Gitte Bunkenborg1, Karin Samuelson2, Ingrid Poulsen3, Steen Ladelund4, Jonas Åkeson5. 1. Department of Anaesthesiology, Copenhagen University Hospital, Hvidovre, Denmark; Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden. 2. Department of Health Sciences, Lund University, and the Intensive Care Unit, Lund University Hospital, Lund, Sweden. 3. Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Glostrup, Denmark. 4. Head of Biostatistics, Copenhagen University Hospital, Hvidovre, Denmark. 5. Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care Medicine, Lund University, Malmö, Sweden. Electronic address: jonas.akeson@med.lu.se.
Abstract
BACKGROUND: In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognition of deviating physiological parameters may enable staff to prevent unexpected in-hospital death. The aim of this study was to evaluate short- and long-term effects of systematic interprofessional use of early warning scoring, structured observation charts, and clinical algorithms for bedside action. METHODS: A prospective non-randomized controlled study of unexpected in-hospital death before and after implementation of a clinical intervention in a medical and surgical ward setting at an urban Danish university hospital. Information was obtained over three four-month study periods - a pre-interventional one in 2009 (1st March-30th June), and two postinterventional ones in 2010 (1st September-31st December) and 2011 (1st March-30th June). The incidence of unexpected patient death, the primary study outcome, was calculated as the rate of unexpected patient mortality based on in-hospital risk time. RESULT: The adjusted unexpected patient mortality rate was significantly lower during the second postinterventional study period than before the intervention, 17 versus 61 per 100 adjusted patient years (P=0.013), corresponding to a rate ratio of 0.271 (95% confidence interval (CI) 0.097-0.762). A tendency to reduced unexpected mortality was found during the first postinterventional study period (25 versus 61 per 100 adjusted patient years, P=0.053; rate ratio 0.404, CI 0.161-1.012). CONCLUSION: Clinical intervention comprising systematic monitoring practice, early warning scoring, an observation chart, and an algorithm for bedside management, implemented by interprofessional teaching, training, and optimization of communication and collaboration, may significantly reduce unexpected in-hospital mortality.
BACKGROUND: In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognition of deviating physiological parameters may enable staff to prevent unexpected in-hospital death. The aim of this study was to evaluate short- and long-term effects of systematic interprofessional use of early warning scoring, structured observation charts, and clinical algorithms for bedside action. METHODS: A prospective non-randomized controlled study of unexpected in-hospital death before and after implementation of a clinical intervention in a medical and surgical ward setting at an urban Danish university hospital. Information was obtained over three four-month study periods - a pre-interventional one in 2009 (1st March-30th June), and two postinterventional ones in 2010 (1st September-31st December) and 2011 (1st March-30th June). The incidence of unexpected patient death, the primary study outcome, was calculated as the rate of unexpected patient mortality based on in-hospital risk time. RESULT: The adjusted unexpected patient mortality rate was significantly lower during the second postinterventional study period than before the intervention, 17 versus 61 per 100 adjusted patient years (P=0.013), corresponding to a rate ratio of 0.271 (95% confidence interval (CI) 0.097-0.762). A tendency to reduced unexpected mortality was found during the first postinterventional study period (25 versus 61 per 100 adjusted patient years, P=0.053; rate ratio 0.404, CI 0.161-1.012). CONCLUSION: Clinical intervention comprising systematic monitoring practice, early warning scoring, an observation chart, and an algorithm for bedside management, implemented by interprofessional teaching, training, and optimization of communication and collaboration, may significantly reduce unexpected in-hospital mortality.
Authors: Caroline S Langkjaer; Dorthe G Bove; Pernille B Nielsen; Kasper K Iversen; Morten H Bestle; Gitte Bunkenborg Journal: Nurs Open Date: 2021-02-27
Authors: Line J H Rasmussen; Steen Ladelund; Thomas H Haupt; Gertrude E Ellekilde; Jesper Eugen-Olsen; Ove Andersen Journal: Crit Care Med Date: 2018-12 Impact factor: 7.598