Evidence map›Paper›PMID 28810207›Full record

ArticleJournal of critical care2017

Intermediate care to intensive care triage: A quality improvement project to reduce mortality.

David N Hager, Pranav Chandrashekar, Robert W Bradsher, Ali M Abdel-Halim, Souvik Chatterjee, Melinda Sawyer, Roy G Brower, Dale M Needham

Abstract read
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In one paragraph

Article in Journal of critical care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

David N HagerDivision of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States. Electronic address: dhager1@jhmi.edu.
Pranav ChandrashekarDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.
Robert W BradsherDepartment of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, United States. Electronic address: bradsher@uthsc.edu.
Ali M Abdel-HalimDivision of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States. Electronic address: alihalim95@ufl.edu.
Souvik ChatterjeeCritical Care Medicine Department, Clinical Center, National Institutes of Health Clinical Center, Bethesda, MD, United States. Electronic address: schatte6@jhmi.edu.
Melinda SawyerArmstrong Institute for Patient Safety, John Hopkins University, Baltimore, MD, United States. Electronic address: msawyer1@jhmi.edu.
Roy G BrowerDivision of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States. Electronic address: rbrower@jhmi.edu.
Dale M NeedhamDivision of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, United States; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, United States. Electronic address: dale.needham@jhmi.edu.

Funding

Short-Term Training Program to Increase Diversity in Health-Related ResearchR25HL084762 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI DAMARLA, MAHENDRA, SHIMODA, LARISSA A. · 2006 to 2024
$2.1M
NHLBI NIH HHS R25 HL084762
6 · The paper itself

Abstract

purposeMedical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur.

methodsTo improve our triage process, we used a 4Es quality improvement framework (engage, educate, execute, evaluate) to (1) educate residents and fellows regarding principles of triage and (2) facilitate real-time communication between MICU residents conducting triage and supervising physicians.

resultsAmong patients transferred from the IMCU to the MICU during baseline (n=83;July-December 2012) and intervention phases (n=94;July-December 2013), unadjusted mortality decreased from 34% to 21% (p=0.06). After adjusting for severity of illness, admitting diagnosis, and bed availability, the odds of death were lower during the intervention vs. baseline phase (OR 0.33; 95%CI 0.11-0.98).

conclusionsUsing a structured quality improvement process targeting triage education and increased resident/supervisor communication, we demonstrated reduced mortality among patients transferred from the IMCU to the MICU.

Indexed as

Patient TransferQuality ImprovementAdultAgedAPACHEBaltimoreCritical CareCritical IllnessFemaleHospital MortalityHospitals, UniversityHumansIntensive Care UnitsMaleMiddle AgedSimplified Acute Physiology ScoreCommunicationCritical careInternship and residencyMedical educationPatient safetySupervisionTriage

Identifiers

PMID28810207
PMCPMC5733724

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.