Unplanned ICU Admissions: Understanding Mechanisms and Identifying Associations with Patient- and Family-Centered Outcomes

项目概要/摘要 来自急症室的计划外ICU入院很常见，最常见的原因是 发展为呼吸衰竭或心功能不全，原因与呼吸或循环障碍有关 超过60%的病例都是ICU入院。这些入院与高发病率和死亡率有关 并伴随着对患者及其家属的其他重要影响，包括 沟通不足和家庭对护理的评价较低。计划外的重症监护室入院 不良事件，但很少有人知道这些入院的机制。 以前的工作集中在与计划外ICU入院相关的患者特征，包括年龄 和疾病的严重程度，但有有限的证据检查非病人因素也有助于，如 人（例如，临床医生）、组织或技术故障。关键是要了解这些非病人 这些因素会影响计划外的ICU入院，因为这些因素导致的入院可能是 可以预防的还必须区分非患者因素（人与组织与 技术）及其相关机制，因为它们需要独特的干预措施。 为了填补这一关键的知识空白，我们建议确定非计划性的影响因素和机制。 ICU入院并将这些因素和机制与以患者和家庭为中心的结局联系起来。这 将通过实现三个具体目标来实现目标，这些目标涉及一组从急性 在学术医疗中心，安全网医院和社区医院的ICU护理。第一个目标 将使用根本原因分析来调整和完善现有的不良事件分类框架， PRISMA（预防和恢复监测和分析信息系统）模型。适配的 PRISMA模型将允许我们识别多个因素-患者、人类（例如，临床医生）、组织和 技术和相关机制导致计划外的ICU入院。第二个目标将 检查导致计划外ICU入院的因素和机制与家庭之间的关联 心理困扰的成员症状，包括抑郁、焦虑和创伤后症状 应力最终的目标是比较不同因素和机制下的无ICU天数和护理成本 意外的重症监护室入院我们的团队对重症患者及其家属有着丰富的研究经验。 家庭成员，具有制定干预措施的专业知识，以改善以患者和家庭为中心的 结果、医疗决策、医疗保健系统以及质量和安全。我们能够在 识别导致计划外ICU入院的因素和机制，并生成知识 需要开发最有潜力的干预措施，以改善患者，家庭成员， 和医疗保健系统。

PROJECT SUMMARY/ABSTRACT Unplanned ICU admissions from the acute care floor are common and most often related to the development of respiratory failure or cardiac dysfunction, with respiratory or circulatory impairment the reason for ICU admission in over 60% of cases. These admissions are associated with high morbidity and mortality and are accompanied by other important repercussions for patients and their family members, including inadequate communication and lower family ratings of care. Unplanned ICU admissions are strong indicators of adverse events, yet little is known about mechanisms underlying these admissions. Prior work has focused on patient characteristics associated with unplanned ICU admissions, including age and severity of illness, but there is limited evidence examining non-patient factors that also contribute, such as human (e.g., clinician), organizational, or technical failures. It is critical to understand how these non-patient factors affect unplanned ICU admissions, because admissions resulting from these factors may be preventable. It is also imperative to differentiate between non-patient factors (human vs organizational vs technical) and their associated mechanisms because they call for unique interventions. To fill this key knowledge gap, we propose to identify contributing factors and mechanisms for unplanned ICU admissions and connect these factors and mechanisms to patient- and family-centered outcomes. This objective will be met by achievement of three specific aims involving a cohort of patients transferred from acute care to the ICU at an academic medical center, a safety-net hospital, and a community hospital. The first aim will use root cause analysis to adapt and refine an existing framework for classification of adverse events, the PRISMA (Prevention and Recovery Information System for Monitoring and Analysis) model. The adapted PRISMA model will allow us to identify multiple factors – patient, human (e.g., clinician), organizational, and technical — and associated mechanisms contributing to unplanned ICU admissions. The second aim will examine associations between factors and mechanisms contributing to unplanned ICU admissions and family member symptoms of psychological distress, including symptoms of depression, anxiety, and post-traumatic stress. The final aim will compare ICU-free days and costs of care across factors and mechanisms contributing to unplanned ICU admissions. Our team has extensive research experience with seriously ill patients and their family members, with expertise in development of interventions to improve patient- and family-centered outcomes, medical decision making, healthcare systems, and quality and safety. We are well-positioned to identify factors and mechanisms contributing to unplanned ICU admissions and generate the knowledge needed to develop interventions with the greatest potential to improve outcomes for patients, family members, and the healthcare system.