Sepsis Education Initiative Targeting qSOFA Screening for Non-ICU Patients to Improve Sepsis Recognition and Time to Treatment.

Background: The quick-Sequential Organ Failure Assessment (qSOFA) criteria are recommended for identifying non-intensive care unit (ICU) patients at risk for sepsis but are underutilized.

Local Problem: We hypothesized that education on recognizing sepsis using qSOFA criteria and empowering nurses to trigger rapid response team (RRT) calls based on positive qSOFA scores would reduce time to recognition and time to intervention and improve treatment compliance in non-ICU patients.

Methods: The methods involved a descriptive retrospective review of 60 sepsis patients (30 pre- and 30 posteducation) to determine sepsis recognition time (qSOFA-to-RRT); time-to-sepsis interventions (reported as median [interquartile range] hours); and percent compliance with interventions.

Prompting with electronic checklist improves clinician performance in medical emergencies: a high-fidelity simulation study.

Background: Inefficient processes of care delivery during acute resuscitation can compromise the "Golden Hour," the time when quick interventions can rapidly determine the course of the patient's outcome. Checklists have been shown to be an effective tool for standardizing care models. We developed a novel electronic tool, the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) to facilitate standardized evaluation and treatment approach for acutely decompensating patients.

Expanding the Presence of Primary Services at Rapid Response Team Activations: A Quality Improvement Project.

Rapid response teams (RRTs) were implemented to provide critical care services for deteriorating patients outside of intensive care units. To date, research on RRT has been conflicting, with some studies showing significant mortality benefit and reduction in cardiac arrest events and others showing no benefit. However, studies have consistently showed improved outcomes when RRTs work closely with primary services.

Improving the Quality of Handoffs in Patient Care Between Critical Care Providers in the Intensive Care Unit.

With the ever-increasing adoption of shift models for intensive care unit (ICU) staffing, improving shift-to-shift handoffs represents an important step in reducing medical errors. The authors developed an electronic handoff tool integrated within the existing electronic medical record to improve handoffs in an adult ICU. First, stakeholder (staff intensivists, fellows, and nurse practitioners/physician assistants) input was sought to define what elements they perceived as being essential to a quality handoff.

Differentiating infectious and noninfectious ventilator-associated complications: A new challenge.

Background: The purpose of this study was to develop an electronic search algorithm which reliably differentiates infectious and noninfectious ventilator-associated events (VAEs). This was a retrospective cohort study used to derive a predictive model. It took place at a tertiary care hospital campus.

Development and validation of clinical performance assessment in simulated medical emergencies: an observational study.

Background: Critical illness is a time-sensitive process which requires practitioners to process vast quantities of data and make decisions rapidly. We have developed a tool, the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN), aimed at enhancing care delivery in such situations. To determine the efficacy of CERTAIN and similar cognitive aids, we developed rubric for evaluating provider performance in a simulated medical resuscitation environments.

The role of the primary care team in the rapid response system.

Purpose: The purpose of the study is to evaluate the impact of primary service involvement on rapid response team (RRT) evaluations.

Materials And Methods: The study is a combination of retrospective chart review and prospective survey-based evaluation. Data included when and where the activations occurred and the patient's code status, primary service, and ultimate disposition.

Intensive care unit readmission prevention checklist: is it worth the effort?

Rationale, Aims And Objectives: Checklists have been adopted by various institutions to improve patient outcomes. In particular, readmission prevention checklists may be of potential value to improve patient care and reduce medical costs. As a result, a prior quality improvement study was conducted to create an intensive care unit readmission prevention checklist.

Correlation of left ventricular systolic dysfunction determined by low ejection fraction and 30-day mortality in patients with severe sepsis and septic shock: a systematic review and meta-analysis.

Introduction: The prognostic implications of myocardial dysfunction in patients with sepsis and its association with mortality are controversial. Several tools have been proposed to evaluate cardiac function in these patients, but their usefulness beyond guiding therapy is unclear. We review the value of echocardiographic estimate of left ventricular ejection fraction (LVEF) in the setting of severe sepsis and/or septic shock and its correlation with 30-day mortality.

Meta-analysis of randomized trials of angioedema as an adverse event of renin-angiotensin system inhibitors.

Angioedema is a rare, potentially life-threatening adverse event of renin-angiotensin system inhibitors. The objective of the present study was to determine the risk of angioedema from randomized clinical trials. A PubMed/CENTRAL/EMBASE search was made for randomized clinical trials from 1980 to October 2011 in patients on angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or direct renin inhibitor (DRI).