Temporal Clustering of Critical Illness Events on Medical Wards.
JAMA Intern Med
; 183(9): 924-932, 2023 09 01.
Article
en En
| MEDLINE
| ID: mdl-37428478
ABSTRACT
Importance Recognizing and preventing patient deterioration is important for hospital safety. Objective:
To investigate whether critical illness events (in-hospital death or intensive care unit [ICU] transfer) are associated with greater risk of subsequent critical illness events for other patients on the same medical ward. Design, Setting, andParticipants:
Retrospective cohort study in 5 hospitals in Toronto, Canada, including 118â¯529 hospitalizations. Patients were admitted to general internal medicine wards between April 1, 2010, and October 31, 2017. Data were analyzed between January 1, 2020, and April 10, 2023. Exposures Critical illness events (in-hospital death or ICU transfer). Main Outcomes andMeasures:
The primary outcome was the composite of in-hospital death or ICU transfer. The association between critical illness events on the same ward across 6-hour intervals was studied using discrete-time survival analysis, adjusting for patient and situational factors. The association between critical illness events on different comparable wards in the same hospital was measured as a negative control.Results:
The cohort included 118â¯529 hospitalizations (median age, 72 years [IQR, 56-83 years]; 50.7% male). Death or ICU transfer occurred in 8785 hospitalizations (7.4%). Patients were more likely to experience the primary outcome after exposure to 1 prior event (adjusted odds ratio [AOR], 1.39; 95% CI, 1.30-1.48) and more than 1 prior event (AOR, 1.49; 95% CI, 1.33-1.68) in the prior 6-hour interval compared with no exposure. The exposure was associated with increased odds of subsequent ICU transfer (1 event AOR, 1.67; 95% CI, 1.54-1.81; >1 event AOR, 2.05; 95% CI, 1.79-2.36) but not death alone (1 event AOR, 1.08; 95% CI, 0.97-1.19; >1 event AOR, 0.88; 95% CI, 0.71-1.09). There was no significant association between critical illness events on different wards within the same hospital. Conclusions and Relevance Findings of this cohort study suggest that patients are more likely to be transferred to the ICU in the hours after another patient's critical illness event on the same ward. This phenomenon could have several explanations, including increased recognition of critical illness and preemptive ICU transfers, resource diversion to the first event, or fluctuations in ward or ICU capacity. Patient safety may be improved by better understanding the clustering of ICU transfers on medical wards.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Enfermedad Crítica
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Unidades de Cuidados Intensivos
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
JAMA Intern Med
Año:
2023
Tipo del documento:
Article
País de afiliación:
Canadá