Using Quality Improvement Methods to Understand Incidence, Timing, and Factors Associated With Unplanned Intensive Care Unit Transfers of Patients With End-Stage Liver Disease
| Autor: | Alyssa Mullins, Kelly S Grimshaw, Kitty Fan, Janet Parkosewich |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Patient Transfer medicine.medical_specialty Quality management Time Factors 030232 urology & nephrology Signs and symptoms 030230 surgery law.invention End Stage Liver Disease 03 medical and health sciences Liver disease 0302 clinical medicine law medicine Humans Intensive care medicine Transplantation business.industry Incidence (epidemiology) Incidence End stage liver disease Middle Aged medicine.disease Intensive care unit Quality Improvement Benchmarking Connecticut Intensive Care Units Female business Emergency Service Hospital Health care quality |
| Zdroj: | Progress in transplantation (Aliso Viejo, Calif.). 29(4) |
| ISSN: | 2164-6708 |
| Popis: | Introduction: Patients with end-stage liver disease are at risk for clinical deterioration, often requiring hospital admissions while awaiting transplantation. Nurses observed that many patients were or became unstable soon after arrival, requiring transfers to the medical intensive care unit. Objective: To explore the incidence, timing, and factors associated with unplanned intensive care transfers. Design: We conducted a quality improvement project using plan-do-study-act methods to explore administrative data from adult patients admitted to the hepatology service’s medical–surgical unit. Chi-square and t-tests were used to examine associations between demographic, clinical, and temporal factors and unplanned transfers. Data were analyzed at the hospital encounter level. Results: Unplanned transfers occurred in 8.6% of 1418 encounters. The number of transfers during these encounters ranged from 1 to 6. Most unplanned transfers (65.9%) occurred during the evening shift. On average, there was a 4.2-hour delay to the transfer. Fifty-one percent of these encounters required support from clinicians outside the unit while waiting for a bed. Factors associated with unplanned intensive care unit transfer were male sex ( P = .02), self-referral to the emergency department ( P < .001), and lower initial mean Rothman Index ( P < .001). Discussion: Results validated nurses’ concerns about the patients’ severity of illnesses at the time of admission and frequent need for transfer to intensive care soon after admission. We now have actionable data that are being used by leaders to assess unit admission criteria and develop operating budgets for human and material resources needed to care for this challenging population. |
| Databáze: | OpenAIRE |
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