Reliability and Validity of the Checklist for Early Recognition and Treatment of Acute Illness and Injury as a Charting Tool in the Medical Intensive Care Unit

Analysis of the Effect of Emergency Ventilators on the Treatment of Critical Illness Based on Smart Medical Big Data

Respiratory failure refers to pulmonary ventilation and ventilatory dysfunction caused by various reasons, which makes the patient unable to maintain the gas exchange required for stillness and causes a series of pathophysiological changes and corresponding clinical manifestations. In order to solve the problem of respiratory failure in critically ill patients, it is of great significance to analyze the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This article aims to study the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This paper presents the key technology based on the ARM11 processor. A breathing motion model is detected and established through a ventilator. The research objects are mainly divided into group A and group B. By comparing the two groups of emergency ventilator ventilation, it can effectively prevent the increase in respiratory muscle fatigue, reduce oxygen consumption, improve the patient's ventilation function and oxygen balance, quickly correct hypoxia and carbon dioxide storage, cooperate with drug treatment, and quickly take out the ventilator after relief. Good treatment results were achieved. The results show that the emergency ventilator controlled by a microcomputer is effective. The total effective rate of the control group was 71.11%, which was significantly lower than that of the observation group (86.67%).

Impact of Checklist for Early Recognition and Treatment of Acute Illness on Treatment of Critically Ill Septic Patients in a Low-Resource Medical Intensive Care Unit

Introduction: Treatment of sepsis and septic shock can be a challenge even for intensive care units (ICUs) in high income countries, but it is especially difficult for ICUs with limited resources. Aim: To evaluate the impact of CERTAIN on treatment of critically ill septic patients in low-resource medical ICU. Materials and Methods: In a before-and-after study design, we compared clinical outcomes, processes, and complications (hospital acquired infections) 1 year before and 2 years after (2016 and 2017) introduction of CERTAIN. Results: A total of 125 patients with sepsis were prospectively identified for a 3-year period. Mean patient age, gender distribution, number of patients on mechanical ventilation (33 [76.7%] vs. 42 [84%] vs. 24 [75%]) and vasopressor use (23 [53.5%] vs. 34 [68%] vs. 24 [75%]) were similar before (2015) and 2 years after (2016 and 2017) the implementation of CERTAIN. Severity of illness (Simplified Acute Physiology Score II [SAPS II score]) was higher after the implementation. The checklist was incorporated in the daily practice with 100% adherence to its use. The duration of mechanical ventilation (5.3 ± 5.3 vs. 4.2 ± 3.6 vs. 3.7 ± 5.5), antibiotic treatment (8.2 ± 5.4 vs. 6.9 ± 4.1 vs. 5.8 ± 5.6), central venous catheter use (6.2 ± 5.7 vs. 5.7 ± 4.6 vs. 4.2 ± 6.1), ICU stay (8.4 ± 5.4 vs. 7.1 ± 4.1 vs. 5.8 ± 5.6), and the incidence of nosocomial infection (33.3% vs. 30% vs. 12.5%) decreased in the period after the onset of the intervention, but the results did not reach statistical significance. When adjusted for baseline characteristics, CERTAIN was not associated with hospital mortality (odds ratio 0.88, 0.38-2.04). Conclusion: CERTAIN was readily adopted in the ICU workflow and was associated with improvement in treatment of critically ill patients with sepsis.

Observation of the Effectiveness of a Diagnostic Model for Acute Abdominal Pain Based on the Etiology Checklist and Process Thinking

Objective

The present study aimed to explore the effectiveness of the etiology checklist and process thinking in the differential diagnosis for acute abdominal pain.

Methods

A retrospective design was used to include 5,403 patients with acute abdominal pain in the Emergency Department of Hebei Provincial People's Hospital. The patients with acute abdominal pain between July and December 2017 in whom the etiology checklist and process thinking were not implemented were selected as the traditional group. Those with acute abdominal pain between July and December 2018 in whom the etiology checklist and process thinking were implemented were selected as the process thinking group. The clinical data, such as the emergency length of stay, hospitalization expenses, hospitalization length of stay, diagnostic accuracy, and outcome, were compared between the two groups.

Results

For patients at emergency level 2 and above, the average emergency length of stay was shorter in the process thinking group than in the traditional group, while the average emergency length of stay was longer for patients at emergency level 3. For hospitalized patients at emergency level 2 and above and patients at emergency level 3, those in the process thinking group had improved diagnostic accuracy, shorter average hospitalization length of stay, reduced average hospital expenses, and improved outcomes. In the comparison among six physicians, the results in the traditional group were inconsistent and statistically different in terms of the average emergency length of stay and diagnostic accuracy, while the results in the process thinking group tended to be consistent. The differences were not statistically different.

Conclusion

The diagnostic model for acute abdominal pain based on the etiology checklist and process thinking could improve the diagnostic accuracy and outcomes for patients with acute abdominal pain.

Checklist design and implementation: critical considerations to improve patient safety for low-frequency, high-risk patient events

Purpose: This pilot project describes the development and implementation of two specialised aviation-style checklist designs for a low-frequency high-risk patient population in a cardiac intensive care unit. The effect of the checklist design as well as the implementation strategies on patient outcomes and adherence to best practice guidelines were also explored. The long-term objective was to improve adherence to accepted processes of care by establishing the checklists as standard practice thereby improving patient safety and outcomes.

Methods: During this project, 10specialised crisis checklists using two specific aviation-style designs were developed. A quasiexperimental prospective pre-post repeated measure design including surveys along with repetitive simulations were used to evaluate self-confidence and self-efficacy over time as well as the perceived utility, ease of use, fit into workflow and benefits of the checklists use to patients. Performance, patient outcomes and manikin outcomes were also used to evaluate the effectiveness of the crisis checklists on provider behaviours and patient outcomes.

Results: Overall self-confidence and self-confidence related to skills and knowledge while not significant demonstrated clinically relevant improvements that were sustained over time. Perceptions of the checklists were positive with consistent utilisation sustained over time. More importantly, use of the checklists demonstrated a reduction in errors both in the simulated and clinical setting.

Conclusion: Recommendations from this study consist of key considerations for development and implementation of checklists including: utilisation of stakeholders in the development phase; implementation in real and simulated environments; and ongoing reinforcement and training to sustain use.