Tag: hospitals

Categories : HospitalsTags :

New Care Review Process Helps Cut Preventable Deaths

On By ModernMedia

At a Los Angeles hospital, a new in-person multidisciplinary rapid mortality review (RMR) process successfully helped identification of critical patient care areas, according to a new study.

This novel approach assisted front-line healthcare workers in understanding key individual- and systems-level issues which increase mortality. The aim is to produce more effective, optimised patient care. Though efforts have been made since the Institute of Medicine’s 1999 report on preventable patient mortality, reducing the number of these deaths has been difficult, and in many cases, elusive.

The study looked at five years of the RMR process that reviewed patient deaths that took place in the 24-bed medical intensive care unit (ICU) at Ronald Reagan University of California Los Angeles (UCLA) Medical Center. Not only immediate concerns were picked up, but also valuable insights into preventable patient deaths.

“Our findings suggest that these short and timely in-person meetings can be a powerful tool for efforts to both improve quality and prevent mortality in the ICU,” said first author Kristin Schwab, MD. “Bringing members of the multidisciplinary care team together for regular face-to-face discussions provided a forum that revealed concerns and solicited tangible ideas for solutions.”

Retrospective case reviews, provider surveys, and structured morbidity and mortality conferences are common tactics, but unlikely to provide an efficient and practical means of reviewing all patient deaths. The RMR process started in 2013 as pilot, using data on a subset of patients who had died in the medical ICU during the week before. The subset gradually increased in size and by 2017, the team tried to review every death that occurred in the unit that week. Over the five-year period, the RMR team reviewed a total 542 deaths, over 80% of all those that occurred in the unit.

For each patient death, a facilitator led a semistructured interview with the care team after reviewing the patient’s chart, and added a brief report to a database. The quality team reviewed the data from each meeting, referring action items to the relevant department.

Only 7% of deaths were determined by the treatment team, RMR facilitator or both to be possibly preventable. However, in more than 40% of the deaths the treatment team thought care could have been improved, while the facilitator identified areas for improvement in over half the cases.

Cases in which the patient required resuscitation after an in-hospital cardiac arrest or those in which the patient did not get comfort care at the time of death were more likely to result in an action item.

Issues included concerns with communication or teamwork, advance care planning, care delays, medical errors, procedural complications and hospital-acquired infections. The systems-related action items were lack of protocols, resource availability and throughput. Among the action items, over 10% led to substantive systemic change, with 29 discrete changes occurring over the study period. Action items included making a standardised checklist for inbound patient transfers, and modifying the electronic health record to separate one-time orders from continuing orders.

Source: News-Medical.Net

Journal information: Schwab, K.E., et al. (2021) Rapid Mortality Review in the Intensive Care Unit: An In-Person, Multidisciplinary Improvement Initiative. American Journal of Critical Care. doi.org/10.4037/ajcc2021829.

Categories : Diseases, Syndromes and Conditions Hospitals PaediatricsTags :

Children with Sepsis Respond Better to ‘Relaxed’ Care Bundle

On By ModernMedia

Following a ‘relaxed care bundle’ was linked to lower 30-day mortality and shorter hospital stays among children with sepsis, according to preliminary data from the Improving Pediatric Sepsis Outcomes (IPSO) FACTO trial.

The study findings were presented virtually at the Society of Critical Care Medicine’s Critical Care Congress.

Sepsis is the leading cause of death in children, with an estimated 7.5 million deaths a year. Childhood sepsis includes severe pneumonia, severe diarrhoea, severe malaria, and severe measles. Some 25-40% of children who recover from sepsis still have long-term consequences.

The ‘relaxed’ sepsis bundle is based on a group of best evidence-based interventions. It involves an initial fluid bolus delivery within 60 minutes, as opposed to 20 minutes; and antibiotic delivery within 180 instead of 60 minutes. Accepted sepsis recognition protocols (screen, huddle, or care order) were also involved with the bundle.

This trial data came from about 40 000 patients with sepsis or suspected sepsis at a range of children’s hospitals across the US, from 2017 to 2019. Raina M Paul, MD, of Advocate Children’s Hospital, Illinois, USA reported the data, saying that the relaxed bundle saw better outcomes than the more original bundle which was more time-restrictive. 
Sepsis-attributable mortality fell by 48.9% among the relaxed bolus-compliant versus non-compliant group (3.1% vs 3.5%), and by 13.7% in original bundle-compliant vs non-compliant cases. Following all aspects of the relaxed bundle was associated with a reduction in median days in hospital from 9 to 6 days.

In a separate presentation, Kayla Bronder Phelps, MD, of CS Mott Children’s Hospital in Michigan, USA, reported the results of a study that showed children hospitalised for severe sepsis were likely to have longer hospital stays if they were from lower-income neighbourhoods. Using a national database, she identified 10 130 cases of children with severe sepsis. Severe sepsis hospitalisations were also highest among the lowest-income quartile, reflecting the fact that there were more children living in low-income neighbourhoods.

Overall, 8.4% of children in the cohort died of sepsis during hospitalisation, with no association between mortality rates and income level. However, children in the lowest-income areas spent a median 9 days in the hospital, while children from the highest-income areas spent 8 days.

Bronder Phelps noted that the study is among the first to examine the impact of poverty on paediatric sepsis outcomes. Poverty is a known risk factor for a wide range of paediatric diseases, such as neonatal bacterial infection, asthma, and migraine, and in adults, poverty is associated with poorer outcomes including higher mortality rates.

Source: MedPage Today

Presentation information 1: Paul R, et al “Improving pediatric sepsis outcomes for all children together (IPSO FACTO): Interim results” SCCM 2021; Abstract 32.

Presentation information 2: Phelps K, et al “The association of socioeconomic status and pediatric sepsis outcomes” SCCM 2021; Abstract 37.

Categories : HospitalsTags :

Life-saving Benefits of Telemedicine in ICUs

On By ModernMedia

A study in Cleveland, USA, showed that at hospitals without 24/7 on-site intensivists, those that had intensivists available to deliver telemedicine had lower ICU mortality rates.

Presented at the Society of Critical Care Medicine’s virtual 50th Critical Care Congress, Cleveland Clinic intensivist Dr Chiedozie Udeh, commented that the COVID pandemic has thrust ICU telemedicine into the spotlight.

“In an ideal world, patients would have an intensivist at the bedside 24/7, but the reality is that even if we had all of the money in the world, we don’t have enough trained professionals to do the job,” Udeh said.

Out of patients treated at one of nine hospitals within the Cleveland Clinic Health System, patients receiving ICU telemedicine were 18% less likely to die and were discharged 2 days sooner than patients who received traditional ICU care, without 24/7 on-site intensivist care.  

The unadjusted 30-day mortality among the telemedicine patients was 5.5%, while in the standard care group it was significantly higher at 6.9%.ICU length of stay was significantly shorter in the ICU telemedicine group, as was the length of total hospital stay.

Udeh said that an intensivist monitoring patients via telemedicine has access to relevant data and can perform the same functions as an on-site clinician, short of physical contact. Intensivists can monitor multiple patients and have two-way communication with bedside nurses. Dedicated software is available, including tools to identify deteriorating patients needing care.

Speaking to MedPage Today, Udeh said ICU telemedicine offers an intermediate treatment strategy between large academic centres with 24/7 on-site intensivist care, and smaller hospitals without such care. More research is needed to understand how telemedicine leads to reduced mortality, he added.

“If I had to speculate I would imagine this would probably be due to patients’ receiving more timely needed interventions,” he said.

“We think these findings provide further reassurance about the value of ICU telemedicine, particularly in light of our collective experience in 2020,” said Udeh. “With the COVID-19 pandemic, telemedicine in general assumed greater prominence.”

CU telemedicine can benefit both large hospital systems and smaller, individual hospitals, he said.

“Smaller hospitals may have no intensivist at all or they may have only one,” he said. He added that, according to one recent survey, about half of US hospitals do not have an intensivist on staff.

ICU telemedicine still has considerable expenses associated with it, however; at $50 000 per bed in first year costs, it may be hard to justify for resource-constrained hospitals.

Source: MedPage Today

Presentation information: Udeh CI, et al “ICU telemedicine and clinical risks associated with 30-day mortality: a retrospective cohort study” SCCM2021.

Categories : COVIDTags :

Telemedicine Promising for Visits After Low-Risk Surgery

On By ModernMedia

A pair of reports suggests that modern communication methods may be appropriate for post-surgery recovery, albeit at the risk of exacerbating the downsides of any language barriers and digital literacy.

In the midst of the COVID pandemic, telemedicine uptake and use has been greatly expanded by health care providers. In one small trial, cut short by COVID, researchers investigated whether telemedicine was an adequate form of patient follow-up after low-risk surgery.

The video-based post-discharge visits were as effective in terms of getting patients to return to the hospital within 30 days for a hospital encounter. The video visits were half an hour shorter but provided patients with the same amount of time with their surgeons.

However, out of 1645 individuals screened, many participants were excluded due to language difficulties, and 50 were excluded due to a “technology barrier”.

Caroline Reinke, MD, MSHP, of Carolinas Medical Center in Charlotte, North Carolina, and her team wrote, “Patients and clinicians should be reassured that the critical visit portion, time together discussing medical needs, is preserved. This information will help surgeons and patients feel more confident in using video-based virtual visits.”

Reinke and her team noted that COVID cut the study short: “Although we did not reach target enrollment, noninferiority was demonstrated for postdischarge virtual visits in our study sample and was further supported via a simulation model.”

In another study, Marie-Laure Cittanova, MD, PhD, of Clinique Saint Jean de Dieu in Paris, and her team compared using SMS to contact patients as opposed to calling them. When contacted after being told to expect a contact throughout the following day, 46.2% of patients were reachable by phone, compared to 85.3% by SMS.

Patients expressed similar levels of satisfaction with the SMS service, which was significantly cheaper than using phone calls. However, the single-centre study lacked generalisability.

Source: MedPage Today

Journal information (primary source): Harkey K, et al “Postdischarge virtual visits for low-risk surgeries: a randomized noninferiority clinical trial” JAMA Surg 2021; DOI: 10.1001/jamasurg.2020.6265.

Journal information (secondary source): Cittanova M, et al “Association of automated text messaging with patient response rate after same-day surgery” JAMA Surg 2021; DOI: 10.1001/jamanetworkopen.2020.33312.

Categories : COVIDTags :

Gauteng Doctors’ Struggle in COVID “Fever Tents”

On By ModernMedia

Angry doctors have opened up concerning recent images of severely ill patients at Steve Biko Academic Hospital (SBAH) being treated in tents amid pouring rain. These images came as David Makhura and MEC for Health Dr Nomathemba Mokgethi visited the hospital on Monday.

Speaking on condition of anonymity, two doctors at SBAH spoke to Daily Maverick about the reality of the situation. The doctors described a desperate situation of overwhelmed facilities, with patients possibly dying as much from the cold and rain as from untreated COVID – or indeed, a condition that presents similarly to COVID.

The image presented to the public by the government is “smoke and mirrors”, said Dr Felicia (not her real name). “This is a show. They [health officials] are lying to you people. They are lying. They are covering it up,” she said.”Fever tents” have been set up outside the Emergency Department, where patients remain while they are being screened for COVID. If they test negative, they are admitted to SBAH If they test positive, they are sent to Tshwane District Hospital.”

According to Dr Felicia, conditions in the tents are abysmal. “There is no nursing, there is no oxygen or beds in these tents. There is no oxygen in the tanks, we actually just do 10 minutes of CPR and many times we don’t have PPE to do it in.”

As infections continue to rise in South Africa, approaching 250 000 active cases, hospitals are buckling under the pressure, and doctors are expecting the worst to come.

Dr Monica (not her real name) spoke of her feelings of the situation. “I don’t feel like I am being protected by our hospital right now. I am running around like a chicken without a head. I feel very hopeless. I feel like I should not care anymore. Caring is actually just hurting me and the patients because instead of me doing what I said I was going to do when I left medicine, I am treating these people like numbers. Someone dies and you have to shrug your shoulders and move on to the next. There is not even a minute to mourn a person or to figure out what went wrong. I feel completely hopeless,” she said.

Dr Monica said people need to stop politicising the pandemic, and get the hospitals the resources they need. She also implored the reporters to convey their message. “Tell the people out there, this is serious. They must wear masks, they must social distance,” she said, breaking off and running to attend to a patient.

Source: Daily Maverick

Categories : UncategorizedTags :

Oncologist Forgives $650 000 in Patient Debts

On By ModernMedia

An oncologist in the United States has forgiven $650 000 in patients’ debts. After 30 years of business, Dr Omar Atiq closed down his Arkansas cancer treatment centre last year. He had previously engaged a debt collector company to chase up clients’ outstanding bills.

“Over time I realised that there are people who just are unable to pay,” Dr Atiq said to ABC’s Good Morning America. “So my wife and I, as a family, we thought about it and looked at forgiving all the debt. We saw that we could do it and then just went ahead and did it.”

Dr Atiq is originally from Pakistan, and founded the Arkansas Cancer Clinic in 1991.”We thought there was not a better time to do this than during a pandemic that has decimated homes, people’s lives and businesses and all sorts of stuff,” Dr Atiq said, quoted by the Arkansas Democrat-Gazette.

When sending his Christmas greeting card to patients, he wrote, “The Arkansas Cancer Clinic was proud to serve you as a patient. Although various health insurances pay most of the bills for [the] majority of patients, even the deductibles and co-pays can be burdensome. Unfortunately, that is the way our health care system currently works. The clinic has decided to forego all balances owed to the clinic by its patients. Happy Holidays.”
In the view of the president of the debt collection company he engaged, Dr Atiq is “a very caring individual”.

Bea Cheesman, of RMC of America, said, “He’s always been extremely easy to work with as a client. It’s just a wonderful thing that he and his family did in forgiving this debt because the people with oncology bills do have more challenges than the bulk of the population.”Dr Atiq approached the Arkansas Medical Society to ensure there was nothing improper about the move.

Source:BBC News

Categories : UncategorizedTags :

Antibiotic Overuse by Children’s Hospitals Contributing to Antibiotic Resistance

On By ModernMedia

Children’s hospitals may be contributing to antibiotic resistance by overprescription of antibiotics, according to a recent study.

The study, conducted by the University of Alabama at Birmingham (UAB),   found that in 51 children’s hospitals across the United States, rates of antibiotic administration ranged from 22% to 52%. Approximately a quarter of children receiving antibiotics were receiving them incorrectly. This adds to a growing body of evidence that points to antibiotics overuse and misuse by children’s hospitals – which ought to know better.Study co-author, Dr Jason Newland said, “There’s no doubt: We’ve seen some extra use of antibiotics, The impact of the pandemic on antibiotic use will be significant.

“The study’s numbers are likely an underestimate since the research involved 32 children’s hospitals already working together on proper antibiotic use. Newland said the US’ more than 250 children’s hospitals need to improve. Even though COVID fears have reduced the numbers of children’s hospital visits, antibiotics are still being prescribed via telemedicine.

“I hear a lot about antibiotic use for the ‘just in case’ scenarios,” said Dr Joshua Watson, at Nationwide Children’s Hospital in Ohio. “We underestimate the downsides.”

Dr Shannon Ross, an associate professor of paediatrics and microbiology at UAB, said that not all doctors have been taught the correct use of antibiotics. Regarding this overuse, she said, “Many of us don’t realize we’re doing it. It’s sort of not knowing what you’re doing until someone tells you.”
Unnecessary antibiotic use is a problem, and the pandemic “has thrown a little bit of gas on the fire,” said Dr Mark Schleiss, a paediatrics professor at the University of Minnesota Medical School.

“It’s irresponsible,” said Christina Fuhrman, who almost lost her infant daughter to a Clostridium difficile infection, and who now advocates for correct antibiotic use. Along with parents begging for antibiotics in paediatricians’ offices, the situation is “creating a monster.”
Many studies have attested to the rise of C. diff in children, which causes gastrointestinal problems. A 2017 study found that cases of a certain multidrug-resistant Enterobacteriaceae type rose 700% in American children in just eight years. And a steady stream of research points to the stubborn prevalence in kids of the better-known MRSA, or methicillin-resistant Staphylococcus aureus.

“It’s getting more and more worrisome,” said Ross. “We have had patients we have not been able to treat because we’ve had no antibiotics available.”

Source: News-Medical.Net

Journal information: Tribble A, Lee B, Flett K et al. Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey. Clinical Infectious Diseases. 2020;71(8):e226-e234. doi:10.1093/cid/ciaa036 

Categories : UncategorizedTags :

New “Spray-on” Wound Dressing Mimics Skin

On By ModernMedia

A new kind of burn dressing developed by an Israeli company, Nanomedic, is being used in Israel, Europe and India, and applies a flexible dressing without contact.

Called “Spincare”, it is contactless and is sprayed on by an applicator. Normal burn dressings are difficult to apply because they can cause so much pain.The breathable “skin substitute” is flexible, which is important for allowing movement for wound rehabilitation, and is also easy for patients to apply. Unlike traditional wound dressings, it also allows patients to shower, and, being translucent, allows clinicians to inspect the wound without having to remove the dressing.

The technology is based on “electrospinning“, where electricity is applied to a solution to make nanofibres. Electrospinning had mostly been used to produce air filters, but it was only until the 1990s that the technology began to acquire other applications. Though the technology has been used in medical applications before, this is the first time such a device small enough to use at a patient’s bedside has been developed.

It is effective at treating shallow burns, but less effective for deep burns, according to the manufacturer. It also has applications in areas such as facial wound dressings, where traditional bandages are cumbersome, This new technology comes at a time when there is debate in wound care management, as to whether frequent replacement of dressing for checking purposes is in fact counterproductive. This new technology would join other types of wound dressing increasingly being used that require fewer changes.

Source: The Guardian

Categories : UncategorizedTags :

Interviews Reveal Most Important ICU Outcomes for Patients and Family

On By ModernMedia

A University of Pennsylvania study has explored the important aspects and outcomes attributed to high quality ICU care by patients and their families.

These may not match the metrics assigned by healthcare providers, which could prompt reassessment, especially considering the increasing numbers of patients successfully discharged from the ICU, and in light of the COVID pandemic (although this study was conducted prior to this).ICU care is typically assessed in terms of mortality rates, durations of stay, ventilator-free days, infection rates and other data from patient health records. On discharge from an intensive care unit (ICU), efforts will often address physical and cognitive functioning, and grief and depression.

This research was aimed at improving the understanding of patient- and family-centred care. Researchers from the Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania conducted hour-long semi-structured interviews with 19 ICU survivors, as well as 30 family members of patients who had either survived or died in ICU.

The key aspects of quality care in the ICU experience were communication, patient comfort and sensing that the medical team’s care was exhaustive. The researchers noted that time and effort put into patient communication was highly valued, often leading patients feeling less alone and afraid. Communication and patient comfort were especially important during the ICU experience, and are delivered by high quality nursing care.

Key post-ICU outcomes were consistently given as survival, quality of life, physical functioning and cognitive functioning. Although survival alone was commonly seen by 25% of participants as a key ICU outcome, some outcomes were seen as worse than death by many. These included an inability to communicate, having a severe physical disability or dependence on machines, and living with severe or constant pain.

Source: Newswise

Journal information: Auriemma, C.L., et al. (2020) What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study. American Journal of Critical Care. doi.org/10.4037/ajcc2021398.

Categories : UncategorizedTags :

New Year Sees SA Hospitals Battling for Resources Amid COVID Surge

On By ModernMedia

As the new year begins, South African hospitals are struggling as unprecedented numbers of COVID cases in the second wave are pushing resources to the limit. Hospitals are having to cope with the situation even as their own workers are off sick or self-isolating.

Last week, at least one province was reported to have reached out to the army to request additional personnel to help cope with the additional burden. Wester Cape premier Alan Winde said the province was recruiting an additional 1 300 health care workers (HCWs)In a weekly media briefing, KwaZulu-Natal premier Sihle Zikalala stated on Sunday that a total of 8 723 public sector HCWs had been infected with COVID since the start of the pandemic.

“Of the total infected, 98 have sadly succumbed to the disease. The majority of the infected health-care workers are nurses,” he said. HCWs are also struggling with burnout and illness.  Experts had long been predicting the impact the second wave would have on South Africa’s already weakened health infrastructure. As of Sunday, 3rd January, there were a total of 167 492 active cases in the country.  

Dr Kams Govender, who works west of Durban, said: “What we are experiencing now is just the tremor, the tsunami is yet to come in mid January. It’s hit us hard and it’s going to hit us even harder then. We are physically and emotionally exhausted, and worse, losing our health-care colleagues every single day. But still we push on and show up and pray for better days where there is more light than darkness.”

The hospital at Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi, KZN, was reported to be full and bodies had to be taken to funeral homes within 48 hours.

One nurse at PMMH said, “The hospital is full, the Covid wards are full, the normal wards are full. There are no beds for our outpatients, they lie in the passage on stretchers waiting for beds. The Covid patients will be placed with one another in a consultation room. We try to separate them but it’s not a proper place for patients to be in because there are no beds, just the stretchers. We are running out of oxygen points because there are so many patients that need oxygen. We tend to prioritise who needs it more, but right now everyone needs it.”
Source: Sowetan Live