National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (8)
- Antibiotics (2)
- Antimicrobial Stewardship (1)
- Behavioral Health (1)
- Burnout (1)
- Cardiovascular Conditions (1)
- Caregiving (3)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
- Central Line-Associated Bloodstream Infections (CLABSI) (3)
- Children/Adolescents (19)
- Communication (1)
- COVID-19 (1)
- Critical Care (24)
- Diagnostic Safety and Quality (3)
- Education: Academic (1)
- Education: Continuing Medical Education (2)
- Elderly (2)
- Emergency Department (2)
- Emergency Preparedness (1)
- Evidence-Based Practice (2)
- Family Health and History (1)
- Guidelines (2)
- Healthcare-Associated Infections (HAIs) (4)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Healthcare Delivery (5)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (2)
- Health Status (1)
- Heart Disease and Health (1)
- Hospitalization (3)
- Hospitals (10)
- Implementation (1)
- Infectious Diseases (2)
- Injuries and Wounds (3)
- Inpatient Care (5)
- (-) Intensive Care Unit (ICU) (49)
- Medical Errors (1)
- Medication (3)
- Medication: Safety (2)
- Mortality (5)
- Neonatal Intensive Care Unit (NICU) (8)
- Neurological Disorders (4)
- Newborns/Infants (10)
- Nursing (3)
- Nutrition (1)
- Outcomes (6)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (7)
- Patient and Family Engagement (1)
- Patient Experience (2)
- Patient Safety (8)
- Prevention (2)
- Provider (1)
- Provider: Nurse (1)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Quality of Care (2)
- Quality of Life (1)
- Registries (2)
- Respiratory Conditions (6)
- Risk (6)
- Sepsis (2)
- Shared Decision Making (2)
- Simulation (2)
- Sleep Problems (1)
- Stress (1)
- Surgery (1)
- Teams (5)
- Training (3)
- Transitions of Care (1)
- Urinary Tract Infection (UTI) (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 49 Research Studies DisplayedGroetzinger LM, Rivosecchi RM, McVerry BJ
A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults.
This study assessed outcomes of using a light-sedation protocol as needed compared to the more usual continuous infusion sedation in mechanically ventilated adults in medical intensive care units (ICUs). This retrospective review compared patients who received the as needed sedation protocol to similar patients treated initially with continuous infusion sedation at a 32-bed medical ICU in a large academic center. Over a 2-year period, 254 total mechanically ventilated patients were evaluated. Of the evaluable patients, 114 received the prioritizing as-needed sedation protocol, and 140 received the continuous infusion approach. In the as-needed group, 42% of patients never received continuous infusion sedation. The group also received significantly less opioid, propofol, and benzodiazepine; and experienced less delirium, shorter duration of mechanical ventilation, and shorter ICU length of stay compared to the continuous infusion sedation group.
AHRQ-funded; HS025455.
Citation: Groetzinger LM, Rivosecchi RM, McVerry BJ .
A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults.
Crit Care Explor 2020 Dec;2(12):e0264. doi: 10.1097/cce.0000000000000264..
Keywords: Quality Improvement, Quality of Care, Intensive Care Unit (ICU), Critical Care, Implementation
Anesi GL, Chelluri J, Qasim ZA
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
The purpose of this study was to evaluate the potential impact of an emergency department-embedded critical care unit (CCU) at the Hospital of the University of Pennsylvania among patients with sepsis and acute respiratory failure (ARF) admitted from the emergency department to a medical ward or ICU from January 2016 to December 2017. Findings showed that the emergency department-embedded CCU was not associated with clinical outcomes among patients admitted with sepsis or ARF. Among less sick patients with sepsis, the emergency department-embedded CCU was initially associated with reduced rates of direct ICU admission from the emergency department. Further research was recommended to further evaluate the impact and utility of the emergency department-embedded CCU model.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chelluri J, Qasim ZA .
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
Ann Am Thorac Soc 2020 Dec;17(12):1599-609. doi: 10.1513/AnnalsATS.201912-912OC..
Keywords: Emergency Department, Critical Care, Intensive Care Unit (ICU), Hospitals, Sepsis, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Healthcare Delivery
Wang S, Hanneman P, Xu C
Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors.
As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). In this study, the investigators described how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI).
AHRQ-funded; HS024384.
Citation: Wang S, Hanneman P, Xu C .
Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors.
Int Psychogeriatr 2020 Dec;32(12):1409-18. doi: 10.1017/s1041610219000553..
Keywords: Intensive Care Unit (ICU), Critical Care, Health Status, Caregiving
Collinsworth AW, Priest EL, Masica AL
Evaluating the cost-effectiveness of the ABCDE bundle: impact of bundle adherence on inpatient and 1-year mortality and costs of care.
This study examined the cost-effectiveness of the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle intervention to improve short- and long-term clinical outcomes for patients requiring ICU care. A 2-year, prospective, cost-effectiveness study in 12 adult ICUs in six hospitals belonging to a large, integrated healthcare delivery system was conducted. Hospitals in the study included a large, urban center and five community hospitals. ICU types included medical/surgical, trauma, neurologic, and cardiac care units. The cohort included 2,953 adults with an ICU stay greater than 24 hours who were on a ventilator for more than 24 hours and less than 14 days. ICUs with high ABCDE bundle adherence significantly decreased odds of inpatient mortality and had significantly higher costs of inpatient care. The incremental cost-effectiveness ratio of high bundle adherence was $15,077 per life saved, and $1,057 per life-year saved.
AHRQ-funded; HS021459.
Citation: Collinsworth AW, Priest EL, Masica AL .
Evaluating the cost-effectiveness of the ABCDE bundle: impact of bundle adherence on inpatient and 1-year mortality and costs of care.
Crit Care Med 2020 Dec;48(12):1752-59. doi: 10.1097/ccm.0000000000004609..
Keywords: Intensive Care Unit (ICU), Critical Care, Mortality, Healthcare Costs
Hsu HE, Mathew R, Wang R
Health care-associated infections among critically ill children in the US, 2013-2018.
The purpose of this study was to examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals. The investigators concluded that recent trends in CLABSI rates noted in this study among critically ill neonates and children in a large cohort of US hospitals indicated that past gains have held, without evidence of further improvements, suggesting novel approaches for CLABSI prevention are needed.
AHRQ-funded; HS025008; HS018414.
Citation: Hsu HE, Mathew R, Wang R .
Health care-associated infections among critically ill children in the US, 2013-2018.
https://www.pubmed.ncbi.nlm.nih.gov/33017011
JAMA Pediatr 2020 Dec;174(12):1176-83. doi: 10.1001/jamapediatrics.2020.3223..
JAMA Pediatr 2020 Dec;174(12):1176-83. doi: 10.1001/jamapediatrics.2020.3223..
Keywords: Children/Adolescents, Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU)
Umoren RA, Sawyer TL, Ades A
Team stress and adverse events during neonatal tracheal intubations: a report from NEAR4NEOS.
This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations. TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated. The investigators concluded that high team stress levels during TI were more frequently reported among TIs with adverse events.
AHRQ-funded; HS024511.
Citation: Umoren RA, Sawyer TL, Ades A .
Team stress and adverse events during neonatal tracheal intubations: a report from NEAR4NEOS.
Am J Perinatol 2020 Dec;37(14):1417-24. doi: 10.1055/s-0039-1693698..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Critical Care, Teams, Stress, Adverse Events
Branca A, Tellez D, Berkenbosch J
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Researchers evaluated the effect of the timing of the PICU fellow academic cycle on tracheal intubation-associated events in a retrospective cohort study of 37 PICUs participating in the National Emergency Airway Registry for Children.. They found that the New Trainee Effect in tracheal intubation safety outcomes was not observed in various types of PICUs. There was a significant improvement in pediatric critical care medicine fellows' first attempt success and a significant decline in tracheal intubation-associated event rates, indicating substantial skills acquisition throughout pediatric critical care medicine fellowship.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Branca A, Tellez D, Berkenbosch J .
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2020 Dec;21(12):1042-50. doi: 10.1097/pcc.0000000000002480..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Registries, Education: Continuing Medical Education, Training
Brady AK, Brown W, Denson JL
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
This study looked at outcomes of participation of fellows for Pulmonary and Critical Medicine (PCCM) training in endotracheal intubation in the medical intensive care unit (ICU). The authors administered a survey to a convenience sample of US PCCM fellows. A total of 89 discrete US PCCM and Internal Medicine CCM training programs were represented. Almost half (43%) of PCCM fellows were “always or almost always” designed the primary operator for intubation, whereas 21% of programs had the PCCM fellow “rarely or never” the primary operator responsible for intubating in the ICU. Various influencing factors included time of day, hospital policies, attending skill or preference, ICU census and acuity, and patient factors. There was an association between location of the training program but not program size whether the PCCM fellow was the primary operator.
AHRQ-funded; HS026122.
Citation: Brady AK, Brown W, Denson JL .
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
ATS Sch 2020 Dec;1(4):395-405. doi: 10.34197/ats-scholar.2020-0004OC..
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Training, Education: Academic, Critical Care
Bowman JA, Nuño M, Jurkovich GJ
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
Researchers characterized interhospital variability in intensive care unit (ICU) vs non-ICU admission of older patients with isolated rib fractures and evaluated whether greater hospital-level use of ICU admission is associated with improved outcomes. This study included trauma patients who were admitted to trauma centers participating in the National Trauma Data Bank. The researchers found that admission location of older patients with isolated rib fractures was variable across hospitals, but hospitalization at a center with greater ICU use was associated with improved outcomes. They recommended that hospitals with low ICU use admit more such patients to an ICU.
AHRQ-funded; HS022236.
Citation: Bowman JA, Nuño M, Jurkovich GJ .
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
JAMA Netw Open 2020 Nov 2;3(11):e2026500. doi: 10.1001/jamanetworkopen.2020.26500..
Keywords: Elderly, Injuries and Wounds, Intensive Care Unit (ICU), Hospitals, Patient-Centered Outcomes Research, Outcomes, Mortality
Anesi GL, Chowdhury M, Small DS GL, Chowdhury M, Small DS
Association of a novel index of hospital capacity strain with admission to intensive care units.
Researchers sought to develop a novel composite strain index and measure its association with intensive care unit (ICU) admission decisions and hospital outcomes.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chowdhury M, Small DS GL, Chowdhury M, Small DS .
Association of a novel index of hospital capacity strain with admission to intensive care units.
Ann Am Thorac Soc 2020 Nov;17(11):1440-47. doi: 10.1513/AnnalsATS.202003-228OC.
.
.
Keywords: Intensive Care Unit (ICU), Hospitals, Healthcare Delivery
Dewan M, O'Halloran A, Kleinman M
eStablish and Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) electronic Delphi: development of a consensus framework for classifying and reviewing cardiac arrests within the PICU.
The authors sought to develop a consensus framework to guide the process of classifying and reviewing pediatric in-hospital cardiac arrest in the PICU. A multidisciplinary group of pediatric resuscitation experts generated a consensus-based framework to classify and review pediatric in-hospital cardiac arrest in the PICU. The authors recommended that future work focus on the application of this framework and further validation of these definitions and contributing factors for in-hospital cardiac arrest both within and outside the PICU.
AHRQ-funded; HS026975.
Citation: Dewan M, O'Halloran A, Kleinman M .
eStablish and Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) electronic Delphi: development of a consensus framework for classifying and reviewing cardiac arrests within the PICU.
Pediatr Crit Care Med 2020 Nov;21(11):992-99. doi: 10.1097/pcc.0000000000002488..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Smith JG, Rogowski JA, Lake ET
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
Being unable to provide required nursing care to infants could contribute to poorer neonatal nurse job outcomes, which may exacerbate staffing challenges. Little evidence exists about how missed nursing care relates to neonatal nurse job outcomes. The purpose of this study was to determine relationships among missed nursing care, job enjoyment and intention to leave for neonatal nurses.
AHRQ-funded; HS024918.
Citation: Smith JG, Rogowski JA, Lake ET .
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
J Nurs Manag 2020 Nov;28(8):1940-47. doi: 10.1111/jonm.12943..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Provider: Nurse, Provider, Burnout, Nursing
Logan GE, Sahrmann JM, Gu H
Parental mental health care after their child's pediatric intensive care hospitalization.
Pediatric intensive care unit (PICU) hospitalization is traumatic for parents, and PTSD, depression, and anxiety have all been found in parents of PICU survivors. This retrospective observational cohort study examined parents of PICU survivors using insurance claims data from 2006 to 2013. Rates of mental health diagnoses, outpatient mental health visits, and prescriptions for antidepressants and anxiolytics were looked at 6 months before and 6 months after their child’s PICU admission. Of the 95,070 parents identified, 9.5% received a new mental health diagnosis in the 6 months after PICU hospitalization with mothers twice as likely to receive a new mental health diagnosis or take new medication than fathers. Parental diagnosis of acute stress disorder or PTSD increased by 87% from the pre-PICU to the post-PICU period.
AHRQ-funded; HS019455.
Citation: Logan GE, Sahrmann JM, Gu H .
Parental mental health care after their child's pediatric intensive care hospitalization.
Pediatr Crit Care Med 2020 Nov;21(11):941-48. doi: 10.1097/pcc.0000000000002559..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Hospitalization, Caregiving, Behavioral Health, Family Health and History
Brown W, Santhosh L, Brady AK
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit.
This article presents a review of endotracheal intubation (EI) training for healthcare professionals in pulmonary and critical care medicine (PCCM). Although the ACGME mandates that trainees in PCCM achieve competence, only 60% of US PCCM trainees feel they are proficient in EI upon graduation. This article includes a review of EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.
Citation: Brown W, Santhosh L, Brady AK .
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit.
Crit Care 2020 Oct 22;24(1):621. doi: 10.1186/s13054-020-03317-3..
Keywords: Training, Education: Continuing Medical Education, Critical Care, Intensive Care Unit (ICU), Guidelines
Lake ET, Smith JG, Staiger DO
Measuring parent satisfaction with care in neonatal intensive care units: the EMPATHIC-NICU-USA questionnaire.
This study’s objective was to adapt the Netherlands-developed parent satisfaction questionnaire on neonatal and pediatric intensive care units EMPATHIC for USA use and translation into English. The researchers selected the EMPATHIC-30 questionnaire due to its’ shorter length and availability of a validated Spanish-language version. Six items from the EMPATHIC-N survey were also added, two of which were split into separate items creating a new EMPATHIC-38 survey which was adapted to USA English. The survey was then tested with NICU and PICU parents. Data from 282 parents (61% White, 61% Black, and 20% Hispanic) was used as a test. Results were positive and indicated acceptable reliability.
Citation: Lake ET, Smith JG, Staiger DO .
Measuring parent satisfaction with care in neonatal intensive care units: the EMPATHIC-NICU-USA questionnaire.
Front Pediatr 2020 Oct 6;8:541573. doi: 10.3389/fped.2020.541573.
.
.
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Patient Experience, Hospitals
Rossol SL, Yang JK, Toney-Noland C
Non-contact video-based neonatal respiratory monitoring.
Respiratory rate (RR) has been shown to be a reliable predictor of cardio-pulmonary deterioration, but standard RR monitoring methods in the neonatal intensive care units (NICU) with contact leads have been related to iatrogenic complications. This iterative design study developed a novel algorithm that produced RR from footage analyzed from stable NICU patients in open cribs with corrected gestational ages ranging from 33 to 40 weeks. The final algorithm used a proprietary technique of micromotion and stationarity detection to model background noise to be able to amplify and record respiratory motions.
AHRQ-funded; HS023506.
Citation: Rossol SL, Yang JK, Toney-Noland C .
Non-contact video-based neonatal respiratory monitoring.
Children 2020 Oct 6;7(10). doi: 10.3390/children7100171..
Keywords: Newborns/Infants, Health Information Technology (HIT), Respiratory Conditions, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Lake ET, Staiger DO, Cramer E
Association of patient acuity and missed nursing care in U.S. neonatal intensive care units.
The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. The authors conducted a correlational study of using 2016 NICU registered nurse survey responses from the National Database of Nursing Quality Indicators. They found that 36% of nurses missed one or more care activities on their past shift. The most common activities missed involved patient comfort and counseling and parent education. They recommended that nurses' assignments account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.
AHRQ-funded; HS024918.
Citation: Lake ET, Staiger DO, Cramer E .
Association of patient acuity and missed nursing care in U.S. neonatal intensive care units.
Med Care Res Rev 2020 Oct;77(5):451-60. doi: 10.1177/1077558718806743..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Nursing, Quality Indicators (QIs), Quality of Care
Emeriaud G, Napolitano N, Polikoff P
Impact of failure of noninvasive ventilation on the safety of pediatric tracheal intubation.
This prospective multicenter cohort study’s objective was to assess whether noninvasive ventilation failure in critically ill children was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. Data from the National Emergency Airway Registry for Children was used to examine data from thirteen PICUs (in 12 institutions) in the United States and Canada. The study included 956 tracheal intubation encounters, with 424 (44%) occurring after noninvasive ventilation failure with a median of 13 hours of noninvasive ventilation. The failure group included more infants (47% vs 33%) and patients with a respiratory diagnosis (56% vs 30%). Noninvasive ventilation failure was not associated with severe tracheal intubation-associated events without noninvasive ventilation but was associated with severe desaturation (15% vs 9%) without noninvasive ventilation.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Emeriaud G, Napolitano N, Polikoff P .
Impact of failure of noninvasive ventilation on the safety of pediatric tracheal intubation.
Crit Care Med 2020 Oct;48(10):1503-12. doi: 10.1097/ccm.0000000000004500..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Patient Safety, Adverse Events
Ma AL, Cohen RS, Lee HC
Learning from wildfire disaster experience in California NICUs.
The authors’ objective was to learn how personnel working in neonatal intensive care units (NICUs) of California hospitals handled issues of neonatal transfer during wildfire disasters in recent years; their ultimate goal was to share lessons learned with healthcare teams on disaster preparedness. They found that while describing disaster preparedness, equipment (such as bassinets and backpacks), ambulance access/transport and documentation/charting were noted as important and essential. They concluded that teamwork, willingness to do other tasks that are not part of typical job descriptions, and unconventional strategies contributed to the success of keeping NICU babies safe when California wildfire strikes.
AHRQ-funded; HS023506.
Citation: Ma AL, Cohen RS, Lee HC .
Learning from wildfire disaster experience in California NICUs.
Children 2020 Oct;7(10):E155. doi: 10.3390/children7100155..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Transitions of Care, Emergency Preparedness, Teams, Healthcare Delivery
Miller Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA
Respiratory therapist intubation practice in pediatric ICUs: a multicenter registry study.
Tracheal intubation by respiratory therapists (RTs) is a well-established practice that has been described primarily in adult and neonatal patients. However, minimal data exist regarding RTs' intubation performance in pediatric ICUs. The purpose of this study was to describe the current landscape of intubations performed by RTs in pediatric ICUs. The investigators found that RTs infrequently intubated in pediatric ICUs, with success rates similar to other providers but higher adverse event rates. RTs were more likely to use video laryngoscopy than other providers.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Miller Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA .
Respiratory therapist intubation practice in pediatric ICUs: a multicenter registry study.
Respir Care 2020 Oct;65(10):1534-40. doi: 10.4187/respcare.07667..
Keywords: Children/Adolescents, Respiratory Conditions, Intensive Care Unit (ICU), Registries, Critical Care
Soberano BT, Brady P, Yunger T
The effects of care team roles on situation awareness in the pediatric intensive care unit: a prospective cross-sectional study.
Improved situation awareness (SA) decreases rates of clinical deterioration in the pediatric inpatient setting. The investigators used a prospective, cross-sectional, observational study to measure interprofessional care team SA for a pediatric intensive care unit (PICU) patients. The resident, bedside nurse, and respiratory therapist for each patient were surveyed regarding high clinical deterioration risk status as defined by clinical criteria identified by the PICU fellow or attending and mitigation plan.
AHRQ-funded; HS026975.
Citation: Soberano BT, Brady P, Yunger T .
The effects of care team roles on situation awareness in the pediatric intensive care unit: a prospective cross-sectional study.
J Hosp Med 2020 Oct;15(10):594-97. doi: 10.12788/jhm.3449..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Teams, Inpatient Care
Daigle CH, Fiadjoe JE, Laverriere EK
Difficult bag-mask ventilation in critically ill children is independently associated with adverse events.
This study looked at the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children. The prevalence and risk factors are described as well as its association with adverse tracheal intubation-associated events and oxygen desaturation in PICU patients. This retrospective review used observational data collected from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from January 2013 to December 2018 from 46 international PICUs. Difficult bag-mask ventilation was reported in 9.5% of 15,810 patients undergoing tracheal intubation with bag-mask ventilation. Difficult bag-mask ventilation was more commonly reported with increasing age, those with a primary respiratory diagnosis/indication for tracheal intubation, presence of difficulty airway features, more experienced provider level, and tracheal intubations without use of neuromuscular blockade. Specific intubation-associated or oxygen desaturation events occurred in 40.2% of patients with reported difficult bag-mask ventilation versus 19.8% in patients without difficult bag-mask ventilation.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Daigle CH, Fiadjoe JE, Laverriere EK .
Difficult bag-mask ventilation in critically ill children is independently associated with adverse events.
Crit Care Med 2020 Sep;48(9):e744-e52. doi: 10.1097/ccm.0000000000004425..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Risk
Morgan RW, Kienzle M, Sen AI
Pediatric resuscitation practices during the coronavirus disease 2019 pandemic.
This multi-institutional survey asked U.S. pediatric intensive care units (PICUs) on practices regarding inpatient resuscitation practices during the 2019 coronavirus pandemic. Out of 130 institutions surveyed, 60% responded. Forty-eight centers had admitted pediatric coronavirus disease patients, with 33% reporting code team activation for patients with suspected/confirmed coronavirus disease. Eighty-six percent of respondents had implemented changes to inpatient emergency response systems, including: limited number of personnel entering patient rooms, limited resident involvement, and new or refined team roles. Most institutions are using enhanced personal protective equipment (PPE) and 23% have PPE policies dependent on the performance of aerosol generating procedures. Most institutions do not have policies regarding limitations of resuscitation efforts in coronavirus disease pediatric patients.
AHRQ-funded; HS026975.
Citation: Morgan RW, Kienzle M, Sen AI .
Pediatric resuscitation practices during the coronavirus disease 2019 pandemic.
Pediatr Crit Care Med 2020 Sep;21(9):e651-e60. doi: 10.1097/pcc.0000000000002512..
Keywords: Children/Adolescents, COVID-19, Intensive Care Unit (ICU), Critical Care
Dadiz R, Riccio J, Brown K
Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit.
This study’s objective was to identify 1) latent safety threats (LSTs) in a new neonatal intensive care unit (NICU) through simulation-based pre-occupancy operations testing, and 2) LSTs that remained unresolved 1-year post-occupancy. This qualitative study included 111 healthcare professionals who participated in patient care simulations and debriefings in a new NICU. Debriefing transcripts were analyzed to characterize LSTs. Three-hundred threats with four major themes affecting staff function and patient safety emerged: relay of information, workplace design, patient care processes, and patient family and staff focus. One-year post occupancy 29 (9%) LSTs were still unresolved.
AHRQ-funded; R18 HS023460.
Citation: Dadiz R, Riccio J, Brown K .
Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit.
J Perinatol 2020 Sep;40(Suppl 1):29-35. doi: 10.1038/s41372-020-0749-3..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Patient Safety, Simulation
Rozenfeld RA, Nannicelli AP, Brown AR
Verbal communication during airway management and emergent endotracheal intubation: observations of team behavior among multi-institutional pediatric intensive care unit in situ simulations.
The objective of this study was to assess health-care teams' verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation. The investigators found that no uniform statement was identified to declare an airway emergency among the care teams. Preintubation medication dosages were not consistently included in intubation medication orders, and frequently, there were multiple requests to obtain medications.
AHRQ-funded; HS017909.
Citation: Rozenfeld RA, Nannicelli AP, Brown AR .
Verbal communication during airway management and emergent endotracheal intubation: observations of team behavior among multi-institutional pediatric intensive care unit in situ simulations.
J Patient Saf 2020 Sep;16(3):e114-e19. doi: 10.1097/pts.0000000000000272..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Teams, Communication, Simulation