Practices and Patterns of Hourly Neurochecks: Analysis of 8,936 Patients With Neurological Injury.

Autor:	LaBuzetta JN; Division of Neurocritical Care, Department of Neurosciences, UC San Diego Health, La Jolla, CA, USA., Hirshman BR; Department of Neurosurgery, UC San Diego Health, La Jolla, CA, USA., Malhotra A; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, UC San Diego Health, La Jolla, CA, USA., Owens RL; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, UC San Diego Health, La Jolla, CA, USA., Kamdar BB; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, UC San Diego Health, La Jolla, CA, USA.
Jazyk:	angličtina
Zdroj:	Journal of intensive care medicine [J Intensive Care Med] 2022 Jun; Vol. 37 (6), pp. 784-792. Date of Electronic Publication: 2021 Jul 05.
DOI:	10.1177/08850666211029220
Abstrakt:	Background: Patients experiencing acute neurological injury often receive hourly neurological assessments ("neurochecks") to capture signs of deterioration. While commonly utilized in the intensive care unit (ICU) setting, little is known regarding practices (i.e., variations by age and ordering services) and patterns (i.e., duration and post-discontinuation plans) of hourly neurochecks. To inform future quality improvement intervention efforts, we performed an analysis of hourly neurochecks using an electronic health record-based dataset. Study Design and Methods: Our 75-month retrospective dataset consisted of all health system ICU patients who received hourly neurochecks. Variables included age, admission diagnosis category, ordering provider, post-discontinuation order, and discharge destination. Multivariable Cox regression was used to evaluate factors associated with hourly neurocheck duration. Results: We evaluated 9,513 first admission hourly neurocheck orders in 8,936 patients. The trauma, neurosurgery, and neurocritical care services were responsible for 4,067 (43%), 2,071 (22%) and 1,697 (18%) hourly neurocheck orders, respectively. Median (interquartile range) hourly neurocheck duration was 1.09 (0.69, 2.35) days, and was greater than 3 and 7 days, respectively, for 1,773 (19%) and 640 (7%) patients. Median hourly neurocheck duration ranged from 0.87 (0.65, 1.68) to 1.60 (0.83, 2.97) days for neurosurgical and non-neurological ICU services, respectively. Upon discontinuation, 2,225 (23%) of hourly neurochecks were transitioned to no neurochecks. Conclusion: Substantial differences exist between ICU services and practice patterns surrounding hourly neurochecks. Understanding these differences will help inform intervention efforts aimed at streamlining hourly neurocheck practices and outcomes for patients with acute neurological injury.
Databáze:	MEDLINE
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