Background: Although head of bed (HOB) elevation is an important strategy to prevent ventilator associated pneumonia (VAP), some observational studies have reported that the application of the semi-recumbent position was lower in patients receiving mechanical ventilator support.We performed this study to assess the effect of implementation of the HOB elevation protocol in the intensive care unit (ICU) on clinical and nutritional outcomes.Methods: We developed a HOB elevation protocol including a flow chart to determine whether the HOB of newly admitted patients to ICU could be elevated.We measured the level of HOB elevation in patients with mechanical ventilator twice a day and 2 days a week for 5 weeks before and after the implementation of the protocol, respectively.Hemodynamic, respiratory and nutritional data were also collected, resulting in 251 observations from 35 patients and 467 observations from 66 patients before and after implementation.Results: After implementing the protocol, the level of HOB elevation (16.7 ± 9.9 vs. 23.6 ±1 2.9, p ＜ 0.0001) and observations of HOB elevation ＞ 30 o increased significantly (34 vs. 151, p ＜ 0.0001).There was no significant difference in the incidence of VAP.Arterial oxygen tension/fraction of inspired oxygen ratio improved (229 ± 115 vs. 262 ± 129, p = 0.02).Mean arterial blood pressure decreased after the implementation of the protocol, but remained within the normal limits.Calorie intake from tube feeding increased significantly (672 ± 649 vs. 798 ± 670, p = 0.021) and the events of high gastric residual volume (＞ 100 ml) occurred less frequently after implementing the protocol (50% vs. 17%, p = 0.001) Conclusions: Implementation of the protocol for HOB elevation could improve the level of HOB elevation, oxygenation parameter and enteral nutrition delivery.
Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the "boarding restriction protocol" that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purpose of this study was to determine the effect of the boarding restriction protocol on ED crowding.
Natural language processing has been established as an important tool when using unstructured text data; however, most studies in the medical field have been limited to a retrospective analysis of text entered manually by humans. Little research has focused on applying natural language processing to the conversion of raw voice data generated in the clinical field into text using speech-to-text algorithms.In this study, we investigated the promptness and reliability of a real-time medical record input assistance system with voice artificial intelligence (RMIS-AI) and compared it to the manual method for triage tasks in the emergency department.From June 4, 2021, to September 12, 2021, RMIS-AI, using a machine learning engine trained with 1717 triage cases over 6 months, was prospectively applied in clinical practice in a triage unit. We analyzed a total of 1063 triage tasks performed by 19 triage nurses who agreed to participate. The primary outcome was the time for participants to perform the triage task.The median time for participants to perform the triage task was 204 (IQR 155, 277) seconds by RMIS-AI and 231 (IQR 180, 313) seconds using manual method; this difference was statistically significant (P<.001). Most variables required for entry in the triage note showed a higher record completion rate by the manual method, but in the recording of additional chief concerns and past medical history, RMIS-AI showed a higher record completion rate than the manual method. Categorical variables entered by RMIS-AI showed less accuracy compared with continuous variables, such as vital signs.RMIS-AI improves the promptness in performing triage tasks as compared to using the manual input method. However, to make it a reliable alternative to the conventional method, technical supplementation and additional research should be pursued.
Pupose: The purpose of this study is to accident prevention program for the elderly and policy proposals were developed. Methods ::.This .study is intended to determine the actual situation of the elderly were accidents. To do this, from January 2012 to August 2013 Korea Consumer Agency CISS (Consumer Injury Surveillance System) collected through the 6650 accident in 65 years or older at the materials that were used. Conclusion: Analysis of gender, women in the 65-69 year old age group, the occurrence part is home place, a place in the bedroom of the home details, the room has a high frequency of accidents, respectively. Accident-related items, the internal finishes, the contents part is falling, slipping, falling, for each part of the head is the highest frequency, respectively.
Purpose: This study was conducted to test a structural model for patient safety culture of clinical nurses focusing on organizational policy and interpersonal factors.Methods: A descriptive structural equation model design was used.Participates in this study were 385 clinical nurses.The variables of safety management system, authentic leadership, team effectiveness, and patient safety culture were measured to test the hypothetical model.SPSS 25.0 and AMOS 21.0 were used to analyze descriptive statistics and path analysis.Results: The final model fit satisfied goodness-of-fit and all path were significant.Authentic leadership (β=.54, p=<.001) was reported as the most influencing factor, followed by team effectiveness (β=.24, p<.001) and safety management system (β=.21,p<.001).Safety management system (β=.38,p=.002) and authentic leadership (β=.12, p=.002) had indirect effects on patient safety culture as well.Conclusion: The findings of this study show the importance of authentic leadership, team effectiveness, and safety management system to develop patient safety culture.The health care organization should develop the programs to increase these influencing factors.
Introduction: Critically ill patients are frequently transferred from other hospitals to the emergency departments (ED) of tertiary hospitals. Due to the unforeseen transfer, the ED length of stay (LOS) of the patient is likely to be prolonged in addition to other potentially adverse effects. In this study we sought to confirm whether the establishment of an organized unit — the Emergency Transfer Coordination Center (ETCC) — to systematically coordinate emergency transfers would be effective in reducing the ED LOS of transferred, critically ill patients. Methods: The present study is a retrospective observational study focusing on patients who were transferred from other hospitals and admitted to the intensive care unit (ICU) of the ED in a tertiary hospital located in northwestern Seoul, the capital city of South Korea, from January 2019 – December 2020. The exposure variable of the study was ETCC approval before transfer, and ED LOS was the primary outcome. We used propensity score matching for comparison between the group with ETCC approval and the control group. Results: Included in the study were 1,097 patients admitted to the ICU after being transferred from other hospitals, of whom 306 (27.9%) were transferred with ETCC approval. The median ED LOS in the ETCC-approved group was significantly reduced to 277 minutes compared to 385 minutes in the group without ETCC approval. The ETCC had a greater effect on reducing evaluation time than boarding time, which was the same for populations with different clinical features. Conclusion: An ETCC can be effective in systematically reducing the ED LOS of critically ill patients who are transferred from other hospitals to tertiary hospitals that are experiencing severe crowding.
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