Abstract 301: Identifying Critical Care Unit Organizational Factors That Impact Cardiac Arrest Incidence and Outcomes: A Report From the Pediatric Cardiac Critical Care Consortium

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Javier J Lasa ◽  
Jeffrey A Alten ◽  
Mousumi Banerjee ◽  
Wenying Zhang ◽  
Kurt Schumacher ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Critical Care Unit ◽  
Organizational Factors ◽  
Full Time ◽  
Provider Education ◽  
Multinomial Regression ◽  
Clinical Registry ◽  
The Impact ◽  
Cardiac Critical Care

Introduction: Patient factors leading to cardiac arrest (CA) in the pediatric cardiac critical care unit (CICU) are well understood, but may be unmodifiable. Our understanding of the impact of CICU organizational factors (OFs) such as staffing models, health care provider education, and CICU bed management is limited. The association between these potentially modifiable CICU OFs on CA prevention and rescue outcomes is unknown. Hypothesis: CICU OFs associate with CA prevention and rescue. Methods: Retrospective analysis of Pediatric Cardiac Critical Care Consortium (PC4) clinical registry including data for all patients admitted to CICUs from August 2014 to March 2019. Prevention was defined as the prevalence of subjects not suffering CA. Rescue was defined as survival after CA. CICU OFs were captured via questionnaire distributed to PC4 participants in 2017 (100% response). Stratified, multivariable regression was used to evaluate associations between OFs and outcome in medical and surgical admission subgroups: competing time-to-events framework (to assess prevention) and multinomial regression (to assess rescue), accounting for clustering of patients within hospitals. Results: We analyzed 54,521 CICU admissions (59% surgical, 41% medical) from 29 hospitals with 1398 CA events (2.5%). We studied 12 OFs that varied across centers after accounting for collinearity. For both surgical and medical admissions, lower average daily occupancy (<80%) was associated with better arrest prevention for all admissions, and better rescue in the surgical cohort. Increased proportion of nurses with >2 years experience, increased proportion of nurses with critical care certification, % of full-time intensivists, % of intensivists with critical care training, dedicated respiratory therapists, quality/safety resources, and annual CICU admission volume were not associated with improved prevention or rescue. Conclusion: Our multi-institutional analysis suggests that lower average CICU occupancy was the only consistent OF evaluated that was associated with CA prevention and rescue. CICUs that have average daily occupancy >80% may need specific strategies to mitigate the risks of CA.

Workforce demographics and unit structure in paediatric cardiac critical care in the United States

2021 ◽  
pp. 1-5
Author(s):  
Robin V. Horak ◽  
Shasha Bai ◽  
Bradley S. Marino ◽  
David K. Werho ◽  
Leslie A. Rhodes ◽  
...  
Keyword(s):  
United States ◽  
Critical Care ◽  
Heart Surgery ◽  
Age Groups ◽  
The United States ◽  
Work Hours ◽  
Full Time ◽  
Full Time Equivalent ◽  
Unit Structure ◽  
Cardiac Critical Care

Abstract Objective: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. Design: REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. Measurements and main results: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). Conclusions: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

The Relationship of Caregiving to Work Conflict and Supervisor Disclosure With Emotional, Physical, and Financial Strain in Employed Family Caregivers

2019 ◽  
Vol 32 (7-8) ◽  
pp. 698-707
Author(s):  
Maureen E. Templeman ◽  
Adrian N. S. Badana ◽  
William E. Haley
Keyword(s):  
Organizational Factors ◽  
The United States ◽  
Ordinary Least Squares ◽  
Population Based ◽  
Financial Strain ◽  
Hierarchical Regression ◽  
Full Time ◽  
Work Conflict ◽  
Workplace Policies ◽  
The Impact

Objective: To determine whether employed family caregiver reports of caregiving to work conflict (CWC) are associated with emotional, physical, and financial strain, and whether organizational factors, including supervisor disclosure and caregiver-friendly workplace policies, attenuate these effects. Method: We examined 369 full-time employed caregivers of adults aged 50 years and above from the 2015 AARP and National Alliance for Caregiving population-based study, Caregiving in the United States, using ordinary least squares hierarchical regression and moderation analyses. Results: Regression analyses showed that caregiver reports of more CWC, in addition to disclosure of caregiving, were associated with greater emotional, physical, and financial strain after controlling for demographics and caregiving stressors, and workplace policies did not attenuate strain. Neither disclosure nor policies moderated the impact of CWC on caregiver strain. Discussion: Results suggest the importance of workplace strain in the caregiving stress process and suggest that disclosing caregiving responsibilities to supervisors should be closely examined.

scholarly journals The impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest

Resuscitation ◽  
2015 ◽  
Vol 96 ◽  
pp. 46
Author(s):  
Johannes von Vopelius-Feldt ◽  
Archibald Coulter ◽  
Jonathan Benger
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Care Team ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Critical Care Team

scholarly journals The impact of an obstetrician-led, labor ward critical care unit: A prospective comparison of outcomes before and after establishment

2019 ◽  
Vol 13 (3) ◽  
pp. 132-136
Author(s):  
Eduard J Langenegger ◽  
DR Hall ◽  
F Mattheyse ◽  
J Harvey
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Maternal Morbidity ◽  
Prospective Comparison ◽  
Labor Ward ◽  
Evaluation Scores ◽  
Maternal Morbidity And Mortality ◽  
Before And After ◽  
One Year ◽  
The Impact

Objective To investigate the outcomes of critically ill obstetric patients managed in a obstetric critical care unit in South Africa. Methods Patients with severe maternal morbidity managed in the labor ward of Tygerberg Hospital were studied over three months before the establishment of the obstetrician-led obstetric critical care unit. One year later, patients managed in the obstetric critical care unit were studied using the same methods. The primary outcome measures were maternal morbidity and mortality. Results In the before-obstetric critical care unit prospective audit 63 patients met criteria for obstetric critical care. During the second period 60 patients were admitted to the obstetric critical care unit. There were no significant differences between the groups in baseline characteristics, admission indications or Acute Physiology and Chronic Health Evaluation scores. Continuous positive airway pressure ( p < 0.01) was utilized more in the second group. Seven deaths occurred in the first, but none in the second group ( p = 0.01). Conclusion The establishment of an obstetrician-led obstetric critical care unit facilitated a decrease in maternal mortality. Trial registration: Not applicable.

Abstract 3: Impact Of Transport To Critical Care Centers Vs. Non-critical Care Hospitals On Outcomes From Out-of-hospital Cardiac Arrest In Osaka, Japan

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kentaro Kajino ◽  
Taku Iwami ◽  
Mohamud Daya ◽  
Naohiro Yonemoto ◽  
Tatuya Nishiuchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Coronary Intervention ◽  
Primary Outcome Measure ◽  
Confounding Variables ◽  
Significant Difference ◽  
Stratified Analysis ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Better Than

Background: Recent studies suggest that specialized hospital care including hypothermia and early percutaneous coronary intervention (PCI) influences the outcome of out-of -hospital cardiac arrest (OHCA) patients. In Japan, selected hospitals are certificated as “Critical Care Centers (CCC)” based on their expertise and ability to provide these higher levels of care. We hypothesized that the outcomes of patients with OHCA who were transported to CCC is better than if they were transported to non-critical care hospitals (NCCH) in Osaka, Japan. Materials and Methods: All adults with OHCA of presumed cardiac etiology, treated by the emergency medical services (EMS) systems, and transported to a hospital in Osaka, Japan from January 1, 2005 to December 31, 2006 were studied using a prospective Utstein style population cohort database. Primary outcome measure was one month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCC were compared to patients transported to NCCH using multiple logistic regression to adjust for the following confounding variables; gender, age, witnessed status, bystander CPR, location, transport time and initial rhythm. We also performed a stratified analysis based on whether the patients achieved ROSC prior to arrival at the hospital. Results: Of 6,943 OHCA of presumed cardiac etiology, 6,706 cases were transported. Of these, 1,780 were transported to CCC while 4,926 were transported to NCCH. Neurologically favorable survival at one-month was greater in the CCC group [103 (5.8 %) versus 119 (2.4 %), p < 0.001]. Transportation to CCC was a significant predictor [OR = 1.7, 95% CI interval (1.3 – 2.4)] of neurologically favorable survival after adjustment for confounding variables. In the stratified analysis, the impact of the CCC was not significant difference in patients transported after field ROSC. [OR = 1.4, 95% CI interval (0.92 – 2.22)] On the other hand, the impact of the CCC was even greater in patients transported prior to field ROSC. [OR = 2.4, 95% CI interval (1.3 – 4.5)] Conclusions: The outcomes of patients with OHCA with or without field ROSC who were transported to Critical Care Centers was better than if they were transported to Non-Critical Care Hospitals.

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