Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016 to 2021: a nationwide registry-based study with 30-day follow-up.

BACKGROUND: Improving oxygenation and ventilation in drowning patients early in the field is critical and may be lifesaving. The critical care interventions performed by physicians in drowning management are poorly described. The aim was to describe patient characteristics and critical care interventions with 30-day mortality as the primary outcome in drowning patients treated by the Danish Air Ambulance. METHODS: This retrospective cohort study with 30-day follow-up identified drowning patients treated by the Danish Air Ambulance from January 1, 2016, through December 31, 2021. Drowning patients were identified using a text-search algorithm (Danish Drowning Formula) followed by manual review and validation. Operational and medical data were extracted from the Danish Air Ambulance database. Descriptive analyses were performed comparing non-fatal and fatal drowning incidents with 30-day mortality as the primary outcome. RESULTS: Of 16,841 dispatches resulting in a patient encounter in the six years, the Danish Drowning Formula identified 138 potential drowning patients. After manual validation, 98 drowning patients were included in the analyses, and 82 completed 30-day follow-up. The prehospital and 30-day mortality rates were 33% and 67%, respectively. The National Advisory Committee for Aeronautics severity scores from 4 to 7, indicating a critical emergency, were observed in 90% of the total population. They were significantly higher in the fatal versus non-fatal group (p < 0.01). At least one critical care intervention was performed in 68% of all drowning patients, with endotracheal intubation (60%), use of an automated chest compression device (39%), and intraosseous cannulation (38%) as the most frequently performed interventions. More interventions were generally performed in the fatal group (p = 0.01), including intraosseous cannulation and automated chest compressions. CONCLUSIONS: The Danish Air Ambulance rarely treated drowning patients, but those treated were severely ill, with a 30-day mortality rate of 67% and frequently required critical care interventions. The most frequent interventions were endotracheal intubation, automated chest compressions, and intraosseous cannulation.

Implementation of an Electronic Checklist to Improve Patient Handover From Ward to Operating Room.

OBJECTIVE: Research has identified numerous safety risks in perioperative patient handover. In handover from ward to operating room (OR), patients are often transferred by a third person. This adds to the risk of loss of important information and of caregivers in the OR not identifying possible risk factors. The aim of this study was to describe the implementation process and completion rate of a new preoperative, ward-to-OR checklist. Our goal was a 90% fulfillment. METHOD: This study is a prospective, observational study in a Danish University Hospital including all patients undergoing surgery in 2013. The checklist was a screen page with 27 checkboxes of information relevant for a safe handover. The checklist should be completed in the ward before handover to the OR and should be checked in the OR before receiving the patient. The Plan-Do-Study-Act (PDSA) cycle method was used in the implementation process of the checklist. RESULTS: A total of 17.361 patients were included. In wards with only elective surgery (plastic and breast surgery), the checklist was used in 1.419 of 2.286 patients (62.1%). In wards with both elective and emergency surgery (abdominal, orthopedic, urology, gynecology and obstetrics), the checklist was used in 1.963 of 7.460 elective patients (26.3%) and in 812 of 7.615 emergency patients (10.7 %). CONCLUSION: Our goal of a 90% fulfillment was not reached. The electronic checklist seemed to be used most frequently in wards with only elective surgery.

Postoperative handover: characteristics and considerations on improvement: a systematic review.

CONTEXT: Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject to a downscale in monitoring and observation, which makes them vulnerable to incidents and errors. OBJECTIVES: To describe the characteristics and potential hazards to quality and patient safety during postoperative handover. To identify concrete recommendations for improvement in this process. DESIGN: A systematic review of the literature. DATA SOURCES: Comprehensive search of electronic databases (Medline, Embase, Cochrane Library) in March 2012. Additional studies were obtained from bibliographies of retrieved reports. ELIGIBILITY CRITERIA: Studies analysing the characteristics of the postoperative handover and interventional studies with the aim of improving postoperative handover. Only original research was included. RESULTS: We identified 23 studies including descriptive and interventional studies. Postoperative handovers are described as a complex work process challenged by interruptions, time pressure and a lack of supporting framework. Interventional studies introduced standardised handover tools in combination with environmental changes, resulting in better flow of information in four out of five, better teamwork in two and less technical errors in two out of three studies. CONCLUSION: Postoperative handover is a complex and dynamic situation. It is very important to analyse the challenges in the local setting and that solutions are customised to fit the specific context in which the postoperative handovers takes place. It is also important to acknowledge the role of non-technical skills in the work process with respect to patient safety. Implementation of new handover strategies must be considered carefully. To optimise the motivation for change among staff, the importance of improvement in postoperative handover in all settings must be outlined in future studies with more patient-specific outcomes.

Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis.

BACKGROUND: Hydroxyethyl starch (HES) [corrected] is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis. METHODS: In this multicenter, parallel-group, blinded trial, we randomly assigned patients with severe sepsis to fluid resuscitation in the ICU with either 6% HES 130/0.42 (Tetraspan) or Ringer's acetate at a dose of up to 33 ml per kilogram of ideal body weight per day. The primary outcome measure was either death or end-stage kidney failure (dependence on dialysis) at 90 days after randomization. RESULTS: Of the 804 patients who underwent randomization, 798 were included in the modified intention-to-treat population. The two intervention groups had similar baseline characteristics. At 90 days after randomization, 201 of 398 patients (51%) assigned to HES 130/0.42 had died, as compared with 172 of 400 patients (43%) assigned to Ringer's acetate (relative risk, 1.17; 95% confidence interval [CI], 1.01 to 1.36; P=0.03); 1 patient in each group had end-stage kidney failure. In the 90-day period, 87 patients (22%) assigned to HES 130/0.42 were treated with renal-replacement therapy versus 65 patients (16%) assigned to Ringer's acetate (relative risk, 1.35; 95% CI, 1.01 to 1.80; P=0.04), and 38 patients (10%) and 25 patients (6%), respectively, had severe bleeding (relative risk, 1.52; 95% CI, 0.94 to 2.48; P=0.09). The results were supported by multivariate analyses, with adjustment for known risk factors for death or acute kidney injury at baseline. CONCLUSIONS: Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer's acetate. (Funded by the Danish Research Council and others; 6S ClinicalTrials.gov number, NCT00962156.).