Bold Voices - August 2012 - (Page 16)

AT THE BEDSIDE Older Patients in ICU at High Risk for HAI Older patients treated with central catheter and/or mechanical ventilation devices in ICUs are at high risk for hospital-acquired infection (HAI), according to research presented at the 22nd European Congress of Clinical Microbiology and Infectious Diseases, London. The retrospective cohort study used the Premier Perspective 2007 hospital database of adults older than 18 years with an ICU stay of at least 48 hours. The database covers 20 percent of hospital discharges in the United States, a total of 460,000 ICU patients. “A device, namely a central catheter [odds ratio (OR), 3.4] or mechanical ventilation [OR, 2.8], trebled the risk of having an HAI, including bloodstream infection, nosocomial pneumonia and surgical-site infection,” study leader Florence Joly of Sanofi R&D, France, tells Medscape Medical News. Higher risks were associated with patients coming from the emergency department and those more than 75 years of age, she notes. Joly adds HAIs cost that mortality was four times an extra higher in $16,000 per patients with an HAI than in ICU stay. those without (18.5 percent vs. 4.5 percent), noting that, for patients with an HAI, ICU length of stay doubled from a mean of 8.1 days to 15.8 days. Bloodstream infection was the greatest driver of mortality, at 24.7 percent, followed by hospital-acquired pneumonia, 16.7 percent, and surgicalsite infection, 10.9 percent. A cost analysis based on direct variable costs and fi xed overhead costs showed HAIs cost an extra $16,000 per ICU stay — from $21,500 for a patient without an HAI to $37,500 for a patient with an HAI, Joly reports in the article. However, Christian Brun-Buisson, professor of medicine and intensive care at Université Paris-Est Créteil, Paris, advises caution when interpreting the study’s outcomes. “The consequences of HAI on morbidity and mortality have often been overestimated, which may lead to unrealistic expectations of the impact from preventive strategies,” he says in the article. Patients With Psychiatric Illness Stay Longer in ED Patients with psychiatric illness seeking emergency care average 11.5 hours in the emergency department (ED), with older age and uninsured status associated with increased length of stay, a study fi nds. “Patient and Practice-Related Determinants of Emergency Department Length of Stay for Patients With Psychiatric Illness” states that hospitalization, restraint use and diagnostic imaging have the greatest effects on post-assessment boarding time. Alcohol detected in toxicology screening leads to delays earlier in ED stays, according to the study published online in Annals of Emergency Medicine. The analysis of 1,092 adult patients with psychiatric illness treated at five Boston-area hospitals from June The longest ED stays 2008 to May 2009 also fi nds that hospitalized patients tend to be seen are associated with and assessed more quickly than those delayed availability discharged home, but they have a significantly longer overall stay. of inpatient beds. Average ED stay ranged from 8.6 hours for patients discharged to home to 15 hours for those sent to outside care facilities. “The need for inpatient admission was the factor associated with the greatest influence on length of stay, an effect that was due to long wait times after the decision to pursue admission had been made,” Anthony Weiss, director of quality management, Massachusetts General Hospital in Boston, and colleagues state in a related MedPage Today article. Hospitals could improve ED care for patients with psychiatric illness by identifying and sharing best practices to overcome factors that slow treatment, the study suggests. “The results of this study are important because they highlight the interrelatedness of the various components of the mental health system and provide objectively identified targets for quality improvement,” the authors note. 16 AUGUST 2012

Table of Contents for the Digital Edition of Bold Voices - August 2012

Front/Digital Edition Viewing Guide
Another Angle
‘AACN CSI Academy’ National Leadership Program Launches
Canadian Dynamics 2012: ‘Speak Up, Speak Out’
Grana Padano May Lower Blood Pressure
New Medicare Patient Satisfaction Requirement Misses Mark, Nurse Argues
FDA, The Joint Commission Aim to Reduce Alarm Fatigue
Fast Food in Hospitals Counters Goal of Healthy Eating
New Federal Hospital Visitation Standards
Nurse Obesity Linked to Long Hours
First-Ever Nurses Float Joins the 2013 Tournament of Roses Parade
AMA Urges Greater Focus on Ambulatory Patient Safety
Minimally Invasive Heart Valve Procedure Increases Patient Survival
Older Patients' in ICU at High Risk for HAI
Tele-ICU Symposium Explores Leading-Edge Technology
In Our Journals
Certification Capsules
Dare To
Contribute to the Evidence: Apply for an AACN Research Grant by Nov. 1
From the President

Bold Voices - August 2012