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Original Article01-17-2023
Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1
- Ana Beatriz Ramos Wasniewski
, - Claudia Pires Ricachinevsky ,
- Raíssa Queiroz Rezende ,
- Bruna Tomasi Lorentz ,
- Edinara da Silva Silveira , [ ... ],
- Themis Reverbel da Silveira
Abstract
Original ArticleAdverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1
Critical Care Science. 2023;35(4):377-385
DOI 10.5935/2965-2774.20230215-en
- Ana Beatriz Ramos Wasniewski ,
- Claudia Pires Ricachinevsky ,
- Raíssa Queiroz Rezende ,
- Bruna Tomasi Lorentz ,
- Edinara da Silva Silveira ,
- Viviane Helena Rampon Angeli ,
- Mariana González de Oliveira ,
- Themis Reverbel da Silveira
Views85ABSTRACT
Objective:
To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events.
Methods:
This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical.
Results:
A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79).
Conclusion:
Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.
Keywords:Cardiac surgical procedures/adverse effectsCardiovascular agentsIntensive care units, pediatricPatient safetyPostoperative periodSafety managementSee moreViews85
Abstract
Original ArticleAdverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1
Critical Care Science. 2023;35(4):377-385
DOI 10.5935/2965-2774.20230215-en
- Ana Beatriz Ramos Wasniewski ,
- Claudia Pires Ricachinevsky ,
- Raíssa Queiroz Rezende ,
- Bruna Tomasi Lorentz ,
- Edinara da Silva Silveira ,
- Viviane Helena Rampon Angeli ,
- Mariana González de Oliveira ,
- Themis Reverbel da Silveira
Views85ABSTRACT
Objective:
To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events.
Methods:
This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical.
Results:
A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79).
Conclusion:
Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.
Keywords:Cardiac surgical procedures/adverse effectsCardiovascular agentsIntensive care units, pediatricPatient safetyPostoperative periodSafety managementSee more
- Ana Beatriz Ramos Wasniewski
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Original Article11-04-2022
Patient safety culture and incidents recorded during nursing shift changes in intensive care units
Revista Brasileira de Terapia Intensiva. 2022;34(3):386-392
Abstract
Original ArticlePatient safety culture and incidents recorded during nursing shift changes in intensive care units
Revista Brasileira de Terapia Intensiva. 2022;34(3):386-392
DOI 10.5935/0103-507X.20220446-en
Views62ABSTRACT
Objective:
To analyze the association of patient safety culture perceived by nursing professionals with incidents recorded during nursing shifts in intensive care units.
Methods:
This was a cross-sectional study that investigated patient safety culture measured by the Hospital Survey on Patient Safety Culture instrument. Descriptive statistics, chi-square tests, Student’s t-test and multiple linear regression models were analyzed considering a significance level of 5%.
Results:
The study reported a mean of 3.1 (standard deviation of 0.4) for the culture of patient safety in the perception of nursing professionals and 480 incidents with and without damage recorded during the nursing shifts. The variables patient safety culture with a difference between means of 0.543 (95%CI 0.022 - 1.065; p < 0.05) and nursing assistants with a difference between means of -0.133 (95%CI -0.192 - -0.074; p < 0.05) were associated with the incidents recorded during the nursing shifts. Further, nursing assistants had a lower tendency to record incidents than did the nurses.
Conclusion:
The strengthening of the patient safety culture and the aspects tangential to the nursing professionals represent a possible target for interventions to encourage the recording of incidents during the nursing shift shifts and improve patient safety.
Keywords:communicationintensive care unitsNursing assistantsOrganizational culturePatient safetyPerceptionSafety managementSee moreViews62Abstract
Original ArticlePatient safety culture and incidents recorded during nursing shift changes in intensive care units
Revista Brasileira de Terapia Intensiva. 2022;34(3):386-392
DOI 10.5935/0103-507X.20220446-en
Views62ABSTRACT
Objective:
To analyze the association of patient safety culture perceived by nursing professionals with incidents recorded during nursing shifts in intensive care units.
Methods:
This was a cross-sectional study that investigated patient safety culture measured by the Hospital Survey on Patient Safety Culture instrument. Descriptive statistics, chi-square tests, Student’s t-test and multiple linear regression models were analyzed considering a significance level of 5%.
Results:
The study reported a mean of 3.1 (standard deviation of 0.4) for the culture of patient safety in the perception of nursing professionals and 480 incidents with and without damage recorded during the nursing shifts. The variables patient safety culture with a difference between means of 0.543 (95%CI 0.022 - 1.065; p < 0.05) and nursing assistants with a difference between means of -0.133 (95%CI -0.192 - -0.074; p < 0.05) were associated with the incidents recorded during the nursing shifts. Further, nursing assistants had a lower tendency to record incidents than did the nurses.
Conclusion:
The strengthening of the patient safety culture and the aspects tangential to the nursing professionals represent a possible target for interventions to encourage the recording of incidents during the nursing shift shifts and improve patient safety.
Keywords:communicationintensive care unitsNursing assistantsOrganizational culturePatient safetyPerceptionSafety managementSee more -
Original Article09-12-2022
Success factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil
- Ladjane Santos Wolmer de Melo ,
- Thaís Moreira Estevão ,
- Juliana Sousa de Castro Chaves ,
- Janaina Maria Silva Vieira ,
- Marialba de Morais Siqueira , [ ... ],
- Heloisa Ramos Lacerda
Abstract
Original ArticleSuccess factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil
Revista Brasileira de Terapia Intensiva. 2022;34(3):327-334
DOI 10.5935/0103-507X.20220070-en
- Ladjane Santos Wolmer de Melo ,
- Thaís Moreira Estevão ,
- Juliana Sousa de Castro Chaves ,
- Janaina Maria Silva Vieira ,
- Marialba de Morais Siqueira ,
- Iêda Ludmer Guedes Alcoforado ,
- Cláudia Fernanda de Lacerda Vidal ,
- Heloisa Ramos Lacerda
Views59ABSTRACT
Objective:
To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections.
Methods:
This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period.
Results:
The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections.
Conclusion:
The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.
Keywords:Health evaluationHealthcare-associated pneumoniaImplementation scienceInfectionsintensive care unitsOutcome and process assessment (Health Care)Outcome assessment (Health Care)Patient safetyProgram developmentQuality improvementRespiration, artificialSee moreViews59Abstract
Original ArticleSuccess factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil
Revista Brasileira de Terapia Intensiva. 2022;34(3):327-334
DOI 10.5935/0103-507X.20220070-en
- Ladjane Santos Wolmer de Melo ,
- Thaís Moreira Estevão ,
- Juliana Sousa de Castro Chaves ,
- Janaina Maria Silva Vieira ,
- Marialba de Morais Siqueira ,
- Iêda Ludmer Guedes Alcoforado ,
- Cláudia Fernanda de Lacerda Vidal ,
- Heloisa Ramos Lacerda
Views59ABSTRACT
Objective:
To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections.
Methods:
This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period.
Results:
The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections.
Conclusion:
The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.
Keywords:Health evaluationHealthcare-associated pneumoniaImplementation scienceInfectionsintensive care unitsOutcome and process assessment (Health Care)Outcome assessment (Health Care)Patient safetyProgram developmentQuality improvementRespiration, artificialSee more
- Ladjane Santos Wolmer de Melo
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Special Article01-20-2019
Brazilian Guidelines for Early Mobilization in Intensive Care Unit
- Esperidião Elias Aquim ,
- Wanderley Marques Bernardo,
- Renata Ferreira Buzzini,
- Nara Selaimen Gaertner de Azeredo,
- Laura Severo da Cunha, [ ... ],
- Cleber Verona
Abstract
Special ArticleBrazilian Guidelines for Early Mobilization in Intensive Care Unit
Revista Brasileira de Terapia Intensiva. 2019;31(4):434-443
DOI 10.5935/0103-507X.20190084
- Esperidião Elias Aquim ,
- Wanderley Marques Bernardo,
- Renata Ferreira Buzzini,
- Nara Selaimen Gaertner de Azeredo,
- Laura Severo da Cunha,
- Marta Cristina Pauleti Damasceno,
- Rafael Alexandre de Oliveira Deucher,
- Antonio Carlos Magalhães Duarte,
- Juliana Thiemy Librelato,
- Cesar Augusto Melo-Silva,
- Sergio Nogueira Nemer,
- Sabrina Donatti Ferreira da Silva,
- Cleber Verona
Views360ABSTRACT
Immobility can cause several complications, including skeletal muscle atrophy and weakness, that influence the recovery of critically ill patients. This effect can be mitigated by early mobilization. Six key questions guided this research: Is early mobilization safe? Which patients are candidates for early mobilization? What are the contraindications? What is the appropriate dose, and how should it be defined? What results are obtained? What are the prognostic indicators for the use of early mobilization? The objective of this guideline was to produce a document that would provide evidence-based recommendations and suggestions regarding the early mobilization of critically ill adult patients, with the aim of improving understanding of the topic and making a positive impact on patient care. This guideline was based on a systematic review of articles conducted using the PICO search strategy, as recommended by the Guidelines Project of the Associação Médica Brasileira. Randomized clinical trials, prognostic cohort studies, and systematic reviews with or without meta-analysis were selected, and the evidence was classified according to the Oxford Center for Evidence-based Medicine Levels of Evidence. For all the questions addressed, enough evidence was found to support safe and well-defined early mobilization, with prognostic indicators that support and recommend the technique. Early mobilization is associated with better functional outcomes and should be performed whenever indicated. Early mobilization is safe and should be the goal of the entire multidisciplinary team.
Keywords:critical careEarly ambulationExerciseintensive care unitsMobilityPatient safetyRespiration, artificialSee moreViews360Abstract
Special ArticleBrazilian Guidelines for Early Mobilization in Intensive Care Unit
Revista Brasileira de Terapia Intensiva. 2019;31(4):434-443
DOI 10.5935/0103-507X.20190084
- Esperidião Elias Aquim ,
- Wanderley Marques Bernardo,
- Renata Ferreira Buzzini,
- Nara Selaimen Gaertner de Azeredo,
- Laura Severo da Cunha,
- Marta Cristina Pauleti Damasceno,
- Rafael Alexandre de Oliveira Deucher,
- Antonio Carlos Magalhães Duarte,
- Juliana Thiemy Librelato,
- Cesar Augusto Melo-Silva,
- Sergio Nogueira Nemer,
- Sabrina Donatti Ferreira da Silva,
- Cleber Verona
Views360ABSTRACT
Immobility can cause several complications, including skeletal muscle atrophy and weakness, that influence the recovery of critically ill patients. This effect can be mitigated by early mobilization. Six key questions guided this research: Is early mobilization safe? Which patients are candidates for early mobilization? What are the contraindications? What is the appropriate dose, and how should it be defined? What results are obtained? What are the prognostic indicators for the use of early mobilization? The objective of this guideline was to produce a document that would provide evidence-based recommendations and suggestions regarding the early mobilization of critically ill adult patients, with the aim of improving understanding of the topic and making a positive impact on patient care. This guideline was based on a systematic review of articles conducted using the PICO search strategy, as recommended by the Guidelines Project of the Associação Médica Brasileira. Randomized clinical trials, prognostic cohort studies, and systematic reviews with or without meta-analysis were selected, and the evidence was classified according to the Oxford Center for Evidence-based Medicine Levels of Evidence. For all the questions addressed, enough evidence was found to support safe and well-defined early mobilization, with prognostic indicators that support and recommend the technique. Early mobilization is associated with better functional outcomes and should be performed whenever indicated. Early mobilization is safe and should be the goal of the entire multidisciplinary team.
Keywords:critical careEarly ambulationExerciseintensive care unitsMobilityPatient safetyRespiration, artificialSee more
- Esperidião Elias Aquim
-
Special Article01-01-2017
Safe prone checklist: construction and implementation of a tool for performing the prone maneuver
Revista Brasileira de Terapia Intensiva. 2017;29(2):131-141
Abstract
Special ArticleSafe prone checklist: construction and implementation of a tool for performing the prone maneuver
Revista Brasileira de Terapia Intensiva. 2017;29(2):131-141
DOI 10.5935/0103-507X.20170023
Views108ABSTRACT
Objective:
To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver.
Methods:
This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane).
Results:
We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice.
Conclusion:
The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.
Keywords:Check listInservice trainingPatient safetyPronation/methodsProne position/methodsRespiratory distress syndrome, adultrespiratory failureSee moreViews108Abstract
Special ArticleSafe prone checklist: construction and implementation of a tool for performing the prone maneuver
Revista Brasileira de Terapia Intensiva. 2017;29(2):131-141
DOI 10.5935/0103-507X.20170023
Views108ABSTRACT
Objective:
To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver.
Methods:
This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane).
Results:
We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice.
Conclusion:
The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.
Keywords:Check listInservice trainingPatient safetyPronation/methodsProne position/methodsRespiratory distress syndrome, adultrespiratory failureSee more
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Review Article01-01-2017
Safety criteria to start early mobilization in intensive care units. Systematic review
Revista Brasileira de Terapia Intensiva. 2017;29(4):509-519
Abstract
Review ArticleSafety criteria to start early mobilization in intensive care units. Systematic review
Revista Brasileira de Terapia Intensiva. 2017;29(4):509-519
DOI 10.5935/0103-507X.20170076
Views187ABSTRACT
Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish which safety criteria are most often used to start early mobilization for patients under mechanical ventilation admitted to intensive care units. Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL databases; randomized and quasi-randomized clinical trials, cohort studies, comparative studies with or without simultaneous controls, case series with 10 or more consecutive cases and descriptive studies were included. The same was performed regarding prospective, retrospective or cross-sectional studies where safety criteria to start early mobilization should be described in the Methods section. Two reviewers independently selected potentially eligible studies according to the established inclusion criteria, extracted data and assessed the studies' methodological quality. Narrative description was employed in data analysis to summarize the characteristics and results of the included studies; safety criteria were categorized as follows: cardiovascular, respiratory, neurological, orthopedic and other. A total of 37 articles were considered eligible. Cardiovascular safety criteria exhibited the largest number of variables. However, respiratory safety criteria exhibited higher concordance among studies. There was greater divergence among the authors regarding neurological criteria. There is a need to reinforce the recognition of the safety criteria used to start early mobilization for critically ill patients; the parameters and variables found might contribute to inclusion into service routines so as to start, make progress and guide clinical practice.
Keywords:critical careEarly ambulationHospitalizationPatient safetyRehabilitationRespiration, artificialSee moreViews187Abstract
Review ArticleSafety criteria to start early mobilization in intensive care units. Systematic review
Revista Brasileira de Terapia Intensiva. 2017;29(4):509-519
DOI 10.5935/0103-507X.20170076
Views187ABSTRACT
Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish which safety criteria are most often used to start early mobilization for patients under mechanical ventilation admitted to intensive care units. Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL databases; randomized and quasi-randomized clinical trials, cohort studies, comparative studies with or without simultaneous controls, case series with 10 or more consecutive cases and descriptive studies were included. The same was performed regarding prospective, retrospective or cross-sectional studies where safety criteria to start early mobilization should be described in the Methods section. Two reviewers independently selected potentially eligible studies according to the established inclusion criteria, extracted data and assessed the studies' methodological quality. Narrative description was employed in data analysis to summarize the characteristics and results of the included studies; safety criteria were categorized as follows: cardiovascular, respiratory, neurological, orthopedic and other. A total of 37 articles were considered eligible. Cardiovascular safety criteria exhibited the largest number of variables. However, respiratory safety criteria exhibited higher concordance among studies. There was greater divergence among the authors regarding neurological criteria. There is a need to reinforce the recognition of the safety criteria used to start early mobilization for critically ill patients; the parameters and variables found might contribute to inclusion into service routines so as to start, make progress and guide clinical practice.
Keywords:critical careEarly ambulationHospitalizationPatient safetyRehabilitationRespiration, artificialSee more
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Original Article09-09-2016
Evaluation of the five-year operation period of a rapid response team led by an intensive care physician at a university hospital
Revista Brasileira de Terapia Intensiva. 2016;28(3):278-284
Abstract
Original ArticleEvaluation of the five-year operation period of a rapid response team led by an intensive care physician at a university hospital
Revista Brasileira de Terapia Intensiva. 2016;28(3):278-284
DOI 10.5935/0103-507X.20160045
Views22ABSTRACT
Objective:
To evaluate the implementation of a multidisciplinary rapid response team led by an intensive care physician at a university hospital.
Methods:
This retrospective cohort study analyzed assessment forms that were completed during the assessments made by the rapid response team of a university hospital between March 2009 and February 2014.
Results:
Data were collected from 1,628 assessments performed by the rapid response team for 1,024 patients and included 1,423 code yellow events and 205 code blue events. The number of assessments was higher in the first year of operation of the rapid response team. The multivariate analysis indicated that age (OR 1.02; 95%CI 1.02 - 1.03; p < 0.001), being male (OR 1.48; 95%CI 1.09 - 2.01; p = 0.01), having more than one assessment (OR 3.31; 95%CI, 2.32 - 4.71; p < 0.001), hospitalization for clinical care (OR 1.77; 95%CI 1.29 - 2.42; p < 0.001), the request of admission to the intensive care unit after the code event (OR 4.75; 95%CI 3.43 - 6.59; p < 0.001), and admission to the intensive care unit before the code event (OR 2.13; 95%CI 1.41 - 3.21; p = 0.001) were risk factors for hospital mortality in patients who were seen for code yellow events.
Conclusion:
The hospital mortality rates were higher than those found in previous studies. The number of assessments was higher in the first year of operation of the rapid response team. Moreover, hospital mortality was higher among patients admitted for clinical care.
Keywords:Hospital mortalityHospital rapid response teamHospital, universitiesintensive care unitsPatient safetySee moreViews22Abstract
Original ArticleEvaluation of the five-year operation period of a rapid response team led by an intensive care physician at a university hospital
Revista Brasileira de Terapia Intensiva. 2016;28(3):278-284
DOI 10.5935/0103-507X.20160045
Views22ABSTRACT
Objective:
To evaluate the implementation of a multidisciplinary rapid response team led by an intensive care physician at a university hospital.
Methods:
This retrospective cohort study analyzed assessment forms that were completed during the assessments made by the rapid response team of a university hospital between March 2009 and February 2014.
Results:
Data were collected from 1,628 assessments performed by the rapid response team for 1,024 patients and included 1,423 code yellow events and 205 code blue events. The number of assessments was higher in the first year of operation of the rapid response team. The multivariate analysis indicated that age (OR 1.02; 95%CI 1.02 - 1.03; p < 0.001), being male (OR 1.48; 95%CI 1.09 - 2.01; p = 0.01), having more than one assessment (OR 3.31; 95%CI, 2.32 - 4.71; p < 0.001), hospitalization for clinical care (OR 1.77; 95%CI 1.29 - 2.42; p < 0.001), the request of admission to the intensive care unit after the code event (OR 4.75; 95%CI 3.43 - 6.59; p < 0.001), and admission to the intensive care unit before the code event (OR 2.13; 95%CI 1.41 - 3.21; p = 0.001) were risk factors for hospital mortality in patients who were seen for code yellow events.
Conclusion:
The hospital mortality rates were higher than those found in previous studies. The number of assessments was higher in the first year of operation of the rapid response team. Moreover, hospital mortality was higher among patients admitted for clinical care.
Keywords:Hospital mortalityHospital rapid response teamHospital, universitiesintensive care unitsPatient safetySee more
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Original Article01-01-2014
Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients
Revista Brasileira de Terapia Intensiva. 2014;26(1):28-35
Abstract
Original ArticleReaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients
Revista Brasileira de Terapia Intensiva. 2014;26(1):28-35
DOI 10.5935/0103-507X.20140005
Views30Objective:
To define the characteristics and measure the reaction time of a health care team monitoring alarms in the intensive care unit.
Methods:
A quantitative, observational, and descriptive study developed at the coronary care unit of a cardiology public hospital in Rio de Janeiro state (RJ). Data were obtained from the information collected on the patients, the monitoring used, and the measurement of the team's reaction time to the alarms of multi-parameter monitors during a non-participatory field observation.
Results:
Eighty-eight patients were followed (49 during the day shift and 39 during the night shift). During the 40 hours of observation (20 hours during the day shift and 20 hours during the night shift), the total number of monitoring alarms was 227, with 106 alarms during the day shift and 121 during the night shift, an average of 5.7 alarms/hour. In total, 145 alarms unanswered by the team were observed, with 68 occurring during the day shift (64.15%) and 77 during the night shift (63.64%). This study demonstrated that the reaction time was longer than 10 minutes in more than 60% of the alarms, which were considered as unanswered alarms. The median reaction time of the answered alarms was 4 minutes and 54 seconds during the day shift and 4 minutes and 55 seconds during the night shift. The respiration monitoring was activated in only nine patients (23.07%) during the night shift. Regarding the alarm quality of these variables, the arrhythmia alarm was qualified in only 10 (20.40%) of the day-shift patients and the respiration alarm in four night-shift patients (44.44%).
Conclusion:
The programming and configuration of the physiological variables monitored and the parameters of alarms in the intensive care unit were inadequate; there was a delay and lack of response to the alarms, suggesting that relevant alarms may have been ignored by the health care team, thus compromising the patient safety.
Keywords:Clinical alarmsEquipament failureintensive care unitsIntensive care/standardsMonitoring, physiologic/instrumentationPatient safetySee moreViews30Abstract
Original ArticleReaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients
Revista Brasileira de Terapia Intensiva. 2014;26(1):28-35
DOI 10.5935/0103-507X.20140005
Views30Objective:
To define the characteristics and measure the reaction time of a health care team monitoring alarms in the intensive care unit.
Methods:
A quantitative, observational, and descriptive study developed at the coronary care unit of a cardiology public hospital in Rio de Janeiro state (RJ). Data were obtained from the information collected on the patients, the monitoring used, and the measurement of the team's reaction time to the alarms of multi-parameter monitors during a non-participatory field observation.
Results:
Eighty-eight patients were followed (49 during the day shift and 39 during the night shift). During the 40 hours of observation (20 hours during the day shift and 20 hours during the night shift), the total number of monitoring alarms was 227, with 106 alarms during the day shift and 121 during the night shift, an average of 5.7 alarms/hour. In total, 145 alarms unanswered by the team were observed, with 68 occurring during the day shift (64.15%) and 77 during the night shift (63.64%). This study demonstrated that the reaction time was longer than 10 minutes in more than 60% of the alarms, which were considered as unanswered alarms. The median reaction time of the answered alarms was 4 minutes and 54 seconds during the day shift and 4 minutes and 55 seconds during the night shift. The respiration monitoring was activated in only nine patients (23.07%) during the night shift. Regarding the alarm quality of these variables, the arrhythmia alarm was qualified in only 10 (20.40%) of the day-shift patients and the respiration alarm in four night-shift patients (44.44%).
Conclusion:
The programming and configuration of the physiological variables monitored and the parameters of alarms in the intensive care unit were inadequate; there was a delay and lack of response to the alarms, suggesting that relevant alarms may have been ignored by the health care team, thus compromising the patient safety.
Keywords:Clinical alarmsEquipament failureintensive care unitsIntensive care/standardsMonitoring, physiologic/instrumentationPatient safetySee more
Patient safety Archives - Critical Care Science (CCS)
