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ISOLATION ROOMS: How many air changes per hour?

Design considerations for negative isolation and positive isolation rooms are discussed in this brief article by an engineering consultant.  Negative-pressure isolation rooms are intended to keep an infectious patient from infecting others in the hospital.  Positive isolation rooms are the opposite – intended to keep germs away from an immunocompromised patient in the room.  The recommendation for both types of isolation rooms is reported to be at least 12 air changes per hour.  Some hospitals use isolation rooms for general patients when they are available.  Although allowed in the past, it is no longer possible to operate isolation rooms that can be switched back and forth from negative to positive pressure.

Source: Herrick, M. (2017, February). Pressure points: Planning and maintaining air isolation rooms. Health Facilities Management, 30(2), 29-32.  Click here: http://www.hfmmagazine.com/articles/2671-planning-and-maintaining-hospital-air-isolation-rooms  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT SAFETY: Handoffs between ICU and OR

There is a lot of literature describing problems with, and best practices for, the transfer of care of post-surgical patients moving into the intensive care unit setting.  However, after conducting a comprehensive literature search, the authors of this brief commentary found no comparable literature about the reverse type of handoff – for patients going from the special care unit into surgery.  They suggest that a checklist be adopted and give an example of one such checklist.  They also recommend that a verbal handoff be required.

What do I like about this article?  The authors are authoritative (Mount Sinai and Johns Hopkins medical schools) and I like the actual example of the handoff checklist.  Also, I like it that they appear to be filling a gap in the medical literature – at least at the time that they wrote this commentary.

Source: Evans, A.S., Yee, M.S., and Hogue, C.W. (2014, Mar.). Often overlooked problems with handoffs: From the intensive care unit to the operating room.  Anesthesia & Analgesia, 118(3), 687-689.  Click here for free full text: http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/03000/Often_Overlooked_Problems_with_Handoffs___From_the.31.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ICUs: How do high-performing hospitals reduce CLABSI rates?

This is a study out of Johns Hopkins of 17 intensive care units at 7 hospitals – comparing practices related to reducing the central line-associated bloodstream infection (CLABSI) rate.  High performers were defined as those with less than 1 infection per 1000 catheter-days over the period of at least one year.  Low performers were defined as having over 3 infections per 1000 catheter-days.

I particularly like the tables and the appendices to this article.  The tables identify characteristics of high-performers in bullet-point brevity for each of the following levels of hospital employees: senior leadership, ICU managers, infection prevention and quality improvement staff, and frontline staff.  The appendices contain specific questions that make up a CLABSI Conversation – again differentiated between senior management, infection control / quality improvement staff, and ICU staff.

Source: Pham, J.C., and others. (2016, Apr.-June). CLABSI Conversations: Lessons from peer-to-peer assessments to reduce central line-associated bloodstream infections. Quality Management in Health Care, 25(2), 67-78.  Click here for publisher’s website:  http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2016&issue=04000&article=00001&type=abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NICU: Length of stay 109 days for technology-dependent babies at Rainbow Babies & Children’s

What is this study? A retrospective medical record review for 93 babies discharged from NICU at one hospital.

More about it: Researchers studied the care needed by babies who were discharged home from the neonatal intensive care unit at Rainbow Babies & Children’s Hospital (Cleveland) during a recent two- year period.  Data on 71 babies who were technology dependent were compared with 22 who were not.  Here are some findings:

Technology-Dependent Newborns Discharged from NICU

  • 66 percent needed supplemental oxygen at home
  • 46 percent needed feeding tubes at home
  • 16 percent needed tracheostomy at home
  • 16 percent needed mechanical ventilation at home

Newborns discharged home dependent on technology had an initial stay in the NICU of about 109 days compared to about 26 days for those discharged home non-dependent on technology.

Hospital readmission risk indicators for the technology-dependent group included: being female, having a gastrostomy tube or having initial lengthy NICU stay.

Sources:

NICU-t0-home transition can be tricky. (2016, June). Managed Care, 25(6), 8.  Click here: http://www.managedcaremag.com/archives/2016/6/nicu-home-transition-can-be-tricky

Toly, V.B., and others. (2016, June 7). Neonates and infants discharged home dependent on medical technology: Characteristics and outcomes. Advances in Neonatal Care,   Click here:  http://journals.lww.com/advancesinneonatalcare/pages/articleviewer.aspx?year=9000&issue=00000&article=99928&type=abstract

ICU: Wearing gowns and gloves for all ICU patients studied

Caregivers entering patient rooms in intensive care units typically use contact precautions – putting on gowns and gloves – when the patient is known to have antibiotic-resistant bacteria.  This study was a randomized trial of universal gown and glove use for adult patients in intensive care units in 2012.  Data on 1800 patients at different hospitals were studied.  The authors comment that:

  • “The observation that universal glove and gown use may result in fewer adverse events was unanticipated.  Universal glove and gown use could potentially have led to a decrease in HAIs [healthcare-associated infections] by serving as a barrier to acquiring new bacteria both through physical use of gloves and gowns as well as fewer HCW [health care worker] visits and better hand hygiene.”

Source: Croft, L.D., Harris, A.D., Pineles, L., and others. (2015, Aug. 15). The effect of universal glove and gown use on adverse events in intensive care unit patients. Clinical Infectious Diseases, 61(4), 545-553.  Click here for full text: cid.oxfordjournals.org/content/61/4/545.full.pdf  Posted by AHA Resource Center (312) 422-2003, rc@aha.org

 

TRANSPORT: Mayo Clinic improved ICU to OR transports

Patient transportation from critical care unit to the operating room was studied over the 2006 to 2010 period.  During this period there were 1,557 such transfers, some done in the existing traditional way, others according to a new coordinated patient transport system (CPTS).  The transfers studied were only those involving the first surgical case of the day.  Here are the findings:

  • “We report a significant improvement in on-time OR starts when a CPTS is used for all ICU patients who require surgery as a first case of the day.  A CPTS resulted in a fourfold improvement in one-time OR start percentage.” (page 359).

The difference between the traditional patient transport and the new CPTS are described in this article.

Source: Brown, M.J., Kor, D.J., Curry, T.B., and others. (2015, Nov.-Dec.). A coordinated patient transport system for ICU patients requiring surgery: Impact on operating room efficiency and ICU workflow. Journal for Healthcare Quality, 37(6), 354-362. Link to publisher’s website: http://journals.lww.com/jhqonline/Abstract/2015/11000/A_Coordinated_Patient_Transport_System_for_ICU.4.aspx Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

ICUs: Where do patients come from? Data on source of admissions from large-scale Project IMPACT database

Cerner’s Project IMPACT (Improved Methods of Patient Information Access of Core Clinical Tasks) is – or perhaps was – a database to which many different hospitals submitted information about their intensive care unit (ICU) patients.  Although I have not yet been able to confirm this, it appears that the IMPACT database may no longer be in existence, or perhaps not being added to any more.  Researchers have studied this database and published a number of articles in the medical literature based on it.  Let’s take a look at some interesting data from one such article, based on over 250,000 adult (aged 18 or older) ICU patients who were hospitalized in 138 ICUs during the period 2001-2008.

Notes: All of the following statistics are given in the original source to one decimal place – I’ve rounded them off in this blog post.  The following statistics are based on patients who were admitted for the first time to the ICU during a hospitalization.

Where did they come from?  Source of adult ICU admissions:

  • 42 percent from the emergency department
  • 32 percent from the surgical suite
  • 16 percent from general care floor or step-down unit
  •  8 percent from another hospital
  •  3 percent from another location

What kind of adult patient is admitted to ICU?

  • 66 percent medical
  • 22 percent scheduled surgical
  • 12 percent unscheduled surgical

Is the ICU a closed model or an open model?

  • 75 percent open model with optional or no intensivist consult
  • 20 percent open model with mandatory intensivist consult
  •   4 percent closed model

Payer mix for adult ICU patients

  • 50 percent Medicare
  • 30 percent private insurance
  •  9 percent self pay
  •  9 percent Medicaid
  •  3 percent other

Source: Brown, S.E., Ratcliffe, S.J., and others. (2014, Aug.) An empirical comparison of key statistical attributes among potential ICU quality indicators. Critical Care Medicine, 42(8), 1821-1831. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212919/pdf/nihms635834.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org  Note: The link takes you to a free full text “author manuscript,” which is what I used to provide the data noted above.  It was later published in the journal Critical Care Medicine, as noted in the citation.