Resuscitation Resident Impact in the Treatment of Sepsis

Burla, Michael J.; Shinthia, Nashid; Boura, Judith; Qu, Lihua; Berger, David

doi:10.7759/cureus.9257

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…Prior work done assessing RR impact has reported improvement in initiating TTM in OHCA [ 13 ]. The RR has also demonstrated an impact in care not related to OHCA, such as improved compliance on sepsis bundle orders and facilitating care of septic shock patients [ 14 ],…”

Section: Discussionmentioning

confidence: 99%

The Effect of Resuscitation Residents on the Duration of Pre-induction of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest

Wloszczynski¹,

Berger²,

Lee³

et al. 2022

Cureus

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Background The Resuscitation Rotation is a novel second-year emergency medicine rotation focusing on the highest acuity patients, including out-of-hospital cardiac arrest (OHCA). The resuscitation resident (RR) functions as an extra physician during resuscitation and post return of spontaneous circulation (ROSC). The objective of this study is to examine if the presence of a RR decreases the pre-induction interval of targeted temperature management (TTM) for patients following OHCA. Methods A retrospective study was conducted at a tertiary care level 1 trauma center with an annual ED census of 127,323 visits in 2019. We retrospectively reviewed consecutive OHCA patients from September 1, 2014, to July 20, 2020, who underwent TTM. Patients were identified as cases with or without a RR. Clinical characteristics were summarized by the status of RR involvement and compared by using t-test and χ 2 test for continuous and categorical variables, respectively. All tests with p < 0.05 were considered to indicate statistical significance. Results Our study population identified 198 adult OHCA patients that underwent TTM from 2014-2020. There were exclusions for missing TTM start time and for missing patient characteristics leaving 176 for final analysis, of which 55 (33.3%) had RR involvement. The mean time (hours) to TTM initiation (ie, the pre-induction phase) for patients involving the RR versus those without was not statistically significant (3.11 vs 3.34, p=0.39). Linear regression analysis indicates that the adjusted effect of RR involvement was not associated with the mean hours of pre-induction (p=0.47). Conclusion There is no statistically significant association of a RR on the duration of the pre-induction phase. Limitations include that both arms had prolonged pre-induction phases. This may represent a non-optimized TTM protocol. Future work will aim to use the RR to improve our pre-induction phase.

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Section: Discussionmentioning

confidence: 99%

The Effect of Resuscitation Residents on the Duration of Pre-induction of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest

Wloszczynski¹,

Berger²,

Lee³

et al. 2022

Cureus

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“…The deployment of sepsis bundles, assessing compliance, and public reporting have been reported to reduce the length of stay and risk-adjusted mortality [ 14 , 15 ]. Additional studies have evaluated the impact of dedicated staffing [ 16 ], electronic medical record alerts [ 17 , 18 ], and other machine-learning-driven research [ 19 ] on sepsis metrics.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Urosepsis and Abdominal Imaging

Siddiqui¹,

Abuelroos²,

Qu³

et al. 2021

Cureus

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IntroductionInsufficient attention has been directed towards urosepsis. Notably, no protocols or clinical decision rules currently exist outlining the appropriate use of imaging in uroseptic patients. The primary objective of our study was to retrospectively evaluate uroseptic emergency department (ED) patients who underwent abdominal imaging, to report the proportion of patients with imaging findings necessitating emergent surgical consultation. MethodsWe retrospectively identified 1142 patients ≥ 18 years of age that presented to the ED from January 2009 to December 2012 with ICD9 code indicative of urosepsis. All included patients underwent ED-ordered abdominal computerized tomography (CT) or retroperitoneal ultrasound (US). Imaging and urinalysis (UA) results were categorized. We report proportions with odds ratios and 95% confidence intervals. ResultsOf 1142 patients, we excluded 80 for neg UA, 167 for < 2 SIRS (systemic inflammatory response syndrome), 320 for positive blood cultures, and 37 for incomplete data. This yielded 538 patients which the authors reviewed the results of the CT or US to determine the proportion who required emergent surgical consultation and who underwent surgical or interventional procedure. There were 243 (45%) that had CT or US results that necessitated emergency surgical consultation, of those 180 (33%) underwent surgical or interventional procedure. Similar rates of emergency surgical consultation occurred when sub-divided by positive versus equivocal UA, with 43% and 47%, respectively. ConclusionsForty-five percent of our abdominally imaged urosepsis cohort had imaging findings that necessitated emergent surgical consultation, with a similar proportion in the subset with positive versus equivocal UA. The utility of abdominal imaging in this population should be studied prospectively.

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“…Andersen et al [222], 2015; Barclay et al [223], 2019; Behnke et al [224], 2023; Javier-DesLoges et al [225], 2019; Katzan et al [226], 2015; Muñoz et al [227], 2018; Noshad et al [228], 2022; Ter-Minassian et al [229], 2019; van den Broek et al [230], 2021 Adult Bajracharya et al [231], 2021; Burla et al [232], 2020; Flatow et al [1], 2015; Hensley et al [233], 2019; Kim [234], 2020; Nagi et al [235], 2023; Weng et al [236], 2021; Wu et al [237], 2014; Wyatt et al [238], 2021…”

Section: Quality Improvementmentioning

confidence: 99%

Use of Epic Electronic Health Record System for Health Care Research: Scoping Review

Chishtie,

Sapiro,

Wiebe

et al. 2023

J Med Internet Res

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Background Electronic health records (EHRs) enable health data exchange across interconnected systems from varied settings. Epic is among the 5 leading EHR providers and is the most adopted EHR system across the globe. Despite its global reach, there is a gap in the literature detailing how EHR systems such as Epic have been used for health care research. Objective The objective of this scoping review is to synthesize the available literature on use cases of the Epic EHR for research in various areas of clinical and health sciences. Methods We used established scoping review methods and searched 9 major information repositories, including databases and gray literature sources. To categorize the research data, we developed detailed criteria for 5 major research domains to present the results. Results We present a comprehensive picture of the method types in 5 research domains. A total of 4669 articles were screened by 2 independent reviewers at each stage, while 206 articles were abstracted. Most studies were from the United States, with a sharp increase in volume from the year 2015 onwards. Most articles focused on clinical care, health services research and clinical decision support. Among research designs, most studies used longitudinal designs, followed by interventional studies implemented at single sites in adult populations. Important facilitators and barriers to the use of Epic and EHRs in general were identified. Important lessons to the use of Epic and other EHRs for research purposes were also synthesized. Conclusions The Epic EHR provides a wide variety of functions that are helpful toward research in several domains, including clinical and population health, quality improvement, and the development of clinical decision support tools. As Epic is reported to be the most globally adopted EHR, researchers can take advantage of its various system features, including pooled data, integration of modules and developing decision support tools. Such research opportunities afforded by the system can contribute to improving quality of care, building health system efficiencies, and conducting population-level studies. Although this review is limited to the Epic EHR system, the larger lessons are generalizable to other EHRs.

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Resuscitation Resident Impact in the Treatment of Sepsis

Abstract: Burla et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 3 publications

References 23 publications

The Effect of Resuscitation Residents on the Duration of Pre-induction of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest

The Effect of Resuscitation Residents on the Duration of Pre-induction of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest

Emergency Department Urosepsis and Abdominal Imaging

Use of Epic Electronic Health Record System for Health Care Research: Scoping Review

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