Surgical Care Unit Research Articles

Ward-Based Nurses' Knowledge and Attitudes Toward Clinical Trials: A Survey Study in Taiwan.

Clinical trial education has not been extensively integrated into nursing education systems. Acute care nurses may lack sufficient knowledge when caring for admitted trial patients, which may negatively influence their attitudes toward clinical trials. The aim of this study was to explore ward-based nurses' knowledge and attitudes toward clinical trials. Ward-based nurses working in medical, surgical, and intensive care units in a medical center in Taiwan were approached to complete a questionnaire. The questionnaire was developed by the research team and included four parts: demographics, experience with clinical trials, clinical trial knowledge, and attitudes toward clinical trials. A total of 161 nurses responded. Nearly 90% of the nurses accessed trial information in their workplace. Nearly 80% of the respondents had experience with caring for trial patients, but the mean score of clinical trial knowledge was 4.5 out of a possible score of 10. For attitudes toward clinical trials, the mean score for positive beliefs was 39.7, and the mean score for negative expectations was 42.5, both out of a possible score of 55. The results indicated that respondents typically tended to hold a negative attitude toward clinical trials, especially in regard to the side effects of study drugs and communication with investigators. Knowledge deficits of ward-based nurses concerning trial participation is apparent. Continuing education for ward-based nurses is necessary to promote implementation of clinical trials and reduce negative expectations related to clinical trials. One way to improve nurses' knowledge is to integrate clinical trial education into nursing education systems, which will provide more channels through which nurses can understand how a trial works, including the risks, benefits, and participant protection. Through such educational initiatives, ward-based nurses may develop more positive beliefs regarding clinical trials and provide higher quality clinical trial care to participants.

Reducing emergency admissions and length of stay by introducing emergency surgical ambulatory service.

BackgroundEmergency surgical ambulatory care provides safe and effective assessment of acute surgical referrals, in addition to reducing the pressures on hospital beds.Our aim was to look at the effect of opening a surgical ambulatory care unit (SACU) and a dedicated surgeon for the unit on length of stay and same day discharge for emergency referrals.MethodsData was collected prospectively and updated daily to include all referrals to SACU. Historical data was retrieved to compare the effect of introduction of SACU and dedicated surgeon on same day discharge and length of stay.ResultsThree groups of patients were identified: pre-SACU, SACU and SACU with dedicated surgeon. There was 104.5% percentage increase in same day discharge rate for emergency GP referrals (22% pre-SACU to 45% in the dedicated surgeon group). Similarly, same day discharge for all emergency referrals increased from 17% pre-SACU to 29% in the dedicated surgeon group.There was 25.88 h reduction in the mean length of stay for emergency GP admissions (92.95 h pre-SACU to 67.07 h in the dedicated surgeon group). In pre-SACU group mean length of stay for all emergency admissions was 125 h, this dropped to 107.09 h in the dedicated surgeon group. This resulted in 102 hospital bed stays saved every month since the opening of SACU.ConclusionsEstablishing an emergency surgical ambulatory service has reduced length of stay and saved significant hospital bed stays. This effect was enhanced by having a dedicated senior surgeon providing early input and decision making.

Study on Surgical Re-Admission in DMCH

Introduction: Re-admission of surgical patients following discharge from a surgical care unit to the same or different hospital is not uncommon. Underlying causes varied. Majority of re-admission are unplanned. Postoperative complications are mainly responsible for patients to seek re-admission. Post operative complications are the mainly liable for surgical re-admission.
 Methods: A prospective study was performed in General Surgical units of Dhaka Medical College Hospital, Dhaka for one year from August’2011 to July’2012. Amongst the patients admitted in surgical units, all re-admitted patients within the period had been studied. Purposive sampling was done. Rate, cause, avoidability etc. were studied according to criteria.
 Results: Among 4396 admitted patients 294 (7%) had history of previous admission in surgical department of different hospitals. 65% patients were male and 70.07% were middle aged (20-50yr). 67% re-admisssion occurred through emergency department of which 67.7% were unplanned. 58% re-admission were avoidable. Diagnosis at readmission contains quite a long list but notables were loop ileostomy (23.47%), enterocutaneous fistula (10.54%), incisional hernia (9.52%), mature colostomy (8.84%), wound infection (8.5%) and subacute intestinal obstruction (4.76%).
 Conclusion: Re-admission can be a contributing factor to assess quality and performance. It should be focused in audit and practice.
 J Bangladesh Coll Phys Surg 2019; 37(2): 54-59

A Systematic Review of the Impact of Surgical Special Care Units on Patient Outcomes and Health Care Resource Utilization.

Perioperative intermediate care units (termed surgical special care units) have been widely implemented across health systems because they are believed to improve surveillance and management of high-risk surgical patients. Our objective was to conduct a systematic review to investigate the effects of a 3-level model of perioperative care delivery (ie, ward, surgical special care unit, or intensive care unit) compared to a 2-level model of care (ie, ward, intensive care unit) on postoperative outcomes. Our protocol was registered with PROSPERO, the international prospective register of systematic reviews (CRD42015025155). Randomized controlled studies and nonrandomized comparator studies were included. We performed a systematic search of Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and the Cochrane library (inception - 11/2017). The primary outcome was mortality; secondary outcomes included length of stay and hospital costs. We identified 1995 citations with our search, and 21 studies met eligibility criteria (2 randomized controlled studies and 19 nonrandomized comparator studies; 44,134 patients in total). Surgical special care units were characterized by continuous monitoring (12 studies), the absence of mechanical ventilation (8 studies), nurse-to-patient ratios (range, 1:2-1:4), and number of beds (median: 5; range: 3-33). Thirteen studies reported on mortality. Notable findings included no observed difference in overall in-hospital mortality, but an apparent increase in intensive care unit mortality in a 3-level model of care. This may reflect a decanting of lower acuity patients from the intensive care unit to the surgical special care unit. No significant difference was found in hospital length of stay; however, 2 studies demonstrated reductions in hospital costs with the implementation of a surgical special care unit. Significant clinical and methodological heterogeneity precluded pooled analysis. Given the prevalence of surgical special care units, the results of our review suggest that additional methodologically rigorous investigations are needed to understand the effect of these units on the surgical population.

Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury.

OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.

Logistical factors associated with adverse outcomes following emergency surgery in an acute care surgical unit.

The Acute Care Surgical Unit at Groote Schuur Hospital was established in 2010 and is the first of its kind in Africa. The aim of this study was to describe the outcomes of emergency surgical cases, as well as determine the logistical factors associated with adverse outcomes following surgery within the unit. This study was a retrospective audit which reviewed the folders of adult patients who underwent an emergency surgical procedure from July 2016 to July 2017. The primary outcome was a major adverse event (AE) which was defined by a Clavien-Dindo score of 3-5. A number of logistical factors related to patient admission and operation were evaluated for association with outcomes. A total of 271 patients were included with a mean age of 47 years, with 48% females and 52% males. A major AE was recorded for 13% of patients. The following factors were found to be predictive of a major AE: referral from outside the hospital, urgent booking colour code, reoperation, and consultant most senior surgeon present during procedure. Patient admission/surgery performed outside of normal working hours, being booked for surgery on admission, as well as delay to surgery beyond colour code were not associated with a major AE. Apart from the traditional clinical parameters, factors related to perioperative logistics may contribute to the risk of a major AE after emergency surgery and should be considered for inclusion in more comprehensive predictive models for adverse outcomes within an acute care surgery unit.

Adherence of surgeons to surgical prophylaxis guidelines

Background: surgical site infections (SSIs) are microbial contamination of the surgical wound during a period of one month that could result in major post-operative morbidity and mortality rates. Objectives: this study aimed to identify the adhesion of surgeons to antibiotics prophylaxis guidelines at Kingdom of Saudi Arabia (KSA). Methods: this study included 180 adult subjects who were scheduled to undergo major surgeries in the hospital. The data of the patients were collected from the surgical wards and day care unit. Results: most of the included surgeons showed no error during pre, intra and post operative duration as give the required antibiotics and didn’t give the non-require antibiotics. The preoperative adherence of surgeons as most of the surgeons (73.9%) followed the prophylactic measures that included correct choice, indications, dosage and duration. Most of the surgeons (76.1%) followed the prophylactic measures including correct choice, indications, dosage and duration during intra-operative period. The majority of the surgeons (75%) followed the prophylactic measures including correct choice, indications, dosage and duration during post-surgical duration. Conclusion: The level of surgeon’s adherence to antibiotic prophylactic guidelines was efficient among most of surgeons regarding the proper choice of antibiotic, duration, timing and indication. However, these results differ from other available studies, this study showed a good sign for application of antibiotic prophylactic measures in KSA hospitals. Further studies should be conducted to increase the knowledge and adherence of surgeons all over KSA.

Factors influencing the outcome of spontaneous intracerebral haematoma in a Neurosurgical Hospital in South-East Nigeria.

Spontaneous intracerebral haemorrhage (SICH) is a major cause of stroke worldwide. SICH management is still challenging, especially in developing countries. This study highlights certain factors affecting outcome of SICH managed in a Nigerian Neurosurgical centre, on a background of the modernisation of the patient care facilities. Retrospective analysis of patients managed for SICH at Memfys Hospital for Neurosurgery and Neurology in Enugu from years 2009-2016. All patients had computed tomography or magnetic resonance imaging for diagnosis. Treatment included medical, surgical and intensive care unit (ICU) care. Patients with aneurysmal subarachnoid haemorrhage and trauma were excluded. Factors analysed include age, admission Glasgow Coma Score (GCS), haematoma location, complications encountered during admission, duration of hospital stay and 6-month Glasgow Outcome Score (GOS). There were 66 cases, age range of 21-85 years (mean 57 years). A total of 30 (45.5%) patients were admitted with GCS ≤ 8/15; 63.3% of these died within 6 months. The proportion of mortalities was 63.6% (>70 years) and 35.6% (41-70 years). Most commonly associated complication was chest infection 27 (40.9%), with 56.6% mortality. Common haematoma locations were basal ganglia (43.9%) and lobar haemorrhage (40.9%) with a similar effect on outcome (P = 0.098). Outcomes were GOS 1: (43.9%), GOS 5: (30.3%) and GOS 4: (13.6%). Among 42 (63.3%) admitted to ICU, 25 (59.5%) died, while 11 (26.2%) achieved GOS of ≥ 4 at 6 months. Those discharged between days 11 and 20 had 26.7% mortality while 53.3% were independent. Good admission GCS, absence of chest infections, younger age group are predictors of good outcome following SICH. Anatomical location of haemorrhage alone does not have a significant impact on 6 months' mortality.

Economic impact of pharmacist interventions on correction of stress-related mucosal damage prophylaxis practice.

IntroductionStress-related mucosal damage (SRMD) is described as the damage of gastric mucosa due to physiological stress that is a very common complication in critically ill patients. SRMD prophylactic medications are widely prescribed all over the world, while numerous studies have revealed that a large percentage of patients admitted to non-intensive care unit (ICU) services do not need to receive these medications. The aim of this study was to determine the frequency and type of medication errors and the economic impact of clinical pharmacist intervention on stress ulcer prophylaxis (SUP).MethodsThis prospective interventional study was conducted on adult patients admitted to internal, surgical, and critical care units at two large academic medical centers over 6 months. Risk factors of stress ulcer were recorded daily during hospital stay, and appropriateness of SUP administration was assessed according to the American Society of Health-System Pharmacists (ASHP) criteria. An intervention was performed by a clinical pharmacist in the case of contradictions. The rate of inappropriate SUP and the economic impact of a pharmacist intervention were recorded.ResultsIn this study, 178 out of 219 (81.2%) patients received prophylactic treatments. Averagely, prophylactic therapy was compatible with standard treatment guidelines in 67.1% of cases. The implementation of ASHP guideline by a clinical pharmacist resulted in a cost saving of >18,000 USD monthly in this study, which would result in an estimated cost saving of >216,000 USD annually.ConclusionAlthough treatment guidelines are available for the prophylaxis of SRMD, failure to observe these guidelines could increase the cost of treatment and adverse effects. The clinical pharmacists’ intervention in order to implement standard protocols has a significant impact on the reduction of unintended mistakes in prescribing prophylaxis, as well as significant cost savings.

Clinical, Therapeutic and Evolutive Aspects of Patients with Hemophilia in the Surgical Resuscitation Care Unit of Joseph Ravoahangy Andrianavalona JRA Hospital Antananarivo

Background: Hemophilia, a constitutional bleeding disease, has always been present in Madagascar considering children who died after bleeding circumcision, as reported in the family history of the diagnosed patients. Hemophilia is serious because of the potentially fatal risk of hemorrhage. The aim of this study was to evaluate the clinical, outcome and therapeutic aspects of inpatients with hemophilia in the Surgical Resuscitation Unit of JRA Hospital in Antananarivo. A descriptive and observational study was led about patients with hemophilia cared in the Surgical Resuscitation Unit from January 2011 to March 2018, studying age, type and severity of hemophilia, reason and duration of hospitalization, treatment instituted and outcome of patients. Results and comments: Thirty-six hemophiliacs (0.2%) were enrolled. The mean age was 9.52 years old; 52.78% were with hemophilia B and 47.22% with hemophilia A, mainly severe. Clinical manifestations were muscle hematomas (25.71%), gum bleeding (14%), epistaxis (14.28%), gastrointestinal bleeding (11.42%), intracranial hemorrhage (11.42%), post circumcision bleeding (11.42%), hematuria, intraperitoneal hematomas and hemarthrosis. Treatment was based on factor concentrate substitution when available. The length of stay ranged from one to thirty days. The evolution was favorable except for two deaths related to delayed management of intracranial hemorrhage. Three patients with hemophilia A developed inhibitors. The results showed that throughout these years of study, a change in management was noted alongside. Conclusion: Hemophilia cases requiring hospitalization were managed in surgical resuscitation unit. The evolution was mainly related to the availability of clotting factor concentrates in coagulation factors, the delay in taking care of the patients and the presence of specialized staff.

Recording Vital Signs: A Neglected Nursing Practice?

Vital signs are patient’s health status indicators and their measurement and interpretation at opportune moments contribute to the early diagnosis of clinical deterioration and implementation of interventions. The IQG surveyors observed the lack of registration of vital signs during their visits, noting the need to evaluate this practice in IQG’s Health Services Accreditation Programs. The objective of this study is to verify the recording of vital signs in the patient’s chart considering the completeness at the opportune moments. The data was obtained between April 2017 and March 2018 by IQG surveyors during national and international accreditation visits to 141 hospitals participating in Health Services Accreditation Programs. The recording completeness of the eight vital signs (blood pressure, respiratory rate, heart rate, body temperature, pain, pulse oximetry, level of consciousness and urinary output) was checked by hospital. At each visit, between 05 and 07 records of patients admitted to open clinical and surgical care units were randomly examined. In the absence of registration of vital signs in one of the medical records, it was considered that the hospital does not present completeness. Evidence for the recording of vital signs at the appropriate moments (hospitalization, transfer of care, immediate postoperative period, nursing prescription and risk score result) defined the completeness criterion in a sample of 141 hospitals. The data were collected from 141 hospitals. At appropriate times, heart rate and blood pressure was recorded in 96% of hospitals and heart rate, blood pressure and body temperature in 81%. The completeness of vital signs at opportune moments was evidenced in 65% of the hospitals. The next challenge of IQG will be to understand the reasons that lead the nursing team to neglect the measurement, recording and interpretation of vital signs in clinical practice.

Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach

BackgroundThe aim of this study was to describe the case load, safety, and cost savings of critical care of the trauma patient provided at the surgical intermediate care unit (IMCU).MethodsThis...

Communication With Physicians as a Mediator in the Relationship Between the Nursing Work Environment and Select Nurse Outcomes in Jordan.

To test whether communication mediated relationships among nurses' work environments and nurse outcomes of job satisfaction and intent to stay. This study used a cross-sectional, quantitative survey design to query 650 nurses who worked in three hospitals in Jordan. We used Arabic versions of valid, reliable instruments measuring the nursing work environment, nurse perceptions of communication with physicians, intent to stay, and job satisfaction. Mediation analysis was used to test hypotheses. A total of 582 questionnaires were returned (89.5% response rate). Nurse perceptions of communication with physicians mediated the relationship between the nursing work environment and job satisfaction in medical, surgical, and critical care units. Nurse perceptions of communication with physicians mediated the relationship between the nursing work environment and intent to stay in all but maternity and "other" units. Depending on the nurse outcome, communication was a significant mediator for various unit types. These results may be related to the type of work that is done in each unit and the influence of patient care. Communication is one of many mechanisms that can specify how a positive nursing work environment can contribute to nurses' job satisfaction and intent to stay. A potential solution to the nursing shortage in Jordan emerges by identifying communication with physicians as a mediator in the relationship between the work environment and selected nurse outcomes.

Association of Standardized Tracheostomy Care Protocol Implementation and Reinforcement With the Prevention of Life-Threatening Respiratory Events

ImportanceMucus plugging after tracheostomy is a preventable cause of respiratory distress. Implementation of standardized tracheostomy care guidelines may reduce the occurrence of fatal respiratory compromise.ObjectiveTo determine the effect of implementing and reinforcing a standardized tracheostomy care protocol on the occurrence of acute life-threatening respiratory events.Design, Setting, and ParticipantsRetrospective cohort study of adult patients who received a tracheostomy between May 2014 and August 2016 at a tertiary care center.Main Outcomes and MeasuresPatient demographics, tracheostomy indication, rapid response for mucus plugging and other acute events, duration of hospital stay, and levels of care that the patients received were recorded through examination of clinical logs. Statistical analysis was conducted between patients before protocol implementation and patients after protocol implementation in terms of rapid-response use, and intragroup comparison of the mean length of stay in various hospital units was also analyzed.ResultsA total of 247 patients (89 women [36%]; mean [SD] age, 58.5 [12.3] years), 117 preprotocol and 130 postprotocol, met inclusion criteria. Of the 130 patients in the postprotocol cohort, 123 (93%) were on the new tracheostomy care protocol. Preprotocol rapid-response rate was 21 of 117 patients (17.9%) and postprotocol response rate was 12 of 130 patients (9.2%) for a difference of 8.7% (95% CI, 0.2%-18.0%). In terms of mucus plugging, preprotocol rate was 8 of 117 patients (6.8%) and the postprotocol rate was 1 of 130 patients (0.8%) for a difference of 6.0% (95% CI, 1.3%-12.2%). Intragroup difference of the mean time spent (days) in various care units between patients in the no rapid-response group vs rapid-response group demonstrated clinically meaningful longer stay for rapid responses in both preprotocol and postprotocol groups for the intensive care unit (preprotocol, 2.03; 95% CI, 1.03-3.03 vs postprotocol, 3.02; 95% CI, 1.49-4.45) and step down units (preprotocol, 1.40; 95% CI, 0.77-2.02 vs postprotocol, 2.11; 95% CI, 0.78 to 3.44).Conclusions and RelevanceImplementation and reinforcement of a standardized tracheostomy care protocol was associated with a reduction in the occurrences of rapid-response calls for life-threatening mucus plugging and is recommended for clinical practice. In addition, length of stay in the intensive care unit and intermediate surgical care unit was increased in a clinically meaningful way for patients who experienced a rapid-response event.

Adult hospital admissions associated with multiple sclerosis in Finland in 2004–2014

Introduction: Treatment of multiple sclerosis (MS) has developed significantly and several new immunotherapeutic drugs have become available in Finland since 2004. We studied whether this is associated with changes in hospital admission frequencies and healthcare costs and whether admission rates due to infection have increased.Methods: The national Care Register for Health Care was searched for all discharges from neurological, medical, surgical, neurosurgical and intensive care units with MS as a primary diagnosis or an auxiliary diagnosis for primary infection diagnosis in 2004–2014. Only patients ≥16 years of age were included.Results: We identified 12,276 hospital admissions for 4296 individuals. The number of admissions declined by 4.6% annually (p = .0024) in both genders. Proportion of admissions with an infection as the primary diagnosis increased but no change in their frequency was found. They were longer than admissions with MS as the primary diagnosis and were associated with increased in-hospital mortality. The annual aggregate cost of hospital admissions declined by 51% during the study period.Conclusions: This study shows that hospital admission rates and costs related to MS hospital admissions have markedly declined from 2004 to 2014 in Finland, which coincides with an increase in the use of disease-modifying therapies.Key messageHospital admission rates and costs related to MS hospital admissions have markedly declined from 2004 to 2014 in Finland.Proportion of admission related to infection has increased and they are associated with longer hospitalizations and increased in-hospital mortality pointing out the importance of infection prevention.

248 Dedicated Physical Therapy Rehab Gym on an Acute Care Inpatient Burn Unit

Burn rehabilitation begins day one post burn injury and can extend for weeks to years of multidisciplinary efforts. At Children’s National Health Systems acute care burn unit, therapy for burned children begins day one of injury; unfortunately we did not have a designated space for therapy sessions to occur. Therapy sessions were often confined to occur in the patient’s room or in public spaces, such as the hallways and stairwells, which provided no privacy, frequent interrupts and were not optimal for healing physically and psychologically. The nurses from the Surgical Care Unit identified the need and opportunity to improve the care of the child with burns. Physical and occupational therapy is an imperative part of the burn recover process and in effort to reduce the child’s fear and anxiety we wanted to provide an environment where the child can experience therapy in a respectful and comfortable manner. A survey was given to patients and families to verify the need of a designated space for physical and occupational therapy. The Surgical care team collaborated with the physical therapists and partnered with the DC Burn Foundation to advocate for a space on the unit that would provide privacy and allow children with burns to focus on their physical and psychological well-being. The DC Burn foundation took on the financial responsibility of the physical and occupational gym. The same survey was given to the patient and families after implementation of the therapy gym to measure the impact and improvement it has on patient care and patient satisfaction. Patient and families did feel safe, that there was enough space and that the equipment was appropriate when therapy occurred in the rooms or public space. Patients and families did express concern that when therapy sessions occurs in the room, that there were frequent interruptions. Before the creation of the physical therapy gym, patients had limited space and little privacy for therapy sessions. The goal of the gym is to allow for developmentally appropriate therapy, updated equipment and the adequate space. The privacy provided allows for the patient to safely focus on their rehabilitation without fear of an audience. The therapy gym will optimize the recovery of the children with burns, providing a safe and efficient environment for healing. Burn patients often experience extreme pain and anxiety during their hospital stay. The goal is to decrease traumatization related to therapy sessions and increase patient satisfaction by providing a safe space for this population.

Steigender Vorhalteaufwand für den Schockraum

Every year up to 35,000 people in Germany are severely injured in accidents in traffic, during work or leisure activities. The 24-h availability of the trauma room as well as surgical and intensive care unit capacities are essential to provide optimal acute care. This study analyzed the frequency of utilization of the resource trauma room in alevel Itrauma center in the past. Data of a level Itrauma center from 2005 to 2016 including trauma room alerts deployed by the rescue coordination center and the number of patients found to be severely injured (ISS≥ 16) during trauma room diagnostics were analyzed retrospectively. Additionally, alerts due to trauma mechanism, accompanying by the emergency physician, ventilation and resuscitation were evaluated via aweb-based interdisciplinary care capacity system (IVENA) from 2012 to 2016. Therefore, acomparison between the number of trauma room alerts and the number of severely injured patients was performed for the time after 2012. For the time from 2012 to 2016, data obtained by IVENA showed acontinuous increase in the number of trauma room alerts (n = 367 to n = 623). At the same time, the number of patients admitted under resuscitation (n = 15 to n = 45) as well as ventilated patients (n = 78 to n = 139) increased significantly; however, there was also an increase in the number of trauma alerts due to trauma mechanisms (n = 84 to n = 194) as well as the number of patients admitted to the trauma room not accompanied by an emergency physician (n = 38 to n = 132). The ratio between the number of trauma room alerts and severely injured patients (ISS≥ 16) increased from 3.1 in 2012 to 5.4 in 2015 and 4.6 in 2016. The data at hand showed aconstant number of severely injured trauma patients admitted to alevel Itrauma center over the past few years. At the same time, there was asignificant increase in utilization of the trauma room; however, in aconsiderable number of patients admitted to the trauma room the diagnostic process resulted in non-traumatic diagnostic findings. In the analyzed cohort, especially patients admitted to the trauma room due to trauma mechanism or without an accompanying emergency physician contributed to this development, necessitating an increased operational readiness of the trauma room team.

Use of Electronic Visibility Boards to Improve Patient Care Quality, Safety, and Flow on Inpatient Pediatric Acute Care Units

PurposeEffective information exchange among healthcare providers is critical to the delivery of high quality care. Electronic visibility boards (EVB) are an established tool for improving health care efficiency and promoting communication between healthcare team members. Design and MethodsSeattle Children's Hospital (SCH) sought to evaluate the use of EVBs as a tool to improve patient care quality, safety and flow in a pediatric inpatient setting. EVBs were placed on the cancer and surgical patient care units at SCH, and displayed data flowing directly from the electronic health record. ResultsThis paper describes the conceptual framework used for designing these boards, and details on the design methodology, testing approach, and successful deployment of the boards. ConclusionsThe close collaboration between development analysts and clinical nursing is highlighted as a key to successful EVB implementation. Initial metrics indicate improvements in incentive spirometry compliance, nursing documentation of care plans, and flow awareness on the units. Practice ImplicationsThese results suggest that with appropriate design, EVBs can effectively enhance patient safety and care, and may be a useful tool for implementation on other pediatric inpatient units.

HEALTH TECHNOLOGY ASSESSMENT UNIT PROCESSES FOR THE VALIDATION OF AN INFORMATION TOOL TO INVOLVE PATIENTS IN THE SAFETY OF THEIR CARE.

Patients and families play an important role in preventing adverse events. The quality council at our hospital produced a communication tool in considering the main causes of adverse events and requested the health technology assessment (HTA) unit to validate it. Assess the validity of the content of a tablemat sticker as an information tool for hospitalized patients. A qualitative validation was first performed with individual interviews and focus groups to evaluate the understanding of the content. The tool was modified and as a second step, a survey was conducted on patients and their families from a surgical care unit to validate their understanding and relevance of the content. From the survey, patients and families found the tablemat attractive and stimulating (97 percent). It encouraged them to communicate with staff about the safety of their care (84 percent). They understood well the objective (79 percent) and text (90 percent), but less for the pictograms (30 percent to 62 percent). The communication and recommendations to avoid falling were good and 99 percent were wearing the medical identification. However, it was not clear that these indicators represented the real concerns of the patients and healthcare staff because no user evaluation was done when developing the tool. The tool was well understood, but some improvements are needed considering that pictograms were not always well understood and so need careful consideration from patient perspective. The HTA unit recommended conducting an unbiased survey to assess the concerns of patients and professionals to identify the most relevant indicators.

Epidemiological Study on Candida Species in Patients with Cancer in the Intensive Care Unit.

ObjectivesAlthough cancer survival rates have increased, serious infection complications can arise in cancer patients. Candida can occur in various tissues and has significant effects on the prognosis of patients with cancer. Thus, we conducted an epidemiological study on Candida infections in patients with cancer admitted to the intensive care unit.MethodsA retrospective study was conducted in adult patients with cancer admitted to the intensive care unit between January 1, 2013, and December 31, 2015. Candida infection status and predictive factors for mortality were examined in 634 patients.ResultsThe predictive factors for mortality included the use of steroids, use of a central venous catheter or mechanical ventilator, and identification of Candida in the blood. Patients who stayed in the surgical and intensive care unit for more than 7 days had a lower risk of death than that in those with shorter days.ConclusionThe present study shows that invasive procedures, bloodstream infections, and the use of steroids increase the risk of mortality in Candida-infected patients with cancer. To improve the quality of life and reduce mortality, further studies are needed on the factors affecting the risk of mortality associated with Candida infection.