Abstract:
OBJECTIVES:To evaluate the impact of a comprehensive unit-based safety program on safety climate in a large cohort of intensive care units participating in the Keystone intensive care unit project. DESIGN/SETTING:A prospective cohort collaborative study to improve quality of care and safety culture by implementing and evaluating patient safety interventions in intensive care units predominantly in the state of Michigan. INTERVENTIONS:The comprehensive unit-based safety program was the first intervention implemented by every intensive care unit participating in the collaborative. It is specifically designed to improve the various elements of a unit's safety culture, such as teamwork and safety climate. We administered the validated Safety Attitudes Questionnaire at baseline (2004) and after 2 yrs of exposure to the safety program (2006) to assess improvement. The safety climate domain on the survey includes seven items. MEASUREMENTS AND MAIN RESULTS:Post-safety climate scores for intensive care units. To interpret results, a score of <60% was in the "needs improvement" zone and a ≥10-point discrepancy in pre-post scores was needed to describe a difference. Hospital bed size, teaching status, and faith-based status were included in our analyses. Seventy-one intensive care units returned surveys in 2004 and 2006 with 71% and 73% response rates, respectively. Overall mean safety climate scores significantly improved from 42.5% (2004) to 52.2% (2006), t = -6.21, p < .001, with scores higher in faith-based intensive care units and smaller-bed-size hospitals. In 2004, 87% of intensive care units were in the "needs improvement" range and in 2006, 47% were in this range or did not score ≥10 points or higher. Five of seven safety climate items significantly improved from 2004 to 2006. CONCLUSIONS:A patient safety program designed to improve teamwork and culture was associated with significant improvements in overall mean safety climate scores in a large cohort of 71 intensive care units. Research linking improved climate scores and clinical outcomes is a critical next step.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Sexton JB,Berenholtz SM,Goeschel CA,Watson SR,Holzmueller CG,Thompson DA,Hyzy RC,Marsteller JA,Schumacher K,Pronovost PJdoi
10.1097/CCM.0b013e318206d26csubject
Has Abstractpub_date
2011-05-01 00:00:00pages
934-9issue
5eissn
0090-3493issn
1530-0293journal_volume
39pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To assess the statistical association of the Acute Physiology and Chronic Health Evaluation (APACHE II) score with multiple intervention and outcome variables in surgical ICU patients. DESIGN:Continuous data collection on every patient admitted to the surgical ICU for a 21-month period. MATERIALS AND METHOD...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199108000-00013
更新日期:1991-08-01 00:00:00
abstract:OBJECTIVE:Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB). DESIGN:Prospective, randomized, experimental, controlled,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00021
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVES:To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. DATA SOURCES:Systematic searches were conducted in November 2016 using five electronic databases: Medline,...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000002691
更新日期:2017-11-01 00:00:00
abstract::The effect of positive-pressure ventilation (PPV) with PEEP on the release of alpha-atrial natriuretic peptide (ANP) was investigated in both humans and an experimental model. In the human study, systemic artery blood samples from 22 critically ill patients were analyzed for ANP. Seventeen of these patients received P...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199008000-00007
更新日期:1990-08-01 00:00:00
abstract:OBJECTIVES:Bag-mask ventilation is commonly used prior to tracheal intubation; however, the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children are not well studied. This study aims to describe prevalence and risk factors for pediatric difficult bag-mask...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004425
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:To determine whether neutrophil depletion could eradicate intestinal bacterial translocation in bum-injured rats. DESIGN:Prospective, randomized, controlled study. SETTING:University research laboratory. SUBJECTS:Adult male Sprague-Dawley rats. INTERVENTIONS:The rats were intravenously administered a rabb...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200005000-00048
更新日期:2000-05-01 00:00:00
abstract:OBJECTIVES:To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN:Clinimetric analysis. SETTINGS:Five international datasets from the United States, Australia, and Brazil. PA...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001949
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Increased intracranial pressure (ICP) worsens the outcome of acute liver failure (ALF). This study investigates the underlying pathophysiological mechanisms and evaluates the therapeutic effect of albumin dialysis in ALF with use of the Molecular Adsorbents Recirculating System without hemofiltration/dialysi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000196203.39832.3c
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that therapeutic hypercapnia enhances the proinflammatory responses to endotoxemia in the lung and spleen of rats. DESIGN:Prospective randomized study. SETTINGS:Hospital research institute. SUBJECTS:Forty-eight adult male rats. INTERVENTIONS:Rats were randomly assigned for a 24-hr p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820ee1f2
更新日期:2011-06-01 00:00:00
abstract::The relationship between oxygen uptake (Vo2) and delivery (Do2) was examined in 64 patients immediately after cardiopulmonary bypass. In 44 patients with lactate levels below 2.5 mmol/L, Vo2 decreased proportionally when Do2 decreased below 300 ml/min X m2. At a Do2 over this level, Vo2 plateaued at 105 +/- 13 (SD) ml...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198703000-00002
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVE:Cytomegalovirus reactivation may complicate critical illness in latent carriers of the virus, even in patients who were previously immunocompetent. Patients with acute respiratory distress syndrome are considered to be prone for reactivation. Prophylactic antiviral therapy in immunocompetent cytomegalovirus s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000712
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. DATA SOURCES:Patient medical records. STUDY SELECTION:Not applicable. DATA EXTRACTION:Not applicable. DATA SYNTHESIS:No...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000935
更新日期:2015-06-01 00:00:00
abstract::The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000252917.25301.18
更新日期:2007-02-01 00:00:00
abstract::A high rate of death from septic shock persists despite general improvements in care. The relative failure of mechanistically based therapies in various clinical trials should also trigger a reconsideration of such mechanistic approaches. Despite reversion of shock by hydrocortisone, the similar death rate compared wi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181f23dc4
更新日期:2010-10-01 00:00:00
abstract::Sixty-four (48%) of 133 children with hematologic malignancy who were admitted to three pediatric ICUs died. Children who required management because of airway obstruction or after general anesthesia had the best outlook (mortality rate of 7% or less); those children who required major circulatory support or mechanica...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198808000-00005
更新日期:1988-08-01 00:00:00
abstract::Although systolic dysfunction of the left ventricle has been characterized in septic shock (SS) and sepsis without shock (SWS), diastolic abnormalities are less well characterized. Diastolic filling was determined using pulsed Doppler transmitral spectral tracings in 13 patients with SS, ten patients with SWS, and 33 ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199007000-00005
更新日期:1990-07-01 00:00:00
abstract::During the control period in this study, small premature infants, 1500 g in birth weight, had insensible water loss (IWL) of 2.28 g/kg/hr (equivlaent to 54 ml/kg/day), which is considerably higher than in full term infants. Under phototherapy, there was a significant increase in IWL (3.14 g/kg/hr) associated with incr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197511000-00006
更新日期:1975-11-01 00:00:00
abstract:OBJECTIVE:To characterize the withholding or withdrawing of life support from patients with severe head injury. SETTING:San Francisco General Hospital, a city and county hospital with a Level I trauma center. DESIGN:A standardized questionnaire was used to collect data on demographics and functional outcome of severe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199509000-00018
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:Intensive care unit (ICU) length of stay (LOS) and hospital LOS are common indices used to compare performance of hospitals and are yardsticks used in efforts to contain costs, yet there is no standardized method of quantitating this outcome variable. Attempts have been made to correct LOS according to diseas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00071
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVES:To define the features of human amniotic mesenchymal stromal cell secretome and its protective properties in experimental models of acute brain injury. DESIGN:Prospective experimental study. SETTING:Laboratory research. SUBJECTS:C57Bl/6 mice. INTERVENTIONS:Mice subjected to sham or traumatic brain injury...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001864
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVES:To measure the impact of staged implementation of full versus partial ABCDE bundle on mechanical ventilation duration, ICU and hospital lengths of stay, and cost. DESIGN:Prospective cohort study. SETTING:Two medical ICUs within Montefiore Healthcare Center (Bronx, NY). PATIENTS:One thousand eight hundred ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003765
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:To describe a severe axonal polyneuropathy that follows acute respiratory failure and, in turn, causes continued ventilator dependence and paralysis after resolution of the primary illness. DESIGN:Retrospective chart review of three patients and prospective analysis of two patients. SETTING:Respiratory and ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199302000-00020
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVES:Neurologic damage following cardiac arrest remains a major burden for modern resuscitation medicine. Cardiopulmonary resuscitation with extracorporeal circulatory support holds the potential to reduce morbidity and mortality. Furthermore, the endogenous gasotransmitter carbon monoxide attracts attention in r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004242
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:Our goal was to demonstrate explicitly that lower-frequency positive-pressure ventilation not only preserves adequate oxygenation and acid-base status in hemorrhagic states, but also that "normal" or higher respiratory rates significantly compromise hemodynamics, even with moderate degrees of hemorrhage. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000134264.88332.37
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVE:To investigate the mechanism by which methylprednisolone protects the liver from hypoxia-induced injury. DESIGN:Prospective control study using the isolated rat liver. SETTING:Animal research facility. SUBJECTS:Male, fasted, pathogen-free Sprague-Dawley rats. INTERVENTIONS:Low-flow hypoxia was produced by...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000066176.49774.CC
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. DESIGN:Retrospective chart review. SETTING:A 600-bed...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199207000-00011
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVES:Case fatality in pregnancy-associated severe sepsis or septic shock appears reduced compared with nonpregnant women with severe sepsis or septic shock. It remains unclear if this difference is due to pregnancy or better baseline health status, among others. Our study compared adverse outcomes of pregnancy-as...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003348
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVES:To show that subjective estimate of patient's condition is related to objective cognitive and functional outcome in cardiac arrest survivors. DESIGN:Longitudinal cohort study. SETTING:ICU and Neuropsychology Service in two hospitals in Switzerland. PATIENTS:Fifty survivors included from a prospective coho...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002946
更新日期:2018-04-01 00:00:00
abstract::Changes in pulmonary function and the development of atelectasis in the postoperative period have been well documented in the adult population. The use of incentive spirometry has been shown to be effective in the prevention of these postoperative complications. At the Hospital of Sick Children, we studied 17 children...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198208000-00009
更新日期:1982-08-01 00:00:00
abstract::Bacterial translocation and ileal and cecal injury have been shown to occur 24 h after limited periods of hemorrhagic shock. The present studies were performed to determine the temporal sequence of mucosal injury, permeability, and bacterial translocation after hemorrhagic shock. The results indicated that bacterial t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199005000-00014
更新日期:1990-05-01 00:00:00