Critical care medicine
-
Critical care medicine · Nov 2009
Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover.
To use a handover assessment tool for identifying patient information corruption and objectively evaluating interventions designed to reduce handover errors and improve medical decision making. The continuous monitoring, intervention, and evaluation of the patient in modern intensive care unit practice generates large quantities of information, the platform on which medical decisions are made. Information corruption, defined as errors of distortion/omission compared with the medical record, may result in medical judgment errors. Identifying these errors may lead to quality improvements in intensive care unit care delivery and safety. ⋯ When asked to recall clinical information discussed at handover, medical members of the intensive care unit team provide data that are significantly corrupted compared with the medical record. Low subjective clinical judgment scores are significant associated with low handover scores. The handover/clinical intention scores may, therefore, be useful screening tools for intensive care unit system vulnerability to medical error. Additionally, handover instruments can identify interventions that reduce system vulnerability to error and may be used to guide quality improvements in handover practice.
-
Critical care medicine · Nov 2009
Multicenter Study Meta Analysis Comparative StudyAssociation between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia.
To compare the 28-day mortality and hospital length of stay of patients with community-acquired pneumonia who were transferred to an intensive care unit on the same day of emergency department presentation (direct-transfer patients) with those subsequently transferred within 3 days of presentation (delayed-transfer patients). ⋯ Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify patients who may benefit from direct intensive care unit admission despite a lack of major severity criteria for community-acquired pneumonia based on the current guidelines.
-
Critical care medicine · Nov 2009
Comparative StudyContinuous right ventricular volumetry by fast-response thermodilution during right ventricular ischemia: head-to-head comparison with conductance catheter measurements.
To evaluate the accuracy of right ventricular ejection fraction and right ventricular end-diastolic volume obtained by volumetric pulmonary artery catheter, using the conductance catheter as reference method. ⋯ Accuracy of volumetric pulmonary artery catheter in conditions of right ventricular ischemia is low and inadequate for diagnosis of right ventricular ischemia and failure.