Integrating a safety smart list into the electronic health record decreases intensive care unit length of stay and cost

This paper by Lamkin and colleagues was first published online in the Journal of Critical Care during October 2019.
Purpose:  To measure how an integrated smartlist developed for critically ill patients would change intensive care units (ICUs) length of stay (LOS), mortality, and charges.
Materials and methods:  Propensity-score analysis of adult patients admitted to one of 14 surgical and medical ICUs between June 2017 and May 2018. The smart list aimed to certain preventative measures for all critical patients (e.g., removing unneeded catheters, starting thromboembolic prophylaxis, etc.) and was integrated into the electronic health record workflows at the hospitals under study.
Results:  During the study period, 11,979 patients were treated in the 14 participating ICUs by 518 unique providers. Patients who had the smart list used during ≥60% of their ICU stay (N = 432 patients, 3.6%) were significantly more likely to have a shorter ICU LOS (HR = 1.20, 95% CI:1.0 to 1.4, p = 0.015) with an average decrease of -$1218 (95% CI: -$1830 to -$607, P < 0.001) in the amount charged per day. The intervention cohort had fewer average ventilator days (3.05 vent days, SD = 2.55) compared to propensity score matched controls (3.99, SD = 4.68, p = 0.015), but no changes in mortality (16.7% vs 16.0%, p = 0.78).
Conclusions:  An integrated smart list shortened LOS and lowered charges in a diverse cohort of critically ill patients.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

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Intensive care unit occupancy and premature discharge rates: A cohort study assessing the reporting of quality indicators

This paper by Blayney and colleagues was first published online in the Journal of Critical Care during October 2019.
Purpose:  ICU occupancy fluctuates. High levels may disadvantage patients. Currently, occupancy is benchmarked annually which may inaccurately reflect strained units. Outcomes potentially sensitive to occupancy include premature (early) ICU discharge and non-clinical transfer (NCT). This study assesses the association between daily occupancy and these outcomes, and evaluates benchmarking care across Scotland using daily occupancy.
Materials and methods:  Population: all Scottish ICU patients, 2006–2014. Exposure: bed occupancy per unit-day; Outcomes: proportion of early discharges and NCTs. Design: Retrospective cohort study. Outcome rates were calculated above various occupancy thresholds. Polynomial regression visualised associations, and inflection points between occupancy and outcomes. Spearman’s rho correlations between occupancy measures and outcomes were reported.
Results:  65,472 discharges occurred over 57,812 unit-days. 1954(3.0%) discharges were early; 429 (0.7%) were NCTs. Early discharge rates above 70%, 80% and 90% occupancy were 3.9%, 5.0% and 7.5% respectively. Occupancies at which outcome rates greatly increased were near 80% for early discharge, and 90% for NCT. Mean annual occupancy was not correlated with outcomes; annual proportion of days ≥90% occupancy correlated most strongly (early discharge rho = 0.46,p < .001; NCT rho = 0.31, p < .001).
Conclusions:  We demonstrate a clear association between daily ICU occupancy and early discharge/NCT. Daily occupancy may better benchmark care quality than mean annual occupancy.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Intensive Care Medicine Volume 45 Number 10 October 2019

To view Intensive Care Medicine’s November issue’s contents page follow this link.
Articles published in this issue include:  “Predictors of gastrointestinal bleeding in adult ICU patients: a systematic review and meta-analysis”, “Randomised evaluation of active control of temperature versus ordinary temperature management (REACTOR) trial” and “Levosimendan in septic shock in patients with biochemical evidence of cardiac dysfunction: a subgroup analysis of the LeoPARDS randomised trial
To read the full text of any of these articles via the journal’s homepage requires a personal subscription to “Intensive Care Medicine” though some are available open access.  Individual articles can be ordered from the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.
The full text of articles from issues older than one year ago is available via this link to an archive of issues of Intensive Care Medicine.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Critical Care Reviews Newsletter 407 29th September 2019

Critical Care Reviews Newsletter contains the best critical care research and open access articles from across the medical literature during the last week.
The highlights of this week’s edition are two randomised controlled trials on antibiotics for pneumonia; lefamulin vs moxifloxacin in community-acquired pneumonia ceftolozane–tazobactam vs meropenem for nosocomial pneumonia; systematic reviews and meta analyses on intensity of renal replacement treatment for acute kidney injury meta-analyses in critical care; and observational studies on plasma-to–red blood cell transfusion ratio in adults with severe traumatic bleeding lung ultrasound for early diagnosis of postoperative need for ventilatory support.
The full text of the newsletter is available via this link.

Critical Care Reviews Newsletter 405 16th September 2019

The Critical Care Reviews Newsletter lists the best critical care research and open access articles from across the medical literature during the last seven days.
The highlights of this week’s edition are randomised controlled trials on supplementation of vitamin D in neurocritical care patients & high-flow nasal cannulae versus non-invasive ventilation for preoxygenation of obese patients; systematic reviews and meta analyses on airway pressure release ventilation & selective digestive decontamination vs. selective oropharyngeal decontamination; and observational studies on prolonged versus brief ICU stay & the association between supra-physiologic arterial oxygen levels and mortality. There are also guidelines on acute and chronic heart failure & immune checkpoint inhibitor–related pneumonitis; narrative reviews on malignant hyperthermia & oral anticoagulant reversal strategies; editorials on crystalloids in sepsis & nasal high‐flow therapy; and commentaries on heart recovery after circulatory determination of death perioperative hemodynamic monitoring; as well as a study critique on the EOLIA trial

The full text of the newsletter is available via this link.

Critical Care Reviews Newsletter 404 9th September 2019

The Critical Care Reviews Newsletter lists the best critical care research and open access articles from across the medical literature during the last seven days.
“The highlights of this week’s edition are randomised controlled trials on masks for preventing influenza among health care personnel & NIV in pneumonia-induced early mild ARDS; systematic reviews and meta analyses on predictors of gastrointestinal bleeding in adult ICU patients & recombinant human soluble thrombomodulin in patients with sepsis-associated coagulopathy; and observational studies on prophylactic pantoprazole in adult intensive care unit patients receiving dialysis & the incidence of maternal sepsis and sepsis-related maternal deaths in the USA.
There are also guidelines on acute pulmonary embolismsupraventricular tachycardia PICU admission, discharge, and triage; narrative reviews on post-cardiac arrest syndrome & antifungal drug dosing adjustment in critical patients with invasive fungal infections; editorials on advances that have led to increased survival in military casualties & critically ill obstetric patients in resource-limited settings; and commentaries on point-of-care ultrasound examination & caution with a new antibacterial.
This week’s Topic of the Week is neurocritical care, starting with a paper on the CT imaging in neurocritical care in today’s Paper of the Day. If you only have time to read one review article this week, try this one on fibrinolysis shutdown in trauma.
The full text of the newsletter is available via this link.

Intensive Care Medicine Volume 45 Number 9 September 2019

To view Intensive Care Medicine’s September issue’s contents page follow this link.
Articles published in this issue include “Acute ischaemic stroke: challenges for the intensivist”, “Safety and efficacy of erythropoiesis-stimulating agents in critically ill patients admitted to the intensive care unit: a systematic review and meta-analysis” and “Speckle tracking quantification of lung sliding for the diagnosis of pneumothorax: a multicentric observational study.”
To read the full text of any of these articles via the journal’s homepage requires a personal subscription to “Intensive Care Medicine” though some are available open access.  Individual articles can be ordered from the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.
The full text of articles from issues older than one year ago is available via this link to an archive of issues of Intensive Care Medicine.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.