دورية أكاديمية
Temporal Clustering of Critical Illness Events on Medical Wards.
| العنوان: | Temporal Clustering of Critical Illness Events on Medical Wards. |
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| المؤلفون: | Doshi S; General Internal Medicine and Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Shin S; Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Lapointe-Shaw L; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Department of Medicine, University Health Network, Toronto, Ontario, Canada., Fowler RA; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Fralick M; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Medicine, Sinai Health System, Toronto, Ontario, Canada., Kwan JL; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Medicine, Sinai Health System, Toronto, Ontario, Canada., Shojania KG; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Tang T; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Institute of Better Health, Trillium Health Partners, Mississauga, Ontario, Canada., Razak F; General Internal Medicine and Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada., Verma AA; General Internal Medicine and Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. |
| المصدر: | JAMA internal medicine [JAMA Intern Med] 2023 Sep 01; Vol. 183 (9), pp. 924-932. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101589534 Publication Model: Print Cited Medium: Internet ISSN: 2168-6114 (Electronic) Linking ISSN: 21686106 NLM ISO Abbreviation: JAMA Intern Med Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, IL : American Medical Association, [2013]- |
| مواضيع طبية MeSH: | Critical Illness*/therapy , Critical Illness*/mortality , Intensive Care Units*, Humans ; Male ; Aged ; Female ; Cohort Studies ; Retrospective Studies ; Hospital Mortality ; Hospitals ; Cluster Analysis |
| مستخلص: | Importance: Recognizing and preventing patient deterioration is important for hospital safety. Objective: To investigate whether critical illness events (in-hospital death or intensive care unit [ICU] transfer) are associated with greater risk of subsequent critical illness events for other patients on the same medical ward. Design, Setting, and Participants: Retrospective cohort study in 5 hospitals in Toronto, Canada, including 118 529 hospitalizations. Patients were admitted to general internal medicine wards between April 1, 2010, and October 31, 2017. Data were analyzed between January 1, 2020, and April 10, 2023. Exposures: Critical illness events (in-hospital death or ICU transfer). Main Outcomes and Measures: The primary outcome was the composite of in-hospital death or ICU transfer. The association between critical illness events on the same ward across 6-hour intervals was studied using discrete-time survival analysis, adjusting for patient and situational factors. The association between critical illness events on different comparable wards in the same hospital was measured as a negative control. Results: The cohort included 118 529 hospitalizations (median age, 72 years [IQR, 56-83 years]; 50.7% male). Death or ICU transfer occurred in 8785 hospitalizations (7.4%). Patients were more likely to experience the primary outcome after exposure to 1 prior event (adjusted odds ratio [AOR], 1.39; 95% CI, 1.30-1.48) and more than 1 prior event (AOR, 1.49; 95% CI, 1.33-1.68) in the prior 6-hour interval compared with no exposure. The exposure was associated with increased odds of subsequent ICU transfer (1 event: AOR, 1.67; 95% CI, 1.54-1.81; >1 event: AOR, 2.05; 95% CI, 1.79-2.36) but not death alone (1 event: AOR, 1.08; 95% CI, 0.97-1.19; >1 event: AOR, 0.88; 95% CI, 0.71-1.09). There was no significant association between critical illness events on different wards within the same hospital. Conclusions and Relevance: Findings of this cohort study suggest that patients are more likely to be transferred to the ICU in the hours after another patient's critical illness event on the same ward. This phenomenon could have several explanations, including increased recognition of critical illness and preemptive ICU transfers, resource diversion to the first event, or fluctuations in ward or ICU capacity. Patient safety may be improved by better understanding the clustering of ICU transfers on medical wards. |
| التعليقات: | Comment in: JAMA Intern Med. 2023 Sep 1;183(9):913-914. doi: 10.1001/jamainternmed.2023.2636. (PMID: 37428490) |
| معلومات مُعتمدة: | Canada CIHR |
| تواريخ الأحداث: | Date Created: 20230710 Date Completed: 20230906 Latest Revision: 20240711 |
| رمز التحديث: | 20240711 |
| مُعرف محوري في PubMed: | PMC10334292 |
| DOI: | 10.1001/jamainternmed.2023.2629 |
| PMID: | 37428478 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2168-6114 |
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| DOI: | 10.1001/jamainternmed.2023.2629 |