Publications by authors named "Tessa Steel"
Background: Treatment of alcohol withdrawal syndrome (AWS) in hospitals is inconsistent. Electronic health record (EHR) order sets protocolize care.
Objective: We examined variation in AWS order sets across hospital organizations and their concordance with AWS guidelines.
Article Synopsis
- * It analyzes data from Kaiser Permanente Washington, evaluating the incidence of AWS hospitalizations across various demographics and health backgrounds over a four-year period.
- * Results indicate a substantial number of adults (over 544,000) involved in primary care, indicating a strong need for better awareness and prevention strategies related to alcohol use disorders in hospital settings.
Background: Sepsis is common and expensive, and evidence suggests that sepsis order sets may help to improve care. Very incomplete evidence exists regarding the effects of sepsis order sets on the value of care produced by hospitals or the societal costs of sepsis care.
Research Question: In patients hospitalized for sepsis, is the receipt a of a sepsis order set vs no order set associated with improved value of care, defined as decreased hospital mortality, decreased hospital direct variable costs, and decreased societal spending on hospitalizations?
Study Design And Methods: This retrospective cohort study included patients discharged with sepsis International Classification of Diseases, Tenth Revision, codes over 2 years from a large integrated delivery system.
Objectives: Alcohol withdrawal syndrome (AWS) may progress to require high-intensity care. Approaches to identify hospitalized patients with AWS who received higher level of care have not been previously examined. This study aimed to examine the utility of Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-Ar) for alcohol scale scores and medication doses for alcohol withdrawal management in identifying patients who received high-intensity care.
View Article and Find Full Text PDFPurpose Of Review: To examine the impact of substance use disorders (SUDs) on critical illness and the role of critical care providers in treating SUDs. We discuss emerging evidence supporting hospital-based addiction treatment and highlight the clinical and research innovations needed to elevate the standards of care for patients with SUDs in the intensive care unit (ICU) amidst staggering individual and public health consequences.
Recent Findings: Despite the rapid increase of SUDs in recent years, with growing implications for critical care, dedicated studies focused on ICU patients with SUDs remain scant.
Objective: To describe initial benzodiazepine dosing strategies and factors associated with variation in benzodiazepine dosing in a national cohort of hospitalized patients with alcohol withdrawal syndrome (AWS).
Patients And Methods: This cross-sectional study included adult patients with AWS admitted to medical services and treated with benzodiazepines at 93 Veterans Health Administration hospitals in 2013. Treatment was categorized by initial benzodiazepine dosing strategy-fixed-dose, symptom-triggered, or front-loading.
Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T-T continuum to advance the care of hospitalized patients who experience SAWS.
View Article and Find Full Text PDFUnlabelled: Low tidal volume ventilation and prone positioning are recommended therapies yet underused in acute respiratory distress syndrome. We aimed to assess the role of interventions focused on implementation of low tidal volume ventilation and prone positioning in mechanically ventilated adult patients with acute respiratory distress syndrome.
Data Sources: PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials.
Background: The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate.
Objectives: To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics.
Methods: The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment.
Objectives: Inpatient alcohol withdrawal syndrome (AWS) is common and early treatment improves outcomes, but no prior study has used electronic health record (EHR) data, available at admission, to predict the probability of inpatient AWS. This study estimated the probability of inpatient AWS using prior-year EHR data, hypothesizing that documented alcohol use disorder (AUD) and AWS would be strongly associated with inpatient AWS while exploring associations with other patient characteristics.
Methods: The study investigated patients hospitalized ≥24 hours on medical services in the Veterans Health Administration during 2013 using EHR data extracted from the Veterans Health Administration Corporate Data Warehouse.
Article Synopsis
- This study analyzed the prevalence and variability of alcohol withdrawal syndrome (AWS) among hospitalized patients in the Veterans Health Administration (VHA) during 2013.
- The findings revealed that the national prevalence of documented AWS was 5.8%, with significant variations based on geographic region, hospital, admitting specialty, and comorbid conditions.
- Notably, psychiatric admissions had the highest prevalence of AWS (19.0%), while it was less common in medical (4.4%) and surgical (0.7%) admissions, indicating potential differences in how alcohol-related issues are managed across different medical settings.
Background: HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States.
Setting: Veterans Health Administration.
Objectives: Colorectal cancer (CRC) screening is low among American Indians (AIs). We describe the demographics, health status, prevalence of modifiable CRC risk factors, and use of CRC screening modalities in a Pacific Northwest AI tribe.
Methods: We conducted a survey among Cowlitz tribal members using a Behavioral Risk Factor Surveillance System (BRFSS) questionnaire.