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

项目摘要/摘要 从急诊室非计划的ICU入院是很常见的，最常见的是 发生呼吸衰竭或心功能不全，伴有呼吸或循环障碍的原因 超过60%的病例为ICU入院。这些入院与高发病率和高死亡率有关。 并伴随着对患者及其家属的其他重要影响，包括 沟通不充分和家庭护理评级较低。计划外的ICU入院是一个强有力的指标 不良事件的发生，但对这些入院背后的机制知之甚少。 先前的工作集中在与非计划的ICU入院相关的患者特征上，包括年龄 和疾病的严重程度，但研究非患者因素的证据有限，例如 人为(例如，临床医生)、组织或技术故障。了解这些非患者是如何 影响计划外ICU入院的因素，因为这些因素导致的入院可能是 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缺口，我们建议确定导致计划外 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，涉及一批从急性胰腺炎转来的患者 在学术医疗中心、安全网医院和社区医院对ICU进行护理。第一个目标 将使用根本原因分析来调整和改进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。改编版 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 导致ICU意外入院的技术和相关机制。第二个目标是 检查导致ICU意外入院的因素和机制与家庭之间的关系 心理困扰的成员症状，包括抑郁、焦虑和创伤后症状 压力。最终目标是比较不同因素和机制的无ICU天数和护理费用。 计划外的重症监护室入院。我们的团队对重症患者和他们的患者有丰富的研究经验 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状况 结果、医疗决策、医疗保健系统以及质量和安全。我们处于有利地位，可以 确定导致ICU意外入院的因素和机制，并生成知识 需要开发最具潜力的干预措施，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.