Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.

The concept of frailty in intensive care.

Our population is ageing, and this is also reflected in the ageing of the hospital and intensive care population. Along with ageing, there is also an increase in age-related chronic health conditions or comorbidities, which in turn affects the patient's functional state. There is an increasing need to describe a patient's clinical condition in terms of their functional capacity, such as frailty.

Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis.

Background: Health care-associated infections (HAI) have been shown to increase length of stay, the cost of care, and rates of hospital deaths (Kaye and Marchaim, J Am Geriatr Soc 62(2):306-11, 2014; Roberts and Scott, Med Care 48(11):1026-35, 2010; Warren and Quadir, Crit Care Med 34(8):2084-9, 2006; Zimlichman and Henderson, JAMA Intern Med 173(22):2039-46, 2013). Importantly, infections acquired during a hospital stay have been shown to be preventable (Loveday and Wilson, J Hosp Infect 86:S1-70, 2014). In particular, due to more invasive procedures, mechanical ventilation, and critical illness, patients cared for in the intensive care unit (ICU) are at greater risk of HAI and associated poor outcomes.

Patient safety and rapid response systems.

Attention was drawn to the safety of patients in acute care hospitals in the early 1990s when studies found large numbers of potentially preventable deaths. Errors were initially ascribed to individual doctors and nurses, but later it was recognised that errors were mainly related to failure of systems rather than individuals. Mortality is not necessarily a good measure of hospital safety.

Rapid response systems.

Rapid response systems (RRSs) are one of the first organisation-wide, patient-focused systems to be developed to prevent potentially avoidable deaths and serious adverse events such as cardiac arrests. RRSs identify seriously ill and at-risk patients and those whose condition is deteriorating, using abnormal vital signs and observations that trigger an urgent response by staff who are able to deal with any medical emergency. RRS teams also respond to staff concern--any bedside nurse or doctor who is concerned about his or her patient can seek assistance.

Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion.

Objectives: To understand the changes in the population incidence of inhospital cardiopulmonary arrest (IHCA) and mortality associated with the introduction of rapid response systems (RRSs).

Design, Setting And Participants: Population-based study of 9 221 138 hospital admissions in 82 public acute hospitals in New South Wales, using data linked to a death registry, from 1 Jan 2002 to 31 Dec 2009.

Main Outcome Measures: Changes in IHCA, IHCA-related mortality, hospital mortality and proportion of IHCA patients surviving to hospital discharge.

Access block and ED overcrowding.

Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand.

A review of the nursing role in central venous cannulation: implications for practice policy and research.

Aims And Objectives: The aim of this article is to review published studies about central vein cannulation to identify implications for policy, practice and research in an advanced practice nursing role.

Design: Modified integrative literature review.

Methods: Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, Embase, and the World Wide Web were undertaken using MeSH key words.

Medical emergency team calls: the need to communicate a resuscitation plan.

As illustrated in the case report of a 79-year-old woman, actions can be taken to ensure that the rapid response system is not used as the surrogate "do not actively resuscitate" team.

The medical emergency team as a safety net.

In the case of an 11-year-old boy with stable physiological parameters, the deterioration in condition was so sudden that only a rapid response system could ensure any chance of survival.

Access block in NSW hospitals, 1999-2001: does the definition matter?

Objectives: To estimate the magnitude of access block and its trend over time in New South Wales hospitals, using different definitions of access block, and to explore its association with clinical and non-clinical factors.

Design And Setting: An epidemiological study using the Emergency Department Information System datasets (1 January 1999 to 31 December 2001) from a sample of 55 NSW hospitals.

Main Outcome Measures: Prevalence of access block measured by four different definitions; strength of association between access block, type of hospital, year of presentation, mode and time of arrival, triage category (an indicator of urgency), age and sex.