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Measuring implementation progress in kangaroo mother care.
Bergh AM, Arsalo I, Malan AF, Patrick M, Pattinson RC, Phillips N.
MRC Research Unit for Maternal and Infant Health Care Strategies and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. apbergh@medic.up.ac.za
AIM: To describe the development and testing of a monitoring model with quantitative indicators or progress markers that could measure the progress of individual hospitals in the implementation of kangaroo mother care (KMC). METHODS: Three qualitative data sets in the larger research programme on the implementation of KMC of the MRC Research Unit for Maternal and Infant Health Care Strategies in South Africa were used to develop a progress-monitoring model and an accompanying instrument. RESULTS: The model was conceptualized around three phases (pre-implementation, implementation and institutionalization) and six constructs depicting progress (awareness, adopting the concept, mobilization of resources, evidence of practice, evidence of routine and integration, sustainable practice). For each construct, indicators were developed for which data could be collected by means of the monitoring instrument used in a walk-through visit to a hospital. The instrument has been tested in 65 hospitals. CONCLUSION: The progress-monitoring model enables the quantification of individual hospitals' progress in the process of implementing KMC and an objective measurement of the effectiveness of different outreach strategies. The model also has potential to be adapted for measuring progress in other innovative healthcare interventions on a large scale.
PMID: 16188856 [PubMed - indexed for MEDLINE]
Comment on:
In patients with obstructive pulmonary disease during controlled ventilation, PEEP decreases dynamic hyperinflation: is this response really "paradoxical"?
Eumorfia K, Alexopoulou C, Prinianakis G, Xirouchaki N, Georgopoulos D.
Publication Types:
PMID: 16352983 [PubMed - indexed for MEDLINE]
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Comment on:
Intensivists should use bedside echocardiography.
Souza LF.
Publication Types:
PMID: 16352980 [PubMed - indexed for MEDLINE]
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Comment on:
Transfusion and mechanical ventilation: two interrelated causes of acute lung injury?
Schultz MJ, Gajic O.
Publication Types:
PMID: 16352979 [PubMed - indexed for MEDLINE]
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Comment on:
Does red blood cell transfusion increase local cerebral oxygenation?
Griesdale DE, Chittock DR.
Publication Types:
PMID: 16352978 [PubMed - indexed for MEDLINE]
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Comment on:
Pediatric extracorporeal life support and central nervous system injury.
van Heijst AF.
Publication Types:
PMID: 16352976 [PubMed - indexed for MEDLINE]
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Comment on:
How accurate are currently used methods of determining glycemia in critically ill patients, and do they affect their clinical course?
Chrousos G, Kaltsas G.
Publication Types:
PMID: 16352973 [PubMed - indexed for MEDLINE]
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Comment on:
Admission hyperglycemia and outcome: the ongoing story.
Oeyen S.
Publication Types:
PMID: 16352972 [PubMed - indexed for MEDLINE]
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Comment on:
Refrigerated intravenous fluids: kick-starting the cooling process.
Mayer SA.
Publication Types:
PMID: 16352970 [PubMed - indexed for MEDLINE]
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Outcome in elderly patients with severe infection is influenced by sex hormones but not gender.
Angstwurm MW, Gaertner R, Schopohl J.
Department of Endocrinology and Medical Intensive Care Unit, Medizinische Klinik Innenstadt, University of Munich, Germany. Matthias.Angstwurm@med.uni-muenchen.de
OBJECTIVE: The influence of gender as a prognostic variable in patients with severe infections is still controversial. Sex steroid hormones have an important impact on the immune system and vice versa, and prospective studies on the hormonal changes during severe infection are lacking. The objective was to compare the influences of gender and adrenal sex steroid hormone levels on hospital mortality rate in patients with infections. DESIGN: Prospective observational study conducted between January 1995 and December 2000. SETTING: University-based level I intensive care unit. PATIENTS: Included were 208 males and 100 females with severe infection at admission to the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mortality rate during hospitalization was analyzed for correlation to gender and the levels of testosterone, 17beta-estradiol, and progesterone; source and clinical signs of infection; Acute Physiology and Chronic Health Evaluation II score; or age. There were no differences in demographic or infectious characteristics between males and females; the survival rate was similar. Males had significantly reduced testosterone levels. Elevation of the steroid hormones 17beta-estradiol (1.5-fold), progesterone (5-fold), and cortisol (1.5-fold) occurred in both genders to the same extent. In addition, testosterone was elevated in septic females and correlated with 17beta-estradiol. Nonsurvivors of both genders had significantly elevated 17beta-estradiol levels. Progesterone was particularly high in nonsurviving males, whereas testosterone was elevated in nonsurviving females. Mortality rate was correlated with high 17beta-estradiol and progesterone in males but with 17beta-estradiol and testosterone in females. Cortisol or dehydroepiandrostenedione sulfate levels were not associated with mortality rates. CONCLUSIONS: In elderly patients with infections, mortality was not dependent on gender but was correlated with elevated 17beta-estradiol in both genders, with elevated progesterone in males and elevated testosterone in females. Although the latter sex hormones may derive from the adrenals, cortisol levels were only moderately increased and not associated with survival. The high 17beta-estradiol concentrations implicate an increased aromatase activity. Therefore, other pathways of sex steroid production must be involved.
PMID: 16352961 [PubMed - indexed for MEDLINE]
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Comment in:
Reliability of point-of-care testing for glucose measurement in critically ill adults.
Kanji S, Buffie J, Hutton B, Bunting PS, Singh A, McDonald K, Fergusson D, McIntyre LA, Hebert PC.
Department of Pharmacy, The Ottawa Hospital, Ottawa, Canada.
BACKGROUND: Glycemic control is increasingly being recognized as a priority in the treatment of critically ill patients. Titration and monitoring of insulin infusions involve frequent blood glucose measurement to achieve target glucose ranges and prevent adverse events related to hypoglycemia. Therefore, it is imperative that bedside glucose testing methods be safe and accurate. OBJECTIVE: To determine the accuracy and clinical impact of three common methods of bedside point-of-care testing for glucose measurements in critically ill patients receiving insulin infusions. DESIGN: Prospective observational study. SETTING: A 21-bed mixed medical/surgical intensive care unit of a tertiary care teaching hospital. PATIENTS: Thirty consecutive critically ill patients who were vasopressor-dependent (n = 10), had significant peripheral edema (n = 10), or were admitted following major surgery (n = 10). MEASUREMENTS: Findings from three different methods of glucose measurement were compared with central laboratory measurements: (1) glucose meter analysis of capillary blood (fingerstick); (2) glucose meter analysis of arterial blood; and (3) blood gas/chemistry analysis of arterial blood. Patients were enrolled for a maximum of 3 days and had a maximum of nine sets of measurements determined during this time. RESULTS: Clinical agreement with the central laboratory was significantly better with arterial blood analysis (69.9% and 76.5% for glucose meter and blood gas/chemistry analysis, respectively) than with capillary blood analysis (56.8%; p = .039 and .001, respectively). During hypoglycemia, clinical agreement was only 26.3% with capillary blood analysis and 55.6% and 64.9% for glucose meter and blood gas/chemistry analysis of arterial blood (p = .010 and <.001, respectively). Glucose meter analysis of both arterial and capillary blood tended to provide higher glucose values, whereas blood gas/chemistry analysis of arterial blood tended to yield lower glucose values. CONCLUSIONS: The magnitude of the differences in the glucose values offered by the four different methods of glucose measurement led to frequent clinical disagreements regarding insulin dose titration in the context of an insulin infusion protocol for aggressive glucose control.
PMID: 16352960 [PubMed - indexed for MEDLINE]
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Clinical implications of temperature curve complexity in critically ill patients.
Varela M, Calvo M, Chana M, Gomez-Mestre I, Asensio R, Galdos P.
Servicio de Medicina Interna, Hospital de Mostoles, Madrid, Spain.
OBJECTIVE: In certain physiologic systems, disease is associated with a loss of complexity in system's output. We test the hypothesis that, in critically ill patients, there is an inverse relation between the complexity of the temperature curve and the clinical status. We also consider whether complexity analysis of the temperature curve may have prognostic value. DESIGN: Prospective, observational study. SETTING: Intensive care unit of a general hospital in Madrid, Spain. PATIENTS: Twenty-four successive patients admitted in the intensive care unit with multiple organ failure. INTERVENTIONS: Skin temperature was measured every 10 mins from inclusion in the study until discharge or death (median length of stay 18.8 days, interquartile range 86). MEASUREMENTS: From the temperature time series, hourly approximate entropy measurements were obtained. Clinical status was evaluated using the Sequential Organ Failure Assessment (SOFA) score. MAIN RESULTS: A significant inverse relationship between approximate entropy and the attributed SOFA score was observed in 89% of the patients considered. Both mean and minimum approximate entropy were significantly lower in patients who died than in patients who survived (mean approximate entropy, 0.47 vs. 0.61; minimum approximate entropy, 0.24 vs. 0.40; in both cases p < .001). To evaluate the prognostic value of both mean and minimum approximate entropy, we fitted logistic regression models against survival. An increase in 0.1 units in minimum or mean approximate entropy increased 15.4- and 18.5-fold the odds of surviving, respectively. CONCLUSIONS: The clinical status of patients suffering multiple organ failure is inversely correlated to the complexity of the temperature curve expressed as approximate entropy. Reduced complexity has dismal prognostic implications. Its assessment is noninvasive and inexpensive and allows for real-time continuous monitoring of clinical status.
PMID: 16352958 [PubMed - indexed for MEDLINE]
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Comment in:
Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluid.
Polderman KH, Rijnsburger ER, Peerdeman SM, Girbes AR.
Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.
OBJECTIVE: Mounting evidence suggests that mild to moderate hypothermia can mitigate neurologic and myocardial injury. The speed of induction appears to be a key factor in determining its efficacy. However, even when the fastest currently available cooling techniques are used, reaching target temperatures takes at least 2 hrs and usually longer. We hypothesized that infusion of refrigerated fluids could be a safe accessory method to increase cooling speed. DESIGN: Prospective intervention study. SETTING: University teaching hospital. PATIENTS: One hundred thirty-four patients with various types of neurologic injury (postanoxic encephalopathy, subarachnoid hemorrhage, or traumatic brain injury). MEASUREMENTS AND MAIN RESULTS: Hypothermia was induced in 134 patients with various types of neurologic injury, by means ice-water cooling blankets and infusion of refrigerated (4 degrees C) saline (110 patients) or saline and colloids (24 patients). An average volume of 2340 +/- 890 mL of refrigerated fluids was infused in 50 mins. Core temperatures decreased from 36.9 +/- 1.9 degrees C to 34.6 +/- 1.5 degrees C at t = 30 mins and to 32.9 +/- 0.9 degrees C at t = 60 mins (target temperature: 32 degrees C-33 degrees C). Monitoring of blood pressure, heart rhythm, central venous pressure, blood gasses, electrolyte and glucose levels, and platelet and white blood cell count revealed no additional adverse effects. Mean arterial pressure increased by 15 mm Hg, with larger increases in blood pressure occurring in hemodynamically unstable patients. No patient developed pulmonary edema. CONCLUSIONS: Induction of hypothermia by means of cold-fluid infusion combined with ice-water cooling blankets is safe, efficacious, and quick. Because the speed of cooling is important to increase its protective effects, we recommend that cold-fluid infusion be used in all patients treated with induced hypothermia. This should be combined with another method to safely and accurately maintain hypothermia once target temperatures have been reached.
PMID: 16352954 [PubMed - indexed for MEDLINE]
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Comment in:
Hydrocortisone increases the sensitivity to alpha1-adrenoceptor stimulation in humans following hemorrhagic shock.
Hoen S, Mazoit JX, Asehnoune K, Brailly-Tabard S, Benhamou D, Moine P, Edouard AR.
Service d'Anesthesie-Reanimation et Unite Propre de Recherche de l'Enseignement Superieur-Equipe d'Accueil (UPRES-EA 3540), Hopital de Bicetre, Bicetre, France.
OBJECTIVE: To assess the pressor response to phenylephrine infusion before and after hydrocortisone in severe trauma patients and to correlate this response with their adrenal reserve. DESIGN: Prospective clinical study. SETTING: Surgical intensive care unit in a university teaching hospital. PATIENTS: Twenty-three young trauma patients (Injury Severity Score, 38 +/- 14) were studied at the end of the resuscitative period (27 +/- 15 hrs after trauma). INTERVENTIONS: Total cortisol response to intravenous corticotropin bolus (250 microg) was obtained. Total cortisol response <9 microg/dL defined an impaired adrenal function and the patient was called a nonresponder. Twelve to 24 hrs following this stimulation, phenylephrine was infused in a stepwise manner to establish the phenylephrine-mean arterial pressure dose-response curve before and after intravenous hydrocortisone administration (50 mg). An Emax model was used to describe the curve; the influence of the group (responder/nonresponder), the sequence (before/after hydrocortisone), and three covariates (Injury Severity Score, shock, and interleukin-6) were thereafter tested. MEASUREMENTS AND MAIN RESULTS: Forty-three percent of patients were nonresponders. Total cortisol response was not correlated with serum albumin concentration and was negatively correlated with the interleukin-6 concentration. A trend for a higher incidence of nonresponders (53% vs. 36%) and a lesser total cortisol response (7.9 +/- 5.1 vs. 12.5 +/- 5.1 microg/dL) was observed in the shock patients. A phenylephrine dose-response structure (E0, ED50, and Emax) was described without influence of the group and the sequence. However, hydrocortisone induced a 37% decrease in ED50 without change in Emax in the shock patients. CONCLUSION: An acute administration of hydrocortisone increases the sensitivity to alpha1-adrenoceptor stimulation in fully resuscitated severe trauma patients following hemorrhagic shock. This effect is independent of the adrenal reserve of the patients and different from that previously reported in septic patients.
PMID: 16352953 [PubMed - indexed for MEDLINE]
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Comment in:
The intensivist in a spiritual care training program adapted for clinicians.
Todres ID, Catlin EA, Thiel MM.
Pediatric Critical Care Unit, MassGeneral Hospital for Children, Boston, MA, USA.
BACKGROUND: Critical illness is a crisis for the total person, not just for the physical body. Patients and their loved ones often reflect on spiritual, religious, and existential questions when seriously ill. Surveys have demonstrated that most patients wish physicians would concern themselves with their patients' spiritual and religious needs, thus indicating that this part of their care has been neglected or avoided. With the well-documented desire of patients to have their caregivers include the patient's spiritual values in their health care, and the well-documented reality that caregivers are often hesitant to do so because of lack of training and comfort in this realm, clinical pastoral education for health care providers fills a significant gap in continuing education for caregivers. OBJECTIVES: To report on the first 6 yrs of a unique training program in clinical pastoral education adapted for clinicians and its effect on the experience of the health care worker in the intensive care unit. We describe the didactic and reflective process whereby skills of relating to the ultimate concerns of patients and families are acquired and refined. DESIGN AND SETTING: Clinical pastoral education designed for clergy was adapted for the health care worker committed to developing skills in the diagnosis and management of spiritual distress. Clinician participants (approximately 10-12) meet weekly for 5 months (400 hrs of supervised clinical pastoral care training). The program is designed to incorporate essential elements of pastoral care training, namely experience, reflection, insight, action, and integration. RESULTS: This accredited program has been in continuous operation training clinicians for the past 6 yrs. Fifty-three clinicians have since graduated from the program. Graduates have incorporated clinical pastoral education training into clinical medical practice, research, and/or further training in clinical pastoral education. Outcomes reported by graduates include the following: Clinical practice became infused with new awareness, sensitivity, and language; graduates learned to relate more meaningfully to patients/families of patients and discover a richer relationship with them; spiritual distress was (newly) recognizable in patients, caregivers, and self. CONCLUSIONS: This unique clinical pastoral education program provides the clinician with knowledge, language, and understanding to explore and support spiritual and religious issues confronting critically ill patients and their families. We propose that incorporating spiritual care of the patient and family into clinical practice is an important step in addressing the goal of caring for the whole person.
PMID: 16352952 [PubMed - indexed for MEDLINE]
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Right Care, Right Now--you can make a difference.
Angood PB.
Society of Critical Care Medicine.
Publication Types:
PMID: 16352951 [PubMed - indexed for MEDLINE]
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Pulse total-hemoglobinometer provides accurate noninvasive monitoring.
Noiri E, Kobayashi N, Takamura Y, Iijima T, Takagi T, Doi K, Nakao A, Yamamoto T, Takeda S, Fujita T.
Department of Nephrology & Endocrinology, University Hospital, University of Tokyo, Tokyo, Japan. noiri-tky@umin.ac.jp
OBJECTIVE: Rapid noninvasive measurement of total hemoglobin would be extremely useful for various clinical situations. This study determined the clinical accuracy and utility for a pulse total-hemoglobinometer using four wavelengths: 660 nm (reduced hemoglobin), 805 nm (isosbestic point), 940 nm (oxygenated hemoglobin), and 1300 nm (water density). DESIGN: Clinical trial. SETTING: University school of medicine. PATIENTS: Patients were 122 individuals (age, 18-82 yrs; 49.4 +/- 16.0 yrs [mean +/- SD]), including 71 healthy volunteers, 24 patients undergoing surgery, and 27 patients undergoing hemodialysis. INTERVENTIONS: The hemoglobinometer probe, which simultaneously indicated peripheral oxygen saturation, pulse rate, and hemoglobin, was placed on the fingertip similarly to a regular pulse oximeter. The hemoglobin values were compared with those obtained by the co-oximeter or the sodium lauryl sulfate-methemoglobin method. Those hemoglobin values were assigned to either the training set or the validation set for statistical evaluation. MEASUREMENTS AND MAIN RESULTS: Multiple regression analysis including the ratio of the pulsatile optical density (phi(ij)) derived from the four wavelengths and other factors demonstrated that the mean value of the normalized pulse wave obtained from the photodiode at 805 nm (DC805) and the ratios of DC940 and DC1300 (DC940/DC1300) were the pivotal factors in the hemoglobinometer's increased accuracy in the clinically useful range. The coefficient of determination between both methods was r2 = .81 (p < .0001) in the training set and r2 = .75 (p < .0001) in the validation set. When the cutoff value of anemia was set at 10 g/dL, and anemia was defined as <10 g/dL, the respective sensitivity and specificity of hemoglobinometer values to detect anemia in intraoperative patients were 84.3% and 84.6% (n = 20). CONCLUSIONS: The data demonstrated the necessity for consideration of light scattering in red blood cells for pulse-spectrophotometric hemoglobin measurement. This was accomplished with additional factors, such as DC805 and DC940/DC1300. With these improvements, the pulse hemoglobinometer provided noninvasive, clinically acceptable measurement of hemoglobin. The pulse hemoglobinometer is a versatile tool that might be useful for routine health checkups of neonates and young children, intraoperative monitoring of bleeding, and emergency care.
Publication Types:
PMID: 16352948 [PubMed - indexed for MEDLINE]
How much time is needed for hand hygiene in intensive care? A prospective trained observer study of rates of contact between healthcare workers and intensive care patients.
McArdle FI, Lee RJ, Gibb AP, Walsh TS.
Department of Anaesthetics, Critical Care and Pain Medicine, Edinburgh Royal Infirmary, Edinburgh, UK.
There are few data measuring rates of contact by healthcare workers (HCWs) with intensive care unit (ICU) patients (direct contacts) and their immediate environment (indirect contacts), or estimates of the time needed for 100% hand hygiene compliance. We measured this using a prospective trained observer study in a 12-bedded UK adult general ICU admitting >600 mixed medical/surgical patients annually. HCWs were observed in ICU bed spaces for 1-h periods by a single researcher using a pre-determined plan, such that all 12 beds were observed for similar times and throughout the day. Mean daily rates of direct and indirect contact between HCWs and ICU patients were calculated. Observed post-contact hand hygiene compliance was also measured. Numbers of contacts/day that were or were not followed by hand hygiene, and estimates of the time needed daily for 100% compliance were calculated. On average, each patient was contacted directly 159 [95% confidence intervals (CI) 144-178] times and contacted indirectly 191 (95% CI 174-210) times/day. Observed post-contact hand hygiene rates were 43% for direct contacts and 12% for indirect contacts. Staff contacting more than one patient during routine care, who carry the highest risk of transmitting infection between patients, made, on average, 22 direct and 107 indirect contacts without adequate hand hygiene/patient/day. One hundred percent hand hygiene compliance by all healthcare workers would require about 230min/patient/day (100min for direct and 130min for indirect contacts).
PMID: 16406198 [PubMed - as supplied by publisher]
Community-acquired bacterial meningitis in adults.
van de Beek D, de Gans J, Tunkel AR, Wijdicks EF.
Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.vandebeek@amc.uva.nl
Publication Types:
PMID: 16394301 [PubMed - indexed for MEDLINE]
What is supportive when an adult next-of-kin is in critical care?
Johansson I, Fridlund B, Hildingh C.
Intensive Care Clin c, Helsingborg Hospital Co, Helsingborg, Sweden. ingrid.j-son@telia.com
There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented.
PMID: 16255336 [PubMed - indexed for MEDLINE]
Optimizing the fluid management of ventilated patients with suspected hypovolaemia.
Murch P.
General Intensive Therapy Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, S5 7AU, UK. philip.murch@sth.nhs.uk
Fluid management is a vital component of patient care within the critical care setting; it has a range of indications and applications, one of the most important being to maintain tissue perfusion and safeguard against single/multiple organ failure. Hypovolaemia is a commonly encountered condition within critical care and has the potential to jeopardize tissue perfusion and accelerate the risk of organ failure. In an attempt to optimize the fluid management of patients within the intensive therapy unit, this article outlines the development and implementation of a fluid prescription for ventilated patients with suspected hypovolaemia.
Publication Types:
PMID: 16255335 [PubMed - indexed for MEDLINE]
Does intermediate care minimize relocation stress for patients leaving the ICU?
Beard H.
High Dependency Unit, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk. helen.beard@wsh.nhs.uk
Relocation stress is a phenomenon in which physical and psychological disturbances are experienced following transfer from one environment to another [Carpenito LJ. (2000). Nursing Diagnosis. Application to Clinical Practice, 8th edn]. The purpose of this review was to identify whether a period of intermediate care minimizes the problems associated with relocation stress after discharge from the intensive care unit (ICU) and before transfer to the ward. Methods of retrieving the literature involved identifying key terms, utilizing a range of databases and applying specific criteria in order to delineate the boundaries of the search. Using electronic and manual search methods, 11 studies were selected, both primary and secondary research. Following tabulation and critiquing of the studies, the findings of the review suggest that the factors which contribute towards relocation stress are the loss of one-to-one nursing, a reduction of visible monitoring equipment, lack of continuity of care and inadequate preparation of the patient for the transfer. The evidence also indicates that in order to minimize these factors, early planning and preparation of the patient for transfer are required, incorporating strategies of gradual reduction in nursing attention and monitoring equipment and the provision of information. Although the benefits of intermediate care are established as being advanced monitoring, appropriate nurse-to-patient ratio, heightened demonstration of expert knowledge and skill, there is no sufficient evidence to indicate a period of intermediate care that can ease the transition from the ICU to the ward.
Publication Types:
PMID: 16255334 [PubMed - indexed for MEDLINE]
Patient misidentification in the neonatal intensive care unit: quantification of risk.
Gray JE, Suresh G, Ursprung R, Edwards WH, Nickerson J, Shiono PH, Plsek P, Goldmann DA, Horbar J.
Center for Patient Safety in Neonatal Intensive Care, University of Vermont, Burlington, Vermont, USA. jgray@bidmc.harvard.edu
OBJECTIVE: To quantify the potential for misidentification among NICU patients resulting from similarities in patient names or hospital medical record numbers (MRNs). METHODS: A listing of all patients who received care in 1 NICU during 1 calendar year was obtained from the unit's electronic medical record system. A patient day was considered at risk for misidentification when the index patient shared a surname, similar-sounding surname, or similar MRN with another patient who was cared for in the NICU on that day. RESULTS: During the 1-year study period, 12186 days of patient care were provided to 1260 patients. The unit's average daily census was 33.4; the maximum census was 48. Not a single day was free of risk for patient misidentification. The mean number of patients who were at risk on any given day was 17 (range: 5-35), representing just over 50% of the average daily census. During the entire calendar year, the risk ranged from 20.6% to a high of 72.9% of the average daily census. The most common causes of misidentification risk were similar-appearing MRNs (44% of patient days). Identical surnames were present in 34% of patient days, and similar-sounding names were present in 9.7% of days. Twins and triplets contributed one third of patient days in the NICU. After these multiple births were excluded from analysis, 26.3% of patient days remained at risk for misidentification. Among singletons, the contribution to misidentification risk of similar-sounding surnames was relatively unchanged (9.1% of patient days), whereas that of similar MRNs and identical surnames decreased (17.6% and 1.0%, respectively). CONCLUSIONS: NICU patients are frequently at risk for misidentification errors as a result of similarities in standard identifiers. This risk persists even after exclusion of multiple births and is substantially higher than has been reported in other hospitalized populations.
PMID: 16396847 [PubMed - in process]
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