Hospital delirium: not as negligible as previously thought

 

University of NE Medical Center in midtown Omaha (Photo credit: Wikipedia)

 

My sister, a nurse practitioner, posted this on Facebook. Something to keep in mind if you have a loved one in ICU..

 

From the 6 August article at Nebraska Live Well

 

Medical professionals once thought patient delirium was a benign byproduct of landing in an intensive care unit.

Now they know otherwise.

Delirium caused by medications, illness and other sources can lead to permanent confusion and death, say experts in ICU delirium.

The Nebraska Medical Center has tested a new set of strategies to combat and diminish hospital delirium. Although the results haven’t been compiled yet, scientists and medical practitioners hope the protocol will make a difference in patients’ conditions in the hospital and after release.

We used to think it just goes away,” Michele Balas, a faculty member at the University of Nebraska Medical Center, said of delirium. Balas, whose doctorate is in nursing, has overseen the research.

Delirium can affect people for the rest of their lives, she said, and may cause depression, memory loss and post-traumatic stress disorder, and affect the cognitive functions required for such simple tasks as balancing a checkbook or following a recipe.

Sedation, sometimes used when patients are on ventilators or are delirious, makes it impossible for them to regain alertness and get up, Balas said. Prolonged bed rest can cause pneumonia and blood clots,

The strategy, called ABCDE, involves getting patients off sedation as soon as possible (Awakening); removing them from ventilators for at least a while so they breathe on their own (Breathing); communication and coordination (C) among doctors, nurses and others; delirium monitoring by staffers (D); and early mobility (E), or getting them up and moving as soon as possible, even patients on ventilators

 

 

 

Related articles

• Alzheimer’s patients experience adverse outcomes, delirium (medicalxpress.com)
• Delirium Hard on Hospitalized Elderly with Alzheimer’s Disease (jajsamos.wordpress.com)
• Delirium (trishadm.wordpress.com)
• Alzheimer’s patients experience adverse outcomes, delirium (eurekalert.org)

 

Researchers working toward automating sedation in intensive care units

Researchers working toward automating sedation in intensive care units

Georgia Institute of Technology Research News) Researchers are one step closer to their goal of automating the management of sedation in hospital intensive care units. They have developed control algorithms that use clinical data to accurately determine a patient’s level of sedation and can notify medical staff if there is a change in the level.

 

 

From the February 15, 2011 Eureka news alert

Computer system for evaluating sedation level shows strong agreement with clinical assessment

		IMAGE: Georgia Tech researchers Wassim Haddad, Allen Tannenbaum and Behnood Gholami (left-right) and Northeast Georgia Medical Center chief medical informatics officer James Bailey have developed control algorithms to automate sedation in… Click here for more information.

Researchers at the Georgia Institute of Technology and the Northeast Georgia Medical Center are one step closer to their goal of automating the management of sedation in hospital intensive care units (ICUs). They have developed control algorithms that use clinical data to accurately determine a patient’s level of sedation and can notify medical staff if there is a change in the level.

“ICU nurses have one of the most task-laden jobs in medicine and typically take care of multiple patients at the same time, so if we can use control system technology to automate the task of sedation, patient safety will be enhanced and drug delivery will improve in the ICU,” said James Bailey, the chief medical informatics officer at the Northeast Georgia Medical Center in Gainesville, Ga. Bailey is also a certified anesthesiologist and intensive care specialist.

During a presentation at the IEEE Conference on Decision and Control, the researchers reported on their analysis of more than 15,000 clinical measurements from 366 ICU patients they classified as “agitated” or “not agitated.” Agitation is a measure of the level of patient sedation. The algorithm returned the same results as the assessment by hospital staff 92 percent of the time.

“Manual sedation control can be tedious, imprecise, time-consuming and sometimes of poor quality, depending on the skills and judgment of the ICU nurse,” said Wassim Haddad, a professor in the Georgia Tech School of Aerospace Engineering. “Ultimately, we envision an automated system in which the ICU nurse evaluates the ICU patient, enters the patient’s sedation level into a controller, which then adjusts the sedative dosing regimen to maintain sedation at the desired level by continuously collecting and analyzing quantitative clinical data on the patient.”…

		IMAGE: Georgia Tech researchers Allen Tannenbaum, Wassim Haddad and Behnood Gholami (left-right) and Northeast Georgia Medical Center chief medical informatics officer James Bailey have developed control algorithms to automate sedation in… Click here for more information.

 

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This project is supported in part by the U.S. Army Medical Research and Material Command (Grant No. 08108002). The content is solely the responsibility of the principal investigator (Wassim Haddad) and does not necessarily represent the official views of the U.S. Army….

 

 

 

 

Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

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Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

From the February 15, 2011 Eureka news alert

(Elsevier) Elsevier/MEDai, a leading provider of advanced clinical analytic health-care solutions, announced today the launch of the latest version of Pinpoint Review, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

ORLANDO, FL – 14 February, 2011 – Elsevier / MEDai, a leading provider of advanced clinical analytic healthcare solutions, announced today the launch of the latest version of Pinpoint Review®, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

“Hospitals are facing an enormous amount of pressure to provide better, safer care with fewer complications while managing costs,” said Swati Abbott, President of Elsevier / MEDai. “Elsevier / MEDai has enhanced its predictive analytics product to continuously give hospitals and clinicians the most up-to-date tools they need to lower mortality rates and healthcare costs, provide a higher quality of care, increase patient safety and maintain regulatory compliance.”

Pinpoint Review generates predictions for acute-care patients, focusing on the likelihood of a patient developing a complication, contracting a healthcare-acquired infection or being readmitted within 30 days of discharge, while patients are still in the hospital and there is time to adjust care to avoid a negative outcome.

With the expansion of Pinpoint Review’s new predictions, care givers are able to enhance their efforts in proactive care management. Pinpoint Review unlocks the power of clinical and administrative hospital data by utilizing predictive technologies to turn data into actionable information. Empowering today’s hospitals with the ability to predict whether or not a patient will be admitted to the ICU or higher intensity care unit, a predicted length of hospital stay or patient expiration goes a long way in driving down the cost of care and brings a proactive approach to quality improvement.

Pinpoint Review addresses the increasing pressure on hospitals from entities such as the Agency for Healthcare Research and Quality and the Joint Commission on Accreditation of Healthcare Organizations to deliver a higher quality of care and fewer medical errors. Pinpoint Review alerts care providers to patients at risk for developing several of the conditions that the Centers for Medicare and Medicaid Services (CMS) no longer reimburse.

Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units

Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units

From the January 31, 2011 AHRQ (Agency for Healthcare Research and Quality) press release

Older Americans who were treated in Michigan intensive care units (ICUs) saw larger decreases in their likelihood of dying while hospitalized than similar ICU patients in other Midwestern hospitals, according to a new study evaluating an innovative quality improvement initiative funded by HHS’ Agency for Healthcare Research and Quality (AHRQ). The initiative, known as the Keystone Project, targeted ways to reduce the number of healthcare-associated infections (HAIs). Previous research has shown that targeted quality improvement programs can reduce HAI rates. This study, “Impact of a Statewide Intensive Care Unit Quality Improvement Initiative on Hospital Mortality and Length of Stay: Retrospective Comparative Analysis,” published in today’s British Medical Journal, is the first to link these programs to reduced death rates. “This study gives us assurance that investing in large-scale, evidence-based quality improvement programs can save lives—the most important outcome for patients and doctors,” said AHRQ Director Carolyn M. Clancy, M.D. “AHRQ and others have already initiated work to expand this project nationwide to other ICUs across the country.” Researchers led by Allison Lipitz-Snyderman, Ph.D., of The Johns Hopkins Bloomberg School of Public Health, analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other Midwestern states. They looked at data before the project was initiated, while it was being phased in, and up to 22 months after implementation. The researchers found that overall a person’s chance of dying decreased by about 24 percent in Michigan after the program was implemented compared to only 16 percent in surrounding Midwestern states where the program was not implemented. “We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives,” says Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine. Dr. Pronovost led development of the AHRQ-sponsored Keystone Intensive Care Unit Project and implemented it in Michigan hospitals with the help of the Michigan Health and Hospital Association. “These results are very exciting, and further research should be done to address other important issues impacting the safety and quality of patient care,” added Dr. Lipitz-Snyderman. The Keystone Project uses a comprehensive approach that includes promoting a culture of patient safety, improving communication among ICU staff teams, and implementing practices based on guidelines by the Centers for Disease Control and Prevention (CDC), such as checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. AHRQ continues to support the Keystone Project through a contract with the Health Research & Educational Trust, an affiliate of the American Hospital Association, by reaching more hospitals and other settings in addition to ICUs and applying the approach to various HAIs. For AHRQ’s recently funded HAI projects, go to http://www.ahrq.gov/qual/haify10.htm. According to the CDC, HAIs are one of the most common complications of hospital care, accounting for an estimated 1.7 million infections, and 99,000 associated deaths in 2002. These infections are responsible for $28 billion to $34 billion in preventable health care expenses every year. Infectious agents, such as bacteria, found in health care settings can cause patients to develop HAIs when they have surgery or require central lines or urinary tract catheters. The Keystone Project is part of a Department-wide effort to address HAIs, as outlined in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ash/initiatives/hai/index.html). Partners across HHS, including AHRQ, CDC, the Centers for Medicare & Medicaid Services, and National Institutes of Health, are working together to achieve the goals of the Action Plan. For more information, please contact AHRQ Public Affairs: (301) 427-1864 or (301) 427-1855. Use Twitter to get AHRQ news updates:http://www.twitter.com/ahrqnews/

Additional articles about this news release

• Safety checklist use yields 10 percent drop in hospital deaths (Science Blog)
• Program reduces serious hospital infections – report (Reuters)

Articles about related studies

• Study finds MRSA screening saves hospitals money
• Private room intensive care unites associated with lower infection rates
• More doctors must join nurses, administrators in leading efforts to improve patient safety, outcomes

ICU communication study reveals complexities of family decision-making

ICU communication study reveals complexities of family decision-making

From the January 5, 2010 Eureka news alert

While a much hailed communication intervention works for families making decisions for chronically-ill loved ones in medical intensive care units, Case Western Reserve University researchers found the intervention was less effective for surgical and neurological ICU patients.

Barbara Daly and Sara Douglas, the study’s lead researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve, attribute the varied results to different types of patients served by the three types of ICUs and differences among ICU cultures.

“We found the same approach is not going to have the same results for everyone,” Daly said

With the number of ICU patients predicted at more than 600,000 patients annually by 2020, researchers search for ways to help families make critical decisions for their loved ones. This study contributes to those ICU practices involving complex communication issues.

The researchers repeated a study from a Boston hospital that resulted in shorter stays and less unneeded tests and treatments when families were routinely informed through a systemized communications intervention about their family member’s progress in a medical ICU. They compared the effect of the new communication system in 346 patients to usual practice in 135 patients.

The intervention involved a 30-minute communication meeting between the clinical staff and family, beginning five days after a patient requiring a ventilator was admitted to the ICU. The staff and family covered five components: medical update, preferences and goals for the patient, treatment plans, prognosis, and milestones (the markers that can tell whether a person is improving).

The meetings continued weekly until the patient was transferred to a regular hospital ward, to a long-term facility, went home or died.

According to Daly, the discussions are important because up to 40% of these ICU patients do not survive beyond two months if they have spent more than five days on a mechanical ventilator.

For survivors, the most likely outcome is for long-term care, which raises issues about the quality of life that the patient might want to have, she said.

Overall, the researchers found no significant differences between the control and intervention groups in length of stay in the ICU or in limitations of aggressive interventions.

“The Boston study had been the ideal situation where the director of the ICU was conducting the study and the ICU staff accepted the intervention as part of its routine practices, said Daly, professor of nursing and clinical ethics director at University Hospitals Case Medical Center. “We took the study into real-life situations.”

Daly attributes the varying effectiveness of the new communication system to different ages and needs of patients in the medical, compared to surgical units and to differences in clinical staff attitudes towards decisions to limit aggressive interventions, such as feeding tubes and tracheostomy.

In the medical units, the patients generally are older and chronically ill—many suffering several chronic illnesses. The other ICUs generally serve younger patients who are more likely to have suffered a sudden acute health crisis, such as an emergency surgery or trauma from a motor vehicle accident.

Daly said many treatments in the medical ICU will not sustain life, and families face complicated end-of-life decisions to stop or continue ineffective treatments.

The research group also tracked conversational interchanges between family members and doctors.

All families received medical updates. About 86% of the meetings covered treatment plans; 94%, prognosis; 78 percent, preferences and goals; and only 68%, milestones.

Daly said analyses of the types of conversations found that 98% of the time was spent relaying facts about the patient, and only 2% was spent on personal, emotional, or relationship conversation.

The researchers also found that on average, doctors asked families one question, which was: “Do you have any questions?”

The families asked an average of six.

“Better communications is needed. Overall the process is not working as well as we would like and there are missed opportunities to better support families in their decisions,” Daly concluded.

 

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The full results of the National Institute for Nursing Research-funded study were published in the article, “Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients,” in the journal Chest.