Effects of pain, sedation and delirium monitoring on clinical and economic outcome: A retrospective study

Abstract

Background Significant improvements in clinical outcome can be achieved by implementing effective strategies to optimise pain management, reduce sedative exposure, and prevent and treat delirium in ICU patients. One important strategy is the monitoring of pain, agitation and delirium (PAD bundle). We hypothesised that there is no sufficient financial benefit to implement a monitoring strategy in a Diagnosis Related Group (DRG)-based reimbursement system, therefore we expected better clinical and decreased economic outcome for monitored patients. Methods This is a retrospective observational study using routinely collected data. We used univariate and multiple linear analysis, machine-learning analysis and a novel correlation statistic (maximal information coefficient) to explore the association between monitoring adherence and resulting clinical and economic outcome. For univariate analysis we split patients in an adherence achieved and an adherence non-achieved group. Results In total 1,323 adult patients from two campuses of a German tertiary medical centre, who spent at least one day in the ICU between admission and discharge between 1. January 2016 and 31. December 2016. Adherence to PAD monitoring was associated with shorter hospital LoS (e.g. pain monitoring 13 vs. 10 days; p<0.001), ICU LoS, duration of mechanical ventilation shown by univariate analysis. Despite the improved clinical outcome, adherence to PAD elements was associated with a decreased case mix per day and profit per day

Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature

“…Out of the total of 27 studies that were identified for the topic of pain, 14 used a prospective cohort design, 197 198 199 200 201 202 203 204 205 206 207 208 209 210 11 used an observational design, 200 204 205 207 210 211 212 213 214 215 216 6 used a retrospective cohort design, 211 214 215 217 218 219 4 used a randomized control trial, 201 212 220 221 1 used a cross-sectional design, 222 and 1 used mixed methods. 223 Most studies used questionnaire/survey data, but eight used administrative databases, 206 207 208 210 212 220 221 222 seven used mobile devices/sensors, 200 203 204 205 210 216 220 and four used a data warehouse or registry.…”

“…223 Most studies used questionnaire/survey data, but eight used administrative databases, 206 207 208 210 212 220 221 222 seven used mobile devices/sensors, 200 203 204 205 210 216 220 and four used a data warehouse or registry. 198 203 208 214 Study populations were mostly done with adults in the outpatient setting but four were inpatient 197 201 211 223 and one was done with a pediatric population. 205 Although many studies were conducted in the United States, others included China, 213 214 215 222 Australia, 207 Canada, 202 the Netherlands, 199 212 Germany, 208 210 211 Norway, 201 Finland, 204 South Korea, 203 Argentina, 219 Portugal, 197 Japan, 209 and Spain.…”

“…198 203 208 214 Study populations were mostly done with adults in the outpatient setting but four were inpatient 197 201 211 223 and one was done with a pediatric population. 205 Although many studies were conducted in the United States, others included China, 213 214 215 222 Australia, 207 Canada, 202 the Netherlands, 199 212 Germany, 208 210 211 Norway, 201 Finland, 204 South Korea, 203 Argentina, 219 Portugal, 197 Japan, 209 and Spain. 206 Sample sizes ranged from 10 to 6,316 observations.…”

“…205 213 215 220 Other outcomes focused on pain as a predictor of anxiety and depression, coronary heart disease, 199 health status, 218 noncancer pain as predictor of brain aging, 208 and length of stay. 211 For patients with low back pain, societal cost, 212 and clinical and sociodemographic predictors of increased disability 221 have been studied. Some outcomes focused on the data science method as a clinical tool such as NLP of pain context from clinical notes.…”

Adult sedation and analgesia in a resource limited intensive care unit – A Systematic Review and evidence based guideline

“…With regard to sedation in the ICU, it is important to note that the treatment of mechanically ventilated patients under the heading of sedation must first understand the need for adequate regulation of pain. Pain is a condition mostly encountered by critically ill patients [ 38 ]. Pain can be experienced as a consequence of intubation and mechanical ventilation itself, or it can be a consequence of other routine clinical care such as moving a patient in bed or adjusting tubes and lines.…”