Australian Critical Care最新文献

{"title":"Critical care nurses’ prioritisation of patient care, including delirium prevention and management strategies: A mixed-method study","authors":"Sarah Crowe MN, PMD-NP, NP ,&nbsp;A. Fuchsia Howard PhD, RN","doi":"10.1016/j.aucc.2024.101154","DOIUrl":"10.1016/j.aucc.2024.101154","url":null,"abstract":"<div><h3>Background</h3><div>Delirium is a common issue in critical care, yet its prevention and management strategies are often inconsistent. Understanding the factors that lead to the omission or delay in delirium-related care by critical care nurses is essential for enhancing patient outcomes.</div></div><div><h3>Objectives</h3><div>This study aimed to identify the specific delirium-related prevention and management strategies that are frequently missed or delayed by critical care nurses. It also explored factors influencing nurses’ prioritisation of care, including delirium-related strategies.</div></div><div><h3>Methods</h3><div>A mixed-method approach was utilised, combining quantitative data from online surveys and qualitative insights from interviews with critical care nurses in a Canadian health authority. The Missed Nursing Care Survey identified instances of missed or delayed care, while interviews provided deeper insights into care prioritisation decisions.</div></div><div><h3>Results</h3><div>Quantitative findings indicated frequent delays in patient mobilisation and physical care that were attributed to staffing shortages, high patient volume, and increased admissions and discharges. Qualitative findings revealed that factors such as patient acuity, structured routines, knowledge gaps, limited support, unit culture, and resource inadequacies influenced the prioritisation of delirium-related care, often leading to its inadvertent deprioritisation.</div></div><div><h3>Conclusion</h3><div>This study underscores the need to integrate delirium care into patient acuity assessments and establish sustainable education programs to enhance the recognition and prioritisation of delirium by critical care nurses. Addressing these factors is critical for improving patient outcomes in critical care settings.</div></div><div><h3>Implications for clinical practice</h3><div>Strengthening critical care nurses’ capacity to consistently recognise and prioritise delirium-related care through targeted education and system-level support could potentially contribute to better patient outcomes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101154"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the referral boundaries for organ and tissue donation: An interpretive description study","authors":"Kim Lecuyer RN, BNurs(Hons) ,&nbsp;Cindy Weatherburn RN, DHlth ,&nbsp;Melanie Greenwood PhD","doi":"10.1016/j.aucc.2024.101158","DOIUrl":"10.1016/j.aucc.2024.101158","url":null,"abstract":"<div><h3>Background</h3><div>The gap between organ availability and the number of people waiting for a transplant remains a major healthcare issue. Most transplanted organs and tissue are received from donors who have died in intensive care units (ICUs). To increase the number of donors, national guidelines and professional bodies in Australia support routine consideration of organ and tissue donation at the end of life. Referral to donation specialists is the first important step to explore a patient's donation wishes and consider the potential for donation, but practice is variable, and not all patients receiving end-of-life care in the ICU are referred.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate health professionals’ experiences of making a referral for organ and tissue donation in the intensive care setting and to identify barriers and facilitators that influence practice.</div></div><div><h3>Methods</h3><div>A qualitative research approach with semistructured interviews and interpretive description analysis methods was used in this study. Doctors and nurses from a single tertiary referral hospital in Australia who had worked in the intensive care setting were invited to participate. Content from interviews was analysed through a process of coding and inductive thematic analysis. Nine health professionals were interviewed.</div></div><div><h3>Findings</h3><div>A local protocol was in place to support multidisciplinary referral for organ and tissue donation; however, there were organisational barriers and referral misconceptions that discouraged clinicians to make a referral. Nurses felt disempowered to refer and had limited knowledge of what was required. Doctors supported nurses making referrals, acknowledging that the responsibility should be shared to minimise the chance that a referral will be missed. Donation specialist nurses provided valuable support for health professionals navigating the organ and tissue donation process.</div></div><div><h3>Conclusions</h3><div>Research outcomes suggest the need for greater interprofessional collaboration to support a more inclusive referral culture in the ICU to optimise opportunities for organ and tissue donation.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101158"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive care unit nurses’ redeployment experiences during the COVID-19 pandemic: A qualitative study","authors":"Louise White RN, BSc ,&nbsp;Nantanit van Gulik RN, PhD ,&nbsp;Jordana Schlieff RN, MSc ,&nbsp;Leanne Boyd RN, PhD ,&nbsp;Lauren Walker RN, BN ,&nbsp;Julie Considine RN, PhD","doi":"10.1016/j.aucc.2024.101157","DOIUrl":"10.1016/j.aucc.2024.101157","url":null,"abstract":"<div><h3>Background</h3><div>The pandemic response required the large-scale redeployment of nurses to support the care of patients with COVID-19. Surveys of staff and analysis of staff feedback indicated that the frequent redeployment of intensive care unit (ICU) registered nurses (RNs) led to dissatisfaction and contributed to voluntary reductions in hours and increased intentions to resign. Whilst much is understood about the redeployment of non-ICU RNs into ICUs to support patient care during periods of high demand, less is known about ICU RNs’ experiences of being redeployed to general wards. ICU RNs are often required to work in other areas to cover staff shortages within the organisation when ICU beds are available.</div></div><div><h3>Aim</h3><div>The aim of this study was to explore ICU RNs’ experiences of redeployment to hospital wards during 2021 and 2022.</div></div><div><h3>Methods</h3><div>A descriptive qualitative study using semi-structured interviews with 26 ICU RNs was conducted at three hospitals within a major health service in Melbourne, Australia. Participants were interviewed in July 2023. Transcribed audio recordings of interviews were analysed using reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Six major themes and 12 subthemes were constructed from the data: (i) risk (subthemes: absenteeism, bad for patients—ICU and ward); (ii) choice (subthemes: no choice, security of the ICU); (iii) lost (subthemes: lack of orientation, unfamiliar everything); (iv) distress (subthemes: clinical and emotional stress); (v) a number (subthemes: undervalued, unfair); and (vi) positive perspectives (subthemes: good experience, has to happen, helping out).</div></div><div><h3>Conclusion</h3><div>ICU RNs’ experiences of redeployment out of the ICU were predominantly negative. However, positive aspects were noted regarding the support of colleagues during staff shortages and the opportunity to provide care to patients. The findings highlight the risks associated with redeployment and its impact on both the ICU and the broader health service. Suggested strategies include implementing through orientation practices, adopting a sustainable team nursing approach, and prioritising staff wellbeing.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101157"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of implementing a communication board for mechanically ventilated patients in intensive care units: A cross-sectional substudy of the intervention arm of a pilot randomised controlled trial","authors":"Nipuna R. Kuruppu RN, BNurs (Hons) ,&nbsp;Kristen Ranse RN, PhD ,&nbsp;Georgia Tobiano RN, PhD ,&nbsp;Anuja Abayadeera MD, FRCA ,&nbsp;Wendy Chaboyer RN, PhD","doi":"10.1016/j.aucc.2024.101153","DOIUrl":"10.1016/j.aucc.2024.101153","url":null,"abstract":"<div><h3>Background</h3><div>Communication boards are a low-technology tool used to facilitate interactions with mechanically ventilated patients in intensive care units (ICUs). Research on the acceptability of communication boards in resource-limited intensive care settings is lacking.</div></div><div><h3>Aim</h3><div>The aim of this study was to assess patients' and nurses’ experienced acceptability of implementing a communication board in Sri Lankan ICUs.</div></div><div><h3>Design</h3><div>This was a cross-sectional substudy of the intervention group patients and nurses who participated in a pilot randomised controlled trial that assessed the feasibility of implementing a communication board in two ICUs in one Sri Lankan hospital.</div></div><div><h3>Methods</h3><div>In the parent trial conscious, ventilated adult ICU patients were recruited. This substudy included all patients in the intervention group in the parent trial and ICU nurses who used the communication board. Sekhon's generic acceptability questionnaire, adapted and translated into Sinhala, was administered to both patients and nurses. The questionnaire comprised eight items; seven items represented the seven constructs of the framework (possible scores ranging from 7 to 35), and a single item measured general acceptability. Descriptive and inferential statistics were used to analyse the data. Additionally, nurses were asked three open-ended questions regarding their views on using the communication board, and data were analysed using content analysis.</div></div><div><h3>Results</h3><div>Of the 123 patients screened in the parent trial, 60 met the inclusion criteria and were randomised, with 30 randomly allocated to the intervention group. In total, 30 patients and 50 nurses completed the survey (response rate: 100%). Both patients and nurses rated all items positively except “burden”. Patient and nurse total mean scores for the seven items, excluding the single-item general acceptability, were 27.5 (standard deviation: 2.6) and 27.2 (standard deviation: 2.2), respectively. Patients and nurses both scored high on the single-item general acceptability, with a median (interquartile range) of 4.0 (4.0–5.0) and 4.0 (4.0–4.0), respectively. Two patient items and five nurse items significantly correlated with the single-item general acceptability. Two categories, (i) drivers for using the communication board and (ii) obstacles to communication board use, were found through content analysis.</div></div><div><h3>Conclusion</h3><div>This substudy demonstrated that the communication board was acceptable to both patients and nurses despite its perceived “burden”.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101153"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonpharmacological interventions to promote sleep in the adult critical patients unit: A scoping review","authors":"Maria P. Carrera RN, MSc ,&nbsp;Leyla Alegria RN, MSc ,&nbsp;Pablo Brockmann MD, PhD ,&nbsp;Paula Repetto Ps, PhD ,&nbsp;Douglas Leonard PhD ,&nbsp;Rodrigo Cádiz PhD ,&nbsp;Fabio Paredes MSc ,&nbsp;Idalid Rojas RN ,&nbsp;Ana Moya RN ,&nbsp;Vanessa Oviedo RN, MSc ,&nbsp;Patricio García PT, MSc ,&nbsp;Mario Henríquez-Beltrán PT, MSc ,&nbsp;Jan Bakker MD, PhD","doi":"10.1016/j.aucc.2024.101159","DOIUrl":"10.1016/j.aucc.2024.101159","url":null,"abstract":"<div><h3>Background</h3><div>Sleep and circadian rhythms are markedly altered in intensive care unit (ICU) patients. Numerous factors related to the patient and the ICU environment affect the ability to initiate and maintain sleep. Therefore, nonpharmacological interventions could play an essential role in improving sleep and circadian rhythm.</div></div><div><h3>Objective</h3><div>The aim of this study was to examine nonpharmacological interventions evaluated for promoting sleep in adult ICUs.</div></div><div><h3>Methods</h3><div>A scoping review was conducted, including randomised controlled trials, nonrandomised controlled trials, quasi-experimental trials, and other controlled studies investigating the effects of nonpharmacological interventions promoting sleep in adult ICU patients.</div></div><div><h3>Results</h3><div>A total of 57 articles and 14 ongoing trials were included in the review, of which 38 were randomised clinical trials. Nine nonpharmacological interventions to improve sleep in critically ill patients were evaluated: earplugs and/or eye masks, aromatherapy, bundles, music intervention, massage or acupressure, noise masking, bright light, and dynamic light. Most included trials simultaneously assessed the effect of more than one intervention on perceived sleep quality using questionnaires. The association between the interventions and improved sleep varied. In the case of multicomponent interventions, it is difficult to identify which components might have influenced sleep improvement.</div></div><div><h3>Conclusions</h3><div>Numerous studies have evaluated various nonpharmacological interventions to promote sleep in critically ill patients, several of which improved perceived sleep quality. However, the substantial variability of the assessed interventions and their implementation complicates drawing reliable conclusions.</div></div><div><h3>Registration</h3><div>The protocol for this scoping review was registered with the Open Science Framework under the identifier <span><span>https://doi.org/10.17605/OSF.IO/MPEQ5</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101159"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses’ perspectives about end-of-life care when family presence is restricted during a pandemic: A qualitative study","authors":"Myung Hui Choi MSN, RN ,&nbsp;Hyun Jung Kim MSN, RN ,&nbsp;Hye Jin Yoo PhD, RN","doi":"10.1016/j.aucc.2024.06.012","DOIUrl":"10.1016/j.aucc.2024.06.012","url":null,"abstract":"<div><h3>Background</h3><div>To prevent the infection from spreading, patients who were dying from COVID-19 were treated in isolation with restricted family access, which differed from existing end-of-life care procedures. This was a significant change that affected the care provided by nurses.</div></div><div><h3>Objectives</h3><div>This study explored nurses' end-of-life care experiences in a limited family visitation setting during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>A descriptive qualitative study was conducted. Data were collected through individual, in-depth, semistructured interviews with ten critical care nurses who provided end-of-life care to patients with COVID-19 in South Korea. The data were analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used to assess the study's rigour.</div></div><div><h3>Findings</h3><div>Three themes were identified: ‘Witnessing patients’ and families' heartbreak over separation’, ‘The gaps between the ideals and realities of end-of-life care’, and ‘Efforts to provide patients with a comfortable final journey’. Nurses realise the importance of their central role in supporting interactions between patients and families during end-of-life care.</div></div><div><h3>Conclusions</h3><div>Family participation, facilitated by nurses’ interest and efforts as mediators connecting patients and families, is essential for achieving high-quality care for inpatients facing end of life. This study is significant as it emphasises that the direction of end-of-life care should be family centric, even in a pandemic situation with limited family participation. To improve interaction between patients and families, creating an environment based on family participation that builds trust and strengthens communication is essential. Additionally, hospital support, such as professional education and counselling, should be provided to strengthen nurses' end-of-life care competency.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101091"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition practices in Australia and New Zealand in response to evolving evidence: Results of three point-prevalence audits","authors":"Lee-anne S. Chapple PhD, APD ,&nbsp;Anneleen Neuts MD ,&nbsp;Stephanie N. O'Connor MNSc, RN ,&nbsp;Patricia Williams BN, RN ,&nbsp;Sally Hurford PG Dip Clinical Research, RN ,&nbsp;Paul J. Young PhD, MBChB ,&nbsp;Naomi E. Hammond PhD, RN ,&nbsp;Serena Knowles PhD, RN ,&nbsp;Marianne J. Chapman PhD, BMBS ,&nbsp;Sandra Peake PhD, BMBS ,&nbsp;the TARGET Investigators, The George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group","doi":"10.1016/j.aucc.2024.07.079","DOIUrl":"10.1016/j.aucc.2024.07.079","url":null,"abstract":"<div><h3>Background</h3><div>The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes.</div></div><div><h3>Aim</h3><div>We aimed to quantify practice change following TARGET.</div></div><div><h3>Methods</h3><div>Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann–Whitney test.</div></div><div><h3>Results</h3><div>The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018–2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and &lt;1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively.</div></div><div><h3>Conclusion</h3><div>In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101098"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Glasgow Coma Scale and Full Outline of UnResponsiveness score to assess the level of consciousness in patients admitted to intensive care units and emergency departments: A quantitative systematic review","authors":"Frida Krag Brun CCRN, MSc ,&nbsp;Vilde Holte Fagertun CCRN, MSc ,&nbsp;Marie Hamilton Larsen RN, PhD ,&nbsp;Marianne Trygg Solberg CCRN, PhD","doi":"10.1016/j.aucc.2024.03.012","DOIUrl":"10.1016/j.aucc.2024.03.012","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to investigate the reliability and validity of the Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) score used by nurses and physicians to assess the level of consciousness in patients admitted to intensive care units (ICUs) and emergency departments (EDs).</div></div><div><h3>Review method used</h3><div>This systematic review was guided by the Cochrane Handbook for Systematic Reviews of Interventions and followed the reporting standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement.</div></div><div><h3>Data sources</h3><div>A systematic search was conducted using the following databases: CINAHL, MEDLINE, and EMBASE.</div></div><div><h3>Review methods</h3><div>All authors performed the study selection process, data collection, and assessment of quality. The following psychometric properties were addressed: inter-rater reliability, internal consistency, and construct validity.</div></div><div><h3>Results</h3><div>Six articles were included. The GCS and the FOUR scores demonstrated excellent reliability and very strong validity when used by nurses and physicians to assess the level of consciousness in patients admitted to the ICU and ED. The FOUR score demonstrated slightly higher overall reliability and validity than the GCS.</div></div><div><h3>Conclusion</h3><div>This systematic review indicates that the FOUR score is especially suitable for assessing the level of consciousness in patients admitted to the ICU and ED. The FOUR score demonstrated higher reliability and validity than the GCS, making it a promising alternative assessment scale, despite the GCS’s longstanding use in clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101057"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors associated within 48-hour unplanned paediatric intensive care unit readmissions: An integrative review","authors":"Martina K. Barnwell RN BNurs, MAP ,&nbsp;Huaqiong Zhou RN, BSc, PhD ,&nbsp;Simon Erickson FRACP FCICM, DipEcho","doi":"10.1016/j.aucc.2024.03.010","DOIUrl":"10.1016/j.aucc.2024.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Unplanned paediatric intensive care unit (PICU) readmission is associated with increased morbidity/mortality, hospital length of stay, and health service cost and is recognised as a key performance indicator of quality-of-care delivery. However, research evidence on unplanned PICU readmission risk factors is limited, and results were inconsistent across studies.</div></div><div><h3>Aim</h3><div>The aim of this experiment was to collate and synthesise unplanned within-48-h PICU readmission prevalence and associated risk factors.</div></div><div><h3>Methods</h3><div>An integrative review was conducted, guided by a five-stage framework. Seven electronic databases were searched (2013–30th June 2023). Studies published in English with full-text accessibility and detailed methodologies were included. The quality of included studies was critically appraised using the Joanna Briggs Institute checklists. Prevalence and risk factors were extracted, synthesised, and presented narratively.</div></div><div><h3>Results</h3><div>Ten studies met eligibility criteria and reported a varied readmission rate from 0.008% to 6.49%. Fifteen types of significant risk factors were extracted. Twelve consistently cited risk factors were age, weight, complex chronic conditions, admission source, unplanned admission, PICU length of stay, positive pressure ventilation, discharge disposition, oxygen requirements, respiratory rate, heart rate, and Glasgow Coma Score at discharge. Of the 12, five predictors were classified as modifiable factors, including discharge disposition, oxygen requirement, abnormal respiratory rate, abnormal heart rate, and decreased Glasgow Coma Score at discharge.</div></div><div><h3>Conclusion</h3><div>This review acknowledges the complexity of confounding factors impacting unplanned PICU readmission and the lack of standardisation examining potential risk factors. The five modifiable factors are suggestive of clinical instability and premature PICU discharge. Patients with modifiable risk factors should have their readiness for discharge re-evaluated. Scaffolding support to manage patients at risk of readmission includes senior bedside nursing allocation, use of PICU outreach services, and 1:2 nurse-to-patient ratios in the ward setting, which are warranted to ensure patient safety.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101055"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing characteristics and outcomes of in-hospital cardiac arrest during the early and late COVID-19 pandemic at an academic institution in Saudi Arabia","authors":"Abdullah Bakhsh MBBS ,&nbsp;Saleh Binmahfooz MBBS ,&nbsp;Ibtihal Balubaid MBBS ,&nbsp;Hind Aljedani MBBS ,&nbsp;Mohsin Khared MBBS ,&nbsp;Abdulrahman Alghamdi MBBS ,&nbsp;Saleh Alabdulwahab MBBS ,&nbsp;Mohannad Alzahrani MBBS ,&nbsp;Aziza Abushosha MBBS ,&nbsp;Layan Alharbi MBBS ,&nbsp;Reem Baarma MBBS ,&nbsp;Elmoiz Babekir MBBS","doi":"10.1016/j.aucc.2024.06.005","DOIUrl":"10.1016/j.aucc.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has introduced major changes in the resuscitation practices of cardiac arrest victims.</div></div><div><h3>Aim</h3><div>We aimed to compare the characteristics and outcomes of patients who sustained in-hospital cardiac arrest (IHCA) during the early COVID-19 pandemic period (2020) with those during the late COVID-19 pandemic period (2021).</div></div><div><h3>Methods</h3><div>This was a retrospective review of adult patients sustaining IHCA at a single academic centre. We compared characteristics and outcomes of IHCA for 5 months in 2020 with those experiencing IHCA for 5 months in 2021.</div></div><div><h3>Results</h3><div>Patients sustaining IHCA during the early COVID-19 pandemic period had higher rates of delayed epinephrine administration of more than 5 min (13.4% vs. 1.9%; p &lt; 0.01), more frequent delays in the initiation of chest compressions (55.6% vs. 17.9%; p &lt; 0.01), and were intubated less often (23.0% vs. 59.3%; p &lt; 0.01). In terms of outcomes, both return of spontaneous circulation (35.8% vs. 51.2%; p &lt; 0.01) and survival to hospital discharge rates (13.9% vs. 30.2%; p &lt; 0.01) were lower during the early COVID-19 pandemic period.</div></div><div><h3>Conclusions</h3><div>The early COVID-19 pandemic period was associated with delays in epinephrine administration and chest compression initiation for IHCA. Moreover, both return of spontaneous circulation and survival to hospital discharge were lower during the early COVID-19 pandemic period.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101082"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}