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

计划外 ICU 入院：了解机制并确定与以患者和家庭为中心的结果的关联

• 批准号: 10621707
• 负责人: Ann Long Jennerich
• 金额: $ 76.22万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621707
• 关键词: Academic Medical Centers; Achievement; Address; Admission activity; Adverse event; Affect; Age; Anxiety; Caring; Characteristics; Classification; Communication; Community Hospitals; Decision Making; Development; Failure; Family; Family member; Floor; Healthcare Systems; Hospitals; Human; Impairment; Individual; Industry; Information Systems; Intervention; Knowledge; Link; Medical; Modeling; Monitor; Morbidity - disease rate; Myocardial dysfunction; Outcome; Patient Transfer; Patient-Focused Outcomes; Patients; Positioning Attribute; Prevention; Process; Protocols documentation; Recovery; Research; Respiratory Failure; Safety; Sample Size; Severity of illness; Standardization; System; Work; acute care; care costs; cohort; depressive symptoms; design; experience; health care settings; high risk; improved; improved outcome; mortality; mortality risk; novel; post-traumatic stress; psychological distress; psychological symptom; respiratory; safety net; therapy development

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.

项目概要/摘要 急症护理区的计划外 ICU 入院很常见，并且最常与 发生呼吸衰竭或心脏功能障碍，原因是呼吸或循环障碍 超过 60% 的病例入住 ICU。这些入院与高发病率和死亡率相关 并伴随着对患者及其家人的其他重要影响，包括 沟通不足，家庭护理评价较低。计划外入住 ICU 是强有力的指标 的不良事件，但人们对这些承认背后的机制知之甚少。 之前的工作重点是与计划外入住 ICU 相关的患者特征，包括年龄 和疾病的严重程度，但检查非患者因素也有影响的证据有限，例如 人为（例如临床医生）、组织或技术故障。了解这些非患者如何 影响计划外 ICU 入院的因素，因为这些因素导致的入院可能 可以预防的。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，我们建议确定意外事件的影响因素和机制。 ICU 入院并将这些因素和机制与以患者和家庭为中心的结果联系起来。这 目标将通过实现三个具体目标来实现，这些目标涉及一组从急性期转院的患者 为学术医疗中心、安全网医院和社区医院的 ICU 提供护理。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（监测和分析预防和恢复信息系统）模型。改编的 PRISMA 模型将使我们能够识别多个因素——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入住 ICU。第二个目标将 检查导致计划外 ICU 入院和家庭的因素和机制之间的关联 心理困扰的成员症状，包括抑郁、焦虑和创伤后症状 压力。最终目标将比较不同因素和机制的无 ICU 天数和护理成本 计划外入住 ICU。我们的团队对重症患者及其患者拥有丰富的研究经验 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情况 结果、医疗决策、医疗保健系统以及质量和安全。我们有能力 确定导致计划外 ICU 入院的因素和机制并生成知识 需要制定最有潜力改善患者、家庭成员、 和医疗保健系统。