Background Previous research investigating the impact of delayed intensive care unit (ICU) transfer on outcomes has utilized subjective criteria for defining critical illness. Objective To investigate the impact of delayed ICU transfer using the electronic Cardiac Arrest Risk Triage (eCART) score, a previously published early warning score, as an objective marker of critical illness. Design Observational cohort study Setting Medical-surgical wards at five hospitals between November 2008 and January 2013 Patients Ward patients Intervention None Measurements eCART scores were calculated for all patients, and the threshold with a specificity of 95% for ICU transfer (eCART >=60) denoted critical illness. A logistic regression model adjusting for age, sex, and surgical status was used to calculate the association between time to ICU transfer from first critical eCART value and in-hospital mortality. Results A total of 3,789 patients met the critical eCART threshold before ICU transfer, and median time to ICU transfer was 5.4 hours. Delayed transfer (>6 hours) occurred in 46% of patients (n=1,734) and was associated with increased mortality compared to patients transferred early (33.2% vs. 24.5%, p<0.001). Each one-hour increase in delay was associated with an adjusted 3% increase in odds of mortality (p<0.001). In patients who survived to discharge, delayed transfer was associated with longer hospital length of stay (median 13 vs. 11 days, p<0.001). Conclusions Delayed ICU transfer is associated with increased hospital length of stay and mortality. Use of an evidence-based early warning score, such as eCART, could lead to timely ICU transfer and reduced preventable death.

Purpose: To identify specific components of ICU clinician supportive care and communication that are associated with increased post-traumatic stress disorder (PTSD) symptoms for surrogate decision makers of patients with chronic critical illness (CCI). Methods: We conducted a secondary analysis of data from a randomized controlled trial of palliative care-led meetings to provide information and support for CCI surrogates. The primary outcome for this secondary analysis was PTSD symptoms at 90 days, measured by the Impact of Event Scale-Revised (IES-R). Caregiver perceptions of clinician support and communication were assessed using a version of the After-Death Bereaved Family Member Interview (ADBFMI)

Purpose To obtain information on how family visitor restriction during the COVID-19 pandemic has impacted the workplace experience of physicians and nurses in the medical intensive care unit, and to assess differences by profession. Materials and methods We developed a survey containing closed- and open-ended questions, applying both quantitative and qualitative analyses to our results. Results Of the 74 respondents, 29 (38%) were nurses and 45 (62%) were physicians. Nurses reported positive changes to daily workflow and the ability to provide medical care, while physicians reported negative changes in these areas. Both groups reported decreased comprehension and increased distress among families, and decreased ability to provide end-of-life care. For the qualitative analysis, eight themes were identified: the patient’s room as space, creation of a new space through virtual communication, time, increased complexity of care, challenges around the use of technology, adjustments to team roles and responsibilities, desire for families to return, and internal tension. Conclusion Intensive care physicians and nurses reported both positive and negative effects of family visitor restriction during the COVID-19 pandemic, with significant differences based on profession. Both groups expressed concern for an overall negative impact of visitor restriction on healthcare workers, patients, and their families.

Among surrogate decision-makers for chronically critically ill patients, high anxiety and depression scores and patient unresponsiveness on or near Day 10 of mechanical ventilation are risk factors for PTSD symptoms at 90 days.

No abstract