mix per day and profit per day shown by univariate analysis. Multiple linear analysis did not confirm these results. PAD monitoring is important for clinical as well as economic outcome and predicted case mix better than severity of illness shown by machine learning analysis. CONCLUSION Adherence to PAD bundles is also important for clinical as well as economic outcome. It is associated with improved clinical and worse economic outcome in comparison to non-adherence in univariate analysis but not confirmed by multiple linear analysis. TRIAL REGISTRATION clinicaltrials.gov NCT02265263, Registered 15 October 2014.
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Affiliation(s)
- Marc Deffland
- Department of Anaesthesiology and Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Bjoern Weiss
- Department of Anaesthesiology and Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Niklas Keller
- Department of Anaesthesiology and Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mirjam Jenny
- Science Communication Unit, Robert Koch Institute, Berlin, Germany
- Harding Center for Risk Literacy, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Jochen Kruppa
- Institute of Biometry and Clinical Epidemiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Felix Balzer
- Department of Anaesthesiology and Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2020; 46:S0210-5691(20)30215-1. [PMID: 32682510 DOI: 10.1016/j.medin.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), MadridEspaña.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Medicina, Universidad de Vic-Central de Cataluña, España
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Safety of Permanent Pacemaker Implantation: A Prospective Study. J Clin Med 2019; 8:jcm8010035. [PMID: 30609668 PMCID: PMC6352172 DOI: 10.3390/jcm8010035] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/12/2022] Open
Abstract
Although pacemaker implantation is considered to be low risk, it is not exempt from complications and technical failures during the procedure, both in the short and long term, and the complications that such patients may present remain unknown. The aim has been to analyze the complication rates associated with permanent pacing and to identify if these differ between patients with or without previous antithrombotic therapy. We used a prospective, single center, observational study of 310 adult patients with indications of permanent pacing. They were hospitalized from 1 January to 31 December 2014 and followed up for 6 months after the pacemaker implant. The participants were distributed into two groups according to the antithrombotic therapy prior to the implant. The most frequent major complications were pneumothorax (3.87%) and lead dislodgement (8.39%), while superficial phlebitis (12.90%) and uncomplicated hematomas (22.58%) were presented as the most recurrent minor complications. Hematomas were the most frequent minor complication in the antithrombotic therapy cohort, and shoulder pain was reported as the most recurrent minor complication in the non-exposed group. Finding out about complications in pacemaker implants enables a complete view of the process, and hence the prioritization of actions aimed at improving safety and reducing associated risks.
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Álvarez-Lerma F, Sánchez García M. "The multimodal approach for ventilator-associated pneumonia prevention"-requirements for nationwide implementation. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:420. [PMID: 30581828 PMCID: PMC6275409 DOI: 10.21037/atm.2018.08.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The multimodal approach for ventilator-associated pneumonia (VAP) prevention has been shown to be a successful strategy in reducing VAP rates in many intensive care units (ICU) in some countries. The simultaneous application of several measures or "bundles" to reduce VAP rates has achieved a higher impact than the progressive implementation of the individual interventions. The ultimate objective of recommendation bundles is their integration in the culture of routine healthcare of the staff in charge of ventilated patients for accomplished rates to persist over time. The noteworthy elements of this new strategy include the selection of the individual recommendations of the bundle, education of care workers (HCW) in the culture of patient safety, audit of compliance with the recommendations, commitment of the hospital management to support implementation, nomination and empowerment of local leaders of the projects in ICUs, both physicians and nurses, and the continuous collection of VAP episodes. The implementation of this new strategy is not an easy task, as both its inherent strength and important barriers to its application have become evident, which need to be overcome for maximal reduction of VAP rates.
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Affiliation(s)
- Francisco Álvarez-Lerma
- Service of Intensive Care Medicine, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M. Sánchez García
- Department of Critical Care, Hospital Clínico San Carlos, Madrid, Spain
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Rubio O, Arnau A, Cano S, Subirà C, Balerdi B, Perea ME, Fernández-Vivas M, Barber M, Llamas N, Altaba S, Prieto A, Gómez V, Martin M, Paz M, Quesada B, Español V, Montejo JC, Gomez JM, Miro G, Xirgú J, Ortega A, Rascado P, Sánchez JM, Marcos A, Tizon A, Monedero P, Zabala E, Murcia C, Torrejon I, Planas K, Añon JM, Hernandez G, Fernandez MDM, Guía C, Arauzo V, Perez JM, Catalan R, Gonzalez J, Poyo R, Tomas R, Saralegui I, Mancebo J, Sprung C, Fernández R. Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study. J Intensive Care 2018; 6:24. [PMID: 29686878 PMCID: PMC5899386 DOI: 10.1186/s40560-018-0283-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/19/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients’ characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. Results We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0–8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59–2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7–44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. Conclusions The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days. Electronic supplementary material The online version of this article (10.1186/s40560-018-0283-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Rubio
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | - Anna Arnau
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | - Sílvia Cano
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | - Carles Subirà
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | | | | | | | | | | | - Susana Altaba
- Hospital Universitario de Castellon, Castellon de la Plana, Spain
| | - Ana Prieto
- 8Hospital Rio Hortega, Valladolid, Spain
| | | | - Mar Martin
- 10Hospital Candelaria de Tenerife, Santa Cruz de Tenerife, Spain
| | - Marta Paz
- 11Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | | | | | | | | | | | | | - Ana Ortega
- 18Hospital Montecelo Pontevedra, Pontevedra, Spain
| | - Pedro Rascado
- 19Centro Hospitalario Universitario Santiago Compostela, Santiago de Compostela, Spain
| | | | | | - Ana Tizon
- 22Hospital Xeral Cíes Vigo, Vigo, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rosa Poyo
- 36Hospital Son Llátzer, Palma, Spain
| | - Roser Tomas
- 37Hospital General de Catalunya, Sant Cugat del Valles, Spain
| | | | - Jordi Mancebo
- 39Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Charles Sprung
- 40Hadassh Hebrew University Medical Center, Jerusalem, Israel
| | - Rafael Fernández
- 41Hospital Sant Joan de Deu, Fundació Althaia Xarxa Universitaria de Manresa, Manresa, Spain
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Hernández-Tejedor A, Peñuelas O, Sirgo Rodríguez G, Llompart-Pou J, Palencia Herrejón E, Estella A, Fuset Cabanes M, Alcalá-Llorente M, Ramírez Galleymore P, Obón Azuara B, Lorente Balanza J, Vaquerizo Alonso C, Ballesteros Sanz M, García García M, Caballero López J, Socias Mir A, Serrano Lázaro A, Pérez Villares J, Herrera-Gutiérrez M. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medine.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. Med Intensiva 2017; 41:285-305. [PMID: 28476212 DOI: 10.1016/j.medin.2017.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/25/2017] [Accepted: 03/11/2017] [Indexed: 12/14/2022]
Abstract
The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients.
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López Camps V, García García MA, Martín Delgado MC, Añón Elizalde JM, Masnou Burrallo N, Rubio Sanchiz O, Estella García A, Monzón Marín JL. National survey on the indicators of quality in Bioethics of the SEMICYUC in the departments of Intensive Care Medicine in Spain. Med Intensiva 2017; 41:523-531. [PMID: 28389026 DOI: 10.1016/j.medin.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/11/2017] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Multiple interventions are performed in critical patients admitted to Intensive Care Units (ICUs). This study explores the presence in the daily practice of ICUs of elements related to the 6 bioethics quality indicators of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units, and the participation of their members in the hospital ethics committees. MATERIALS AND METHODS A multicenter observational study was carried out, using a survey exploring descriptive aspects of the ICUs, with 25 questions related to bioethics quality indicators, and assessing the participation of ICU members in the hospital ethics committees. The ICUs were classified by size (larger or smaller than 10 beds) and type of hospital (public/private-public concerted center, with/without teaching). RESULTS The 68 analyzed surveys revealed: daily informing of the family (97%), carried out in the information room (82%); end-of-life care protocols (44%); life support limitation form (48.43%); and physical containment protocol (40%). Compliance with the informed consent process referred to different procedures is: tracheostomy (92%), vascular procedures (76%), and extrarenal clearance (25%). The presence of ICU members in the hospital ethics committee is currently frequent (69%). CONCLUSIONS Information supplied to relatives is adequate, although there are ICUs without an information room. Compliance with the informed consent requirements of various procedures is insufficient. The participation of ICU members in the hospital ethics committees is frequent. The results obtained suggest a chance for improvement in the bioethical quality of the ICU.
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Affiliation(s)
| | | | | | | | | | - O Rubio Sanchiz
- UCI, Hospital Sant Joan de Déu, Fundación Althaia, Manresa, Barcelona, España
| | - A Estella García
- UCI, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España
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González-Méndez MI, López-Rodríguez L. Safety and quality in critical patient care. ENFERMERIA CLINICA 2017; 27:113-117. [PMID: 28274547 DOI: 10.1016/j.enfcli.2017.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/27/2022]
Abstract
The care quality has gradually been placed in the center of the health system, reaching the patient safety a greater role as one of the key dimensions of quality in recent years. The monitoring, measurement and improvement of safety and quality of care in the Intensive Care Unit represent a great challenge for the critical care community. Health interventions carry a risk of adverse events or events that can cause injury, disability and even death in patients. In Intensive Care Unit, the severity of the critical patient, communication barriers, a high number of activities per patient per day, the practice of diagnostic procedures and invasive treatments, and the quantity and complexity of the information received, among others, put at risk these units as areas for the occurrence of adverse events. This article presents some of the strategies and interventions proposed and tested internationally to optimize the care of critical patients and improve the safety culture in the Intensive Care Unit.
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Affiliation(s)
| | - Luís López-Rodríguez
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, España; Hospital Virgen del Rocío, Sevilla, España
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14
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Can patient and family satisfaction influence the management of department of intensive care medicine? Med Intensiva 2017; 41:67-69. [PMID: 28209291 DOI: 10.1016/j.medin.2016.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/23/2022]
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Holanda Peña MS, Talledo NM, Ots Ruiz E, Lanza Gómez JM, Ruiz Ruiz A, García Miguelez A, Gómez Marcos V, Domínguez Artiga MJ, Hernández Hernández MÁ, Wallmann R, Llorca Díaz J. Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone. Med Intensiva 2016; 41:78-85. [PMID: 27793389 DOI: 10.1016/j.medin.2016.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN A prospective, 5-month observational and descriptive study was carried out. SETTING ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. INTERVENTION Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.
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Affiliation(s)
- M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - N Marina Talledo
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Ots Ruiz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J M Lanza Gómez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Ruiz Ruiz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A García Miguelez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - V Gómez Marcos
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M J Domínguez Artiga
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M Á Hernández Hernández
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España; Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
| | - R Wallmann
- Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
| | - J Llorca Díaz
- Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
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Pinto WAM, Rossetti HB, Araújo A, Spósito JJ, Salomão H, Mattos SS, Rabelo MV, Machado FR. [Impact of a continuous education program on the quality of assistance offered by intensive care physiotherapy]. Rev Bras Ter Intensiva 2015; 26:7-12. [PMID: 24770683 PMCID: PMC4031892 DOI: 10.5935/0103-507x.20140002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/05/2014] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the role of quality indicators and adverse events registering in the
quality assessment of intensive care physiotherapy and to evaluate the impact of
implementing protocolized care and professional training in the quality
improvement process. Methods A prospective before-after study was designed to assess 15 indicators of the
quality of care. Baseline compliance and adverse events were collected before and
after the implementation of treatment protocols and staff training. Results Eighty-nine patients admitted, being 48 in the pre-intervention period and 41 in
the post-intervention period with a total of 1246 and 1191 observations
respectively. Among the indicators related to the global population, there was a
significant improvement in chest x-ray control, multidisciplinary rounds and shift
changes as well as in compliance with these decisions. Indicators related to the
population under mechanical ventilation, obtained by direct observation at
bedside, showed a significant improvement in the compliance with the tidal volume
of 6-8mL/Kg, plateau pressure <30cmH2O, adequate mechanical
ventilation alarm setting, mechanical ventilation humidification control, adequate
humidification line exchange and orotracheal tube position. Among the mechanical
ventilation indicators collected through the physiotherapy records, there was
significantly improved compliance with the predicted tidal volume registry and
cuff pressure registry. There was a significant reduction in the number of adverse
events. There was no impact on intensive care unit mortality, length of stay,
duration of mechanical ventilation and ventilator-free days. Conclusion It is possible to measure the quality of physiotherapy care using indicators of
quality control. The implementation of care protocols and training of the
professionals can improve team performance.
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Affiliation(s)
| | | | - Abigail Araújo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - José Jonas Spósito
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Hellen Salomão
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Melina Vieira Rabelo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Cuzco Cabellos C, Guasch Pomés N. [Application and evalauation of care plan for patients admitted to Intensive Care Units]. ENFERMERIA INTENSIVA 2015; 26:137-43. [PMID: 26340906 DOI: 10.1016/j.enfi.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 06/15/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Assess whether the use of the nursing care plans improves outcomes of nursing care to patients admitted to the intensive care unit (ICU). METHODS The study was conducted in a University Hospital of Barcelona in Spain, using a pre- and post-study design. A total of 61 patient records were analysed in the pre-intervention group. A care plan was applied to 55 patients in the post-intervention group. Specific quality indicators in a medical intensive care unit to assess the clinical practice of nursing were used. Fisher's exact test was used to compare the degree of association between quality indicators in the two groups. RESULTS A total of 116 records of 121 patients were evaluated: 61 pre-intervention and 55 post-intervention. Fisher test: The filling of nursing records, p=.0003. Checking cardiorespiratory arrest equipment, p <.001. Central vascular catheter related bacteraemia (B-CVC) p=.622. Ventilator associated pneumonia (VAP) p=.1000. Elevation of the head of the bed more than 30° p=.049, and the pain management in non-sedated patients p=.082. CONCLUSIONS The implementation of nursing care plans in patients admitted to the intensive care area may contribute to improvement in the outcomes of nursing care.
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Affiliation(s)
- C Cuzco Cabellos
- Diplomada en Enfermería, Máster Oficial Enfermo Crítico y Emergencias, Área de Vigilancia Intensiva, Hospital Clínic de Barcelona, Barcelona, España.
| | - N Guasch Pomés
- Coordinadora Asistencial de Enfermería, Máster Oficial Enfermo Crítico y Emergencias, Área de Vigilancia Intensiva Hospital Clínic de Barcelona, Barcelona, España
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Grupo de trabajo para la revisión, modificación y desarrollo de indicadores de calidad para unidades de cuidados intensivos respiratorios en México. Arch Bronconeumol 2015; 51:357-8. [DOI: 10.1016/j.arbres.2013.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/15/2013] [Accepted: 12/19/2013] [Indexed: 11/22/2022]
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Álvarez Maldonado P, Cueto Robledo G, Cicero Sabido R. Cambios en tres indicadores de calidad después de la implementación de estrategias de mejora en la unidad de cuidados intensivos respiratorios. Med Intensiva 2015; 39:142-8. [DOI: 10.1016/j.medin.2014.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/08/2014] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
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Calidad y registros en trauma. Med Intensiva 2015; 39:114-23. [DOI: 10.1016/j.medin.2014.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/22/2014] [Accepted: 06/29/2014] [Indexed: 11/21/2022]
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Martin Delgado MC. [Measuring the quality of intensive care medicine]. Med Intensiva 2014; 39:1-3. [PMID: 24951246 DOI: 10.1016/j.medin.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/11/2014] [Indexed: 11/27/2022]
Affiliation(s)
- M C Martin Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, España.
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22
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Curiel Balsera E, Joya Montosa C, Trujillo García E, Martinez Gonzalez MC, Molina Diaz H. [Daily evaluation of the FASTHUG protocol and short-term outcomes]. Med Intensiva 2013; 38:393-4. [PMID: 24199990 DOI: 10.1016/j.medin.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 12/21/2022]
Affiliation(s)
- E Curiel Balsera
- Unidad de Cuidados Críticos y Urgencias, Hospital Regional Universitario Carlos Haya, Málaga, España.
| | - C Joya Montosa
- Unidad de Cuidados Críticos y Urgencias, Hospital Regional Universitario Carlos Haya, Málaga, España
| | - E Trujillo García
- Unidad de Cuidados Críticos y Urgencias, Hospital Regional Universitario Carlos Haya, Málaga, España
| | - M C Martinez Gonzalez
- Unidad de Cuidados Críticos y Urgencias, Hospital Regional Universitario Carlos Haya, Málaga, España
| | - H Molina Diaz
- Unidad de Cuidados Críticos y Urgencias, Hospital Regional Universitario Carlos Haya, Málaga, España
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Effect of a Multifaceted Performance Feedback Strategy on Length of Stay Compared With Benchmark Reports Alone. Crit Care Med 2013; 41:1893-904. [DOI: 10.1097/ccm.0b013e31828a31ee] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soler-Palacín P, Provens AC, Martín-Nalda A, Espiau M, Fernández-Polo A, Figueras C. [Quality of care indicators for the care of human immunodeficiency virus-infected individuals, adapted to the pediatric age]. Enferm Infecc Microbiol Clin 2013; 32:160-9. [PMID: 23582193 DOI: 10.1016/j.eimc.2013.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/15/2013] [Accepted: 02/18/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Since infection with human immunodeficiency virus (HIV) was first described, there have been many advances in its diagnosis, monitoring and treatment. However, few contributions are related to the area of health care quality. In this sense, the Spanish Study Group on AIDS (GESIDA) has developed a set of quality care indicators for adult patients living with HIV infection that includes a total of 66 indicators, 22 of which are considered to be relevant. Standards were calculated for each of them in order to reflect the level of the quality of care offered to these patients. Similar documents for pediatric patients are currently lacking. METHODS Preparation of a set of quality care indicators applicable to pediatric patients based on the GESIDA document and the Spanish Guidelines for monitoring of pediatric patients infected with HIV. Each indicator was analysed with respect to the required standards in all patients under 18 years of age followed-up in our Unit, with the aim of evaluating the quality of care provided. RESULTS A total of 61 indicators were collected (51 from the GESIDA document and 10 from currently available pediatric guidelines), 30 of which were considered to be relevant. An overall compliance of 81%-83% was obtained when assessing the relevant indicators. CONCLUSION The availability of health care quality standards is essential for the care of pediatric HIV-infected patients. The assessment of these indicators in our Unit yielded satisfactory results.
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Affiliation(s)
- Pere Soler-Palacín
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Ana Clara Provens
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Andrea Martín-Nalda
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - María Espiau
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Aurora Fernández-Polo
- Servei de Farmàcia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Concepció Figueras
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
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Anema HA, van der Veer SN, Kievit J, Krol-Warmerdam E, Fischer C, Steyerberg E, Dongelmans DA, Reidinga AC, Klazinga NS, de Keizer NF. Influences of definition ambiguity on hospital performance indicator scores: examples from The Netherlands. Eur J Public Health 2013; 24:73-8. [PMID: 23543677 DOI: 10.1093/eurpub/ckt036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
RESEARCH OBJECTIVE Reliable and unambiguously defined performance indicators are fundamental to objective and comparable measurements of hospitals' quality of care. In two separate case studies (intensive care and breast cancer care), we investigated if differences in definition interpretation of performance indicators affected the indicator scores. DESIGN Information about possible definition interpretations was obtained by a short telephone survey and a Web survey. We quantified the interpretation differences using a patient-level dataset from a national clinical registry (Case I) and a hospital's local database (Case II). In Case II, there was additional textual information available about the patients' status, which was reviewed to get more insight into the origin of the differences. PARTICIPANTS For Case I, we investigated 15 596 admissions of 33 intensive care units in 2009. Case II consisted of 144 admitted patients with a breast tumour surgically treated in one hospital in 2009. RESULTS In both cases, hospitals reported different interpretations of the indicators, which lead to significant differences in the indicator values. Case II revealed that these differences could be explained by patient-related factors such as severe comorbidity and patients' individual preference in surgery date. CONCLUSIONS With this article, we hope to increase the awareness on pitfalls regarding the indicator definitions and the quality of the underlying data. To enable objective and comparable measurements of hospitals' quality of care, organizations that request performance information should formalize the indicators they use, including standardization of all data elements of which the indicator is composed (procedures, diagnoses).
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Affiliation(s)
- Helen A Anema
- 1 Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Vázquez Calatayud M, Portillo MC. [The transition process from the intensive care unit to the ward: a review of the literature]. ENFERMERIA INTENSIVA 2013; 24:72-88. [PMID: 23375829 DOI: 10.1016/j.enfi.2012.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 11/27/2012] [Accepted: 12/10/2012] [Indexed: 11/19/2022]
Abstract
UNLABELLED The optimum transition process from the ICU to the ward is key to avoiding the appearance of anxiety in the patient and family, increase of re-admissions in the ICU with the consequent increase in costs and jeopardization to the patient's safety. OBJECTIVE 1) To identify, study and give a critical presentation of the existing evidence on how patients, families and nurses experience the transition from ICU to the ward; 2) to analyze the possible interventions available for the development of an optimum transition process. METHODOLOGY A review was made of the evidence available in the main databases. In addition, several journals specialized in Intensive Care were reviewed. Studies with a qualitative, quantitative or mixed approach and reviews on the subject with a systematic methodology or narrative reviews were included. RESULTS A total of 23 papers were selected for review, 10 of which were qualitative studies, 11 quantitative and two had combined methodology. «Transfer anxiety» was identified after the analysis of these articles as one of the recurring aspects. Discrepancies regarding who should take responsibility for the preparation of the transition process and when it should be performed were also found. In the literature reviewed, several interventions have been proposed to facilitate an optimal transition process such as developing information brochures, creating a profile of practicing nursing liaison between the ICU and the ward and ICU discharge report. CONCLUSIONS This review emphasizes the importance of taking into account the perspectives of patients, families and nurses to perform optimal planning of the transition of the patient from the ICU to the ward to ensure their safety.
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Affiliation(s)
- M Vázquez Calatayud
- Área de Investigación, Formación y Desarrollo Profesional en Enfermería, Clínica Universidad de Navarra, Pamplona, España.
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Masclans J, Vicente R, Ballesteros M, Sabater J, Roca O, Rello J. Objetivos docentes en la formación de médicos residentes en trasplante de órganos sólidos. Med Intensiva 2012; 36:584-8. [DOI: 10.1016/j.medin.2012.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 03/21/2012] [Accepted: 03/27/2012] [Indexed: 11/24/2022]
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Álvarez-Maldonado P, Cueto-Robledo G, Cerón-Díaz U, Pérez-Rosales A, Navarro-Reynoso F, Cicero-Sabido R. Indicadores de calidad en una unidad de cuidados intensivos respiratorios. Análisis inicial de la base de datos DEDUCIR. Med Intensiva 2012; 36:518-20. [DOI: 10.1016/j.medin.2011.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 11/15/2011] [Accepted: 11/17/2011] [Indexed: 11/25/2022]
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Martin J, Braun JP. [Quality management in intensive care medicine. Indispensable for daily routine]. Med Klin Intensivmed Notfmed 2012; 107:255-60. [PMID: 22526121 DOI: 10.1007/s00063-011-0062-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/01/2012] [Indexed: 11/26/2022]
Abstract
In areas requiring maximum safety like intensive care units or operating room departments, modern quality management and risk management are essential. Treatment of critically ill patients is associated with high risk and, therefore, demands risk management and quality management. External quality assessment in intensive care medicine has been developed based on a core data set and quality indicators. A peer review procedure has been established. In addition, regional networks of intensive care physicians result in improved local networking. In intensive care medicine, this innovative modular system of quality management and risk management is pursued more consequently than in any other specialty.
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Affiliation(s)
- J Martin
- Kliniken des Landkreises Göppingen gGmbH, Eichertstr. 3, 73035, Göppingen, Germany.
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Vincent JL, Takala J, Flaatten H. Impact of reimbursement schemes on quality of care: a European perspective. Am J Respir Crit Care Med 2012; 185:119-21. [PMID: 22246700 DOI: 10.1164/rccm.201108-1472ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Braun JP, Bause H. Peer Reviews in der Intensivmedizin. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2012; 106:566-70. [DOI: 10.1016/j.zefq.2012.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 11/24/2022]
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Pita MJ, Díaz-Agero C, Robustillo A, Prieto I, Gómez P, Monge V. [Quality indicators in an intensive care unit: a two-year healthcare-associated infection surveillance program]. ACTA ACUST UNITED AC 2011; 27:103-7. [PMID: 22177693 DOI: 10.1016/j.cali.2011.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To estimate quality healthcare indicators in an intensive care unit (ICU). METHODS A prospective observational study was conducted on all patients referred to the medical ICU of Ramón y Cajal hospital (Madrid) for more than 48 hours, from January 1 2008 to December 31 2009. RESULTS A total of 503 patients were included, of whom 7.4% developed a healthcare-associated infection (HAI) attributable to their stay in the ICU. The median length of stay was 5 days. A ventilator-associated pneumonia (VAP) was observed in 1.9% of patients, with a VAP rate of 3.8 per 1,000 ventilator-days. A catheter-associated urinary tract infection (CAUTI) was found in 3.6% of the patients, with a CAUTI rate of 4.5 per 1,000 catheter-days. The cumulative incidence of central line-associated bloodstream infection (CLABSI) was 1.8%, with a CLABSI rate of 2.2 per 1,000 central line-days. CONCLUSIONS Our results are similar to those of other studies using the same methodology. An HAI surveillance system is a key factor for implementing a healthcare quality improvement system. The obtained indicators allow intra-comparison over time and with other similar hospitals, the monitoring of infection control measures, and thus an effective improvement in healthcare quality and patient safety.
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Affiliation(s)
- M J Pita
- Servicio de Medicina Preventiva, Hospital Ramón y Cajal, Madrid, España.
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van der Veer SN, de Vos MLG, Jager KJ, van der Voort PHJ, Peek N, Westert GP, Graafmans WC, de Keizer NF. Evaluating the effectiveness of a tailored multifaceted performance feedback intervention to improve the quality of care: protocol for a cluster randomized trial in intensive care. Implement Sci 2011; 6:119. [PMID: 22024188 PMCID: PMC3217909 DOI: 10.1186/1748-5908-6-119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 10/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feedback is potentially effective in improving the quality of care. However, merely sending reports is no guarantee that performance data are used as input for systematic quality improvement (QI). Therefore, we developed a multifaceted intervention tailored to prospectively analyzed barriers to using indicators: the Information Feedback on Quality Indicators (InFoQI) program. This program aims to promote the use of performance indicator data as input for local systematic QI. We will conduct a study to assess the impact of the InFoQI program on patient outcome and organizational process measures of care, and to gain insight into barriers and success factors that affected the program's impact. The study will be executed in the context of intensive care. This paper presents the study's protocol. METHODS/DESIGN We will conduct a cluster randomized controlled trial with intensive care units (ICUs) in the Netherlands. We will include ICUs that submit indicator data to the Dutch National Intensive Care Evaluation (NICE) quality registry and that agree to allocate at least one intensivist and one ICU nurse for implementation of the intervention. Eligible ICUs (clusters) will be randomized to receive basic NICE registry feedback (control arm) or to participate in the InFoQI program (intervention arm). The InFoQI program consists of comprehensive feedback, establishing a local, multidisciplinary QI team, and educational outreach visits. The primary outcome measures will be length of ICU stay and the proportion of shifts with a bed occupancy rate above 80%. We will also conduct a process evaluation involving ICUs in the intervention arm to investigate their actual exposure to and experiences with the InFoQI program. DISCUSSION The results of this study will inform those involved in providing ICU care on the feasibility of a tailored multifaceted performance feedback intervention and its ability to accelerate systematic and local quality improvement. Although our study will be conducted within the domain of intensive care, we believe our conclusions will be generalizable to other settings that have a quality registry including an indicator set available. TRIAL REGISTRATION Current Controlled Trials ISRCTN50542146.
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Affiliation(s)
- Sabine N van der Veer
- Department of Medical Informatics, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
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Martín Delgado MC, Gordo-Vidal F. [The quality and safety of intensive care medicine in Spain. More than just words]. Med Intensiva 2011; 35:201-5. [PMID: 21414688 DOI: 10.1016/j.medin.2011.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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Abstract
Intensive care medicine is a medical specialty that was officially established in our country in 1978, with a 5-year training program including two years of common core training followed by three years of specific training in an intensive care unit accredited for training. During this 32-year period, intensive care medicine has carried out an intense and varied activity, which has allowed its positioning as an attractive and with future specialty in the hospital setting. This document summarizes the history of the specialty, its current situation, the key role played in the programs of organ donation and transplantation of the National Transplant Organization (after more than 20 years of mutual collaboration), its training activities with the development of the National Plan of Cardiopulmonary Resuscitation, with a trajectory of more than 25 years, its interest in providing care based on quality and safety programs for the severely ill patient. It also describes the development of reference registries due to the need for reliable data on the care process for the most prevalent diseases, such as ischemic heart disease or ICU-acquired infections, based on long-term experience (more than 15 years), which results in the availability of epidemiological information and characteristics of care that may affect the practical patient's care. Moreover, features of its scientific society (SEMICYUC) are reported, an organization that agglutinates the interests of more than 280 ICUs and more than 2700 intensivists, with reference to the journal Medicina Intensiva, the official journal of the society and the Panamerican and Iberian Federation of Critical Medicine and Intensive Care Societies. Medicina Intensiva is indexed in the Thompson Reuters products of Science Citation Index Expanded (Scisearch(®)) and Journal Citation Reports, Science Edition. The important contribution of the Spanish intensive care medicine to the scientific community is also analyzed, and in relation to the future of intensive care medicine in Spain and in Europe, recommendations are made towards specialization in intensive care medicine incorporating in the training program those competences (knowledge, skills and attitudes) that should be present an intensivist in Europe and that are extensively fulfilled by the current Spanish training program. The trajectory followed by intensive care medicine in Europe and recently in China, shows the increasing need of intensive care and the progressive recognition of the specialty in economically growing countries, and emphasizes the need of homogenization in the training of future specialists in intensive care medicine globally.
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Braun JP, Bause H, Bloos F, Geldner G, Kastrup M, Kuhlen R, Markewitz A, Martin J, Mende H, Quintel M, Steinmeier-Bauer K, Waydhas C, Spies C. Peer reviewing critical care: a pragmatic approach to quality management. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2010; 8:Doc23. [PMID: 21063473 PMCID: PMC2975265 DOI: 10.3205/000112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Indexed: 01/10/2023]
Abstract
Critical care medicine frequently involves decisions and measures that may result in significant consequences for patients. In particular, mistakes may directly or indirectly derive from daily routine processes. In addition, consequences may result from the broader pharmaceutical and technological treatment options, which frequently involve multidimensional aspects. The increasing complexity of pharmaceutical and technological properties must be monitored and taken into account. Besides the presence of various disciplines involved, the provision of 24-hour care requires multiple handovers of significant information each day. Immediate expert action that is well coordinated is just as important as a professional handling of medicine's limitations.Intensivists are increasingly facing professional quality management within the ICU (Intensive Care Unit). This article depicts a practical and effective approach to this complex topic and describes external evaluation of critical care according to peer reviewing processes, which have been successfully implemented in Germany and are likely to gain in significance.
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Affiliation(s)
- Jan-Peter Braun
- Dept. of Anaesthesiology and Surgical Intensive Care Medicine, Charité - University Medicine Berlin, Germany.
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Braun JP, Mende H, Bause H, Bloos F, Geldner G, Kastrup M, Kuhlen R, Markewitz A, Martin J, Quintel M, Steinmeier-Bauer K, Waydhas C, Spies C. Quality indicators in intensive care medicine: why? Use or burden for the intensivist. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2010; 8:Doc22. [PMID: 21063472 PMCID: PMC2975264 DOI: 10.3205/000111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Indexed: 12/18/2022]
Abstract
In order to improve quality (of therapy), one has to know, evaluate and make transparent, one’s own daily processes. This process of reflection can be supported by the presentation of key data or indicators, in which the real as-is state can be represented. Quality indicators are required in order to depict the as-is state. Quality indicators reflect adherence to specific quality measures. Continuing registration of an indicator is useless once it becomes irrelevant or adherence is 100%. In the field of intensive care medicine, studies of quality indicators have been performed in some countries. Quality indicators relevant for medical quality and outcome in critically ill patients have been identified by following standardized approaches. Different German societies of intensive care medicine have finally agreed on 10 core quality indicators that will be valid for two years and are currently recommended in German intensive care units (ICUs).
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Affiliation(s)
- Jan-Peter Braun
- Dept. of Anaesthesiology and Surgical Intensive Care Medicine, Charité - University Medicine Berlin, Germany
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Lorenzo Torrent R, Sánchez Palacios M, Santana Cabrera L, Cobian Martinez JL, García del Rosario C. [Management of quality in an Intensive Care Unit: implementation of ISO 9001:2008 international standard]. Med Intensiva 2010; 34:476-82. [PMID: 20822737 DOI: 10.1016/j.medin.2009.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 06/16/2009] [Accepted: 06/18/2009] [Indexed: 11/28/2022]
Abstract
The Quality Management Systems make it possible to prioritize actions to maintain the safety and efficacy of health technologies. The Intensive Care Unit of our hospital has implemented a quality management plan, which has obtained accreditation as "Service Certificate that manages its activities according to UNE-EN ISO 9001:2008" standard. With the application of quality management system, it has been possible to detect the needs that the Service can cover in order to obtain the satisfaction of the patient, relative or health personnel of the other services of the hospital, to improve communications inside and outside of service, to secure greater understanding of the processes of the organization and control of risk, to delimit responsibilities clearly to all the personnel, to make better use of the time and resources and, finally, to improve the motivation of the personnel.
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Affiliation(s)
- R Lorenzo Torrent
- Servicio de Medicina Intensiva, Hospital Universitario Insular de Gran Canaria, Gran Canaria, España
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Felices-Abad F, Latour-Pérez J, Fuset-Cabanes M, Ruano-Marco M, Cuñat-de la Hoz J, del Nogal-Sáez F. Indicadores de calidad en el síndrome coronario agudo para el análisis del proceso asistencial pre e intrahospitalario. Med Intensiva 2010; 34:397-417. [DOI: 10.1016/j.medin.2010.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 02/22/2010] [Accepted: 02/25/2010] [Indexed: 12/22/2022]
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Epidemiología e impacto de las infecciones nosocomiales. Med Intensiva 2010; 34:256-67. [DOI: 10.1016/j.medin.2009.11.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 11/22/2009] [Indexed: 11/22/2022]
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Kastrup M, von Dossow V, Seeling M, Ahlborn R, Tamarkin A, Conroy P, Boemke W, Wernecke KD, Spies C. Key performance indicators in intensive care medicine. A retrospective matched cohort study. J Int Med Res 2010; 37:1267-84. [PMID: 19930832 DOI: 10.1177/147323000903700502] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Expert panel consensus was used to develop evidence-based process indicators that were independent risk factors for the main clinical outcome parameters of length of stay in the intensive care unit (ICU) and mortality. In a retrospective, matched data analysis of patients from five ICUs at a tertiary university hospital, agreed process indicators (sedation monitoring, pain monitoring, mean arterial pressure [MAP] >or= 60 mmHg, tidal volume [TV] <or= 6 ml/kg body weight, peak inspiratory pressure [PIP] <or= 35 cmH(2)O and blood glucose [BG] >or= 80 and <or= 130 mg/dl) were validated using a prospective dataset of 4445 consecutive patients. After matching for age, sex and ICU, 634 patients were analysed. Logistic regression of the 634 patients showed that monitoring analgesia and sedation, MAP >or= 60 mmHg and BG >or= 80 mg/dl were relevant for survival. Linear regression of the 634 patients showed that analgesia monitoring, PIP <or= 35 cmH(2)O and TV <or= 6 ml/kg were associated with reduced length of ICU stay. Linear regression on all 4445 patients showed analgesia, sedation monitoring, MAP >or= 60 mmHg, BG >or= 80 mg/dl and <or= 130 mg/dl, PIP <or= 35 cmH(2)O and TV <or= 6 ml/kg were associated with reduced length of ICU stay, indicating that adherence to evidence-based key process indicators may reduce mortality and length of ICU stay.
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Affiliation(s)
- M Kastrup
- Department of Anaesthesiology and Intensive Care, Campus Virchow-Klinikum and Campus Charité Mitte, Charité University Medicine Berlin, Berlin, Germany
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Sabatier C, Peredo R, Villagrá A, Bacelar N, Mariscal D, Ferrer R, Gallego M, Vallés J. [Community-acquired pneumonia: a 7-years descriptive study. Usefulness of the IDSA/ATS 2007 in the assessment of ICU admission]. Med Intensiva 2010; 34:237-45. [PMID: 20116135 DOI: 10.1016/j.medin.2009.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 11/24/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the clinical characteristics and outcomes of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU). To evaluate new ATS/IDSA criteria to identify patients with CAP who required admission to ICU. DESIGN Retrospective analysis of prospective collected data in a 7-year period (2000-2007). SETTING Medical-surgical ICU with 16 beds. PATIENTS All patients with severe CAP admitted to the ICU (n=147). PRIMARY ENDPOINTS: Clinical and microbiological characteristics. Prognostic factors. Comparison of patients admitted in the ICU and ATS/IDSA criteria (group 1: > or = 1 major criterion, group 2: > or = 3 minor criteria and group 3: no criterion). INTERVENTION None. RESULTS Admission to the ICU is required for patients with acute respiratory failure (60.5%) and with septic shock (28.5%). A total of 71.4%, had an identifiable microbial etiology, S. pneumoniae being the most frequently isolated. Mean time to antibiotic therapy was 4.3+/-4.2h, this being adequate in 97.1%. ICU global mortality rate was 32%. Prognostic factors associated with higher mortality were acute renal failure (OR:4.7), mechanical ventilation (OR:3.4), non-identifiable etiology (OR:4.2) and non-S. pneumonia etiology (OR:3.5). Sixty-eight percent of the patients were included in the first group of the ATS/IDSA criteria and 21% in the second group. CONCLUSIONS CAP mortality is still high despite early antibiotic therapy, especially in those patients with a non-S. pneumonia etiology or who require mechanical ventilation. Almost 90% of the ICU admissions were identified by the new criteria from ATS/IDSA.
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Affiliation(s)
- C Sabatier
- Centro de Críticos, Hospital de Sabadell, Instituto Universitario Parc Taulí, UAB, CIBER-Enfermedades Respiratorias, España
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Manzano F, Navarro MJ, Roldán D, Moral MA, Leyva I, Guerrero C, Sanchez MA, Colmenero M, Fernández-Mondejar E. Pressure ulcer incidence and risk factors in ventilated intensive care patients. J Crit Care 2009; 25:469-76. [PMID: 19879730 DOI: 10.1016/j.jcrc.2009.09.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 09/08/2009] [Accepted: 09/13/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to determine the incidence of pressure ulcers (PUs) in ventilated patients in all intensive care units (ICUs) in Granada (Spain) and identify risk factors for their development. MATERIALS AND METHODS A prospective cohort study in 9 medical-surgical ICUs was conducted. Two hundred ninety-nine patients with more than 24 hours on mechanical ventilation (MV) were enrolled during 2 periods in a 5-month study. Pressure ulcers of patients were measured according to the European Pressure Ulcer Advisory Panel. RESULTS Of the 299 patients initially enrolled, 47 (16%) developed PUs of at least grade II severity. The incidence density of PUs was 13.4 cases per 1000 patient-days of ICU stay and 19.6 cases per 1000 patient-days on MV. Logistic regression identified first-day respiratory sequential organ failure assessment (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.026-2.360; P = .037), fourth-day cardiovascular sequential organ failure assessment (OR, 1.33; 95% CI, 1.066-1.664; P = .012), age (OR, 1.042; 95% CI, 1.013-1.072; P = .004), winter period (OR, 4.60; 95% CI, 1.99-10.59; P < .001), and length of MV before PUs (OR, 1.042; 95% CI, 1.005-1.080; P = .024) as significant independent predictors of PU development. CONCLUSIONS Among other factors previously known in ventilated patients, duration of MV and winter period were identified as risk factors for PUs.
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Affiliation(s)
- Francisco Manzano
- Intensive Care Unit, Hospital General (University Hospital Virgen de las Nieves), Granada, Spain.
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Murias G, Sales B, García-Esquirol O, Blanch L. [Telemedicine: Improving the quality of care for critical patients from the pre-hospital phase to the intensive care unit]. Med Intensiva 2009; 34:46-55. [PMID: 19811855 DOI: 10.1016/j.medin.2009.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 05/05/2009] [Accepted: 05/09/2009] [Indexed: 11/25/2022]
Abstract
The Health System is in crisis and critical care (from transport systems to the ICU) cannot escape from that. Lack of integration between ambulances and reference Hospitals, a deep shortage of critical care specialists and assigned economical resources that increase less than critical care demand are the cornerstones of the problem. Moreover, the analysis of the situation anticipated that the problem will be worse in the future. "Closed" ICUs in which critical care specialists direct patient care outperform "open" ones in which primary admitting physicians direct patient care in consultation with critical care specialists. However, the current paradigm in which a critical care specialist is close to the patient is in the edge of the trouble so, only a new paradigm could help to increase the number of patients under intensivist care. Current information technology and networking capabilities should be fully exploited to improve both the extent and quality of intensivist coverage. Far to be a replacement of the existing model Telemedicine might be a complimentary tool. In fact, to centralize medical data into servers has many additional advantages that could even improve the way in which critical care physicians take care of their patients under the traditional system.
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Affiliation(s)
- G Murias
- Unidad de Cuidados Intensivos, Clínica Bazterrica y Clínica Santa Isabel, La Plata, Buenos Aires, Argentina
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Sánchez-Palacios M, Lorenzo Torrent R, Santana-Cabrera L, Martín García JA, Campos SG, Carrasco de Miguel V. [Evacuation plan of an intensive care unit: a new quality indicator?]. Med Intensiva 2009; 34:198-202. [PMID: 20353900 DOI: 10.1016/j.medin.2009.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 05/04/2009] [Accepted: 05/06/2009] [Indexed: 11/17/2022]
Abstract
The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU.
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Affiliation(s)
- M Sánchez-Palacios
- Servicio de Medicina Intensiva, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, España
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[Safety and quality in intensive care medicine]. Med Intensiva 2009; 33:346-52. [PMID: 19828397 DOI: 10.1016/j.medin.2009.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 02/26/2009] [Accepted: 03/03/2009] [Indexed: 11/20/2022]
Abstract
The safety and quality care are two attributes of the health care that are closely intertwined. Quality is a feature of the system that delivers health care, thereby improving it, we need a proper reorganization teamwork. Measurements of quality are intended to assess whether the process of health care reaches the desired objectives, while avoiding the processes that predispose to harm the patient. The critically ill patients are vulnerable to medical errors, and may experience side effects preventable, often associated with: medications, mechanical ventilation, and intravascular devices. The evidence currently available suggest that the safety and quality of care can be improved. In this article presents some of the strategies and interventions developed to optimize the processes of care in critically ill patients, and improve the safety culture in the ICU.
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