The Association of ICU Acuity With Outcomes of Patients at Low Risk of Dying.

Objective: Many ICU patients do not require critical care interventions. Whether aggressive care environments increase risks to low-acuity patients is unknown. We evaluated whether ICU acuity was associated with outcomes of low mortality-risk patients.

The high cost of low-acuity ICU outliers.

Direct variable costs were determined on each hospital day for all patients with an intensive care unit (ICU) stay in four Phoenix-area hospital ICUs. Average daily direct variable cost in the four ICUs ranged from $1,436 to $1,759 and represented 69.4 percent and 45.

Readmissions and death after ICU discharge: development and validation of two predictive models.

Introduction: Early discharge from the ICU is desirable because it shortens time in the ICU and reduces care costs, but can also increase the likelihood of ICU readmission and post-discharge unanticipated death if patients are discharged before they are stable. We postulated that, using eICU® Research Institute (eRI) data from >400 ICUs, we could develop robust models predictive of post-discharge death and readmission that may be incorporated into future clinical information systems (CIS) to assist ICU discharge planning.

Methods: Retrospective, multi-center, exploratory cohort study of ICU survivors within the eRI database between 1/1/2007 and 3/31/2011.

Severity scoring in the critically ill: part 2: maximizing value from outcome prediction scoring systems.

Part 2 of this review of ICU scoring systems examines how scoring system data should be used to assess ICU performance. There often are two different consumers of these data: lCU clinicians and quality leaders who seek to identify opportunities to improve quality of care and operational efficiency, and regulators, payors, and consumers who want to compare performance across facilities. The former need to know how to garner maximal insight into their care practices; this includes understanding how length of stay (LOS) relates to quality, analyzing the behavior of different subpopulations, and following trends over time.

Severity scoring in the critically ill: part 1--interpretation and accuracy of outcome prediction scoring systems.

This review examines the use of scoring systems to assess ICU performance. APACHE (Acute Physiology and Chronic Health Evaluation), MPM (mortality probability model), and SAPS (simplified acute physiology score) are the three major ICU scoring systems in use today. Central to all three is the use of physiologic data for severity adjustment.

Remote ICU care programs: current status.

The desire to provide continuous intensivist management for all intensive care unit (ICU) patients in the face of a massive shortfall of available intensivists prompted the introduction of remote ICU care programs in 1999. The past several years have seen a dramatic increase in the number of health systems adopting this care model. These health systems have increased our understanding of both the ability of this new care model to improve clinical outcomes and the clinical processes that are required to achieve program quality goals.

Adrenal insufficiency--an unusual cause of shock in postoperative patients.

Objective: To remind physicians that adrenal insufficiency can cause postoperative shock and that the manifestations are difficult to distinguish from those of sepsis.

Methods: We present detailed case reports of three patients who had hyperdynamic shock in the surgical intensive-care unit and describe their response to the cosyntropin stimulation test.

Results: All three patients were diagnosed as having adrenal insufficiency with use of the cosyntropin stimulation test.

Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing.

Objective: To examine whether a supplemental remote intensive care unit (ICU) care program, implemented by an integrated delivery network using a commercial telemedicine and information technology system, can improve clinical and economic performance across multiple ICUs.

Design: Before-and-after trial to assess the effect of adding the supplemental remote ICU telemedicine program.

Setting: Two adult ICUs of a large tertiary care hospital.

Treatment of acromioclavicular joint separation: suture or suture anchors?

This investigation compared the stability of 2 methods of fixation for acromioclavicular (AC) joint separations. A complete AC joint separation was simulated in 6 matched pairs of fresh-frozen human cadaveric shoulders. One specimen from each pair was repaired with two No.

The eICU: it's not just telemedicine.

Intensive care units (ICUs) are major sites for medical errors and adverse events. Suboptimal outcomes reflect a widespread failure to implement care delivery systems that successfully address the complexity of modern ICUs. Whereas other industries have used information technologies to fundamentally improve operating efficiency and enhance safety, medicine has been slow to implement such strategies.

Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery.

Background: The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery.

Patients/methods: We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely represent major surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeon volumes.

Differential gene expression in a murine model of cancer cachexia.

Murine adenocarcinoma 16 (MAC16) tumors and cell lines induce cachexia in NMRI nude mice, whereas histologically similar MAC13 tumors do not. After confirming these findings in BALB/c nude mice, we demonstrated that this tissue wasting was not related to decreased food intake or increased total body oxidative metabolism. Previous studies have suggested that MAC16's cachexigenic properties may involve the production of tumor-specific factors.

Cervical spine injuries in football.

The game of football, as it is played today, poses serious risk of injury for players of all ages. Injury may occur to any structure of the spinal column, including its bony, ligamentous and soft tissue components. The majority of cervical spine injuries occurring in football are self limited, and a full recovery can be expected.

Distal biceps tendon ruptures: a historical perspective and current concepts.

Distal biceps tendon rupture is a relatively rare injury most commonly seen in the dominant extremity of men between 40 and 60 years of age. It occurs when an eccentric extension force is applied to a contracting biceps muscle. The hallmark finding is a palpable defect in the distal biceps, which is accentuated by elbow flexion.

Nicardipine versus nitroprusside for breakthrough hypertension following carotid endarterectomy.

Study Objective: To evaluate the effectiveness of nicardipine and nitroprusside for breakthrough hypertension following carotid endarterectomy.

Design: Prospective, randomized, double-blind, controlled effectiveness trial.

Setting: University-based surgical intensive care unit.

Weight loss is not associated with hyperleptinemia in humans with pancreatic cancer.

Pathological weight loss is a feature of many diseases and contributes to mortality and morbidity. Although cytokines have been implicated in some models of pathological weight loss, little is known about cellular mechanisms responsible for cachexia in patients with cancer. Leptin is a fat cell product that acts centrally to reduce appetite and decrease metabolism.

Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care.

Objective: Intensive care units (ICUs) account for an increasing percentage of hospital admissions and resource consumption. Adverse events are common in ICU patients and contribute to high mortality rates and costs. Although evidence demonstrates reduced complications and mortality when intensivists manage ICU patients, a dramatic national shortage of these specialists precludes most hospitals from implementing an around-the-clock, on-site intensivist care model.

ICU telemedicine. Organization and communication.

Telemedicine offers off-site physicians the ability to care for patients by providing them with audio-video links and access to relevant clinical data. Traditionally, this care modality has been used to overcome geographic barriers by bringing needed expertise to patients in remote locations. The same technology can be used to bring intensivist expertise to ICU patients.

Bundle-branch block as a risk factor in noncardiac surgery.

Background: Despite extensive data examining perioperative risk in patients with coronary artery disease, little attention has been devoted to the implications of conduction system abnormalities.

Objective: To define the clinical significance of bundle-branch block (BBB) as a perioperative risk factor.

Methods: Retrospective, cohort-controlled study of all noncardiac, nonophthalmologic, adult patients with BBB seen in our preoperative evaluation center.

Survival and functional outcome after prolonged intensive care unit stay.

Objective: To examine the functional outcome and costs of a prolonged illness requiring a stay in the surgical intensive care unit (SICU) of 7 of more days.

Summary Background Data: The long-term benefits and costs after a prolonged SICU stay have not been well studied.

Methods: All patients with an SICU length of stay of 7 or more days from July 1, 1996, to June 30, 1997, were enrolled.

The association between preoperative patient characteristics and both clinical and economic outcomes after abdominal aortic surgery.

Objective: To evaluate the association between patient characteristics and both clinical and economic outcomes in patients having abdominal aortic surgery in Maryland between 1994 and 1996.

Design: Retrospective study using an administrative data set.

Setting: All Maryland hospitals that performed abdominal aortic surgery from 1994 through 1996 (n = 46).