Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1535
J. Wykowski, S. Merel, P. Kritek, K. G. Hicks
{"title":"A Just-in-Time Curriculum to Teach Critical Incident Debriefing","authors":"J. Wykowski, S. Merel, P. Kritek, K. G. Hicks","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1535","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1535","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126060189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1536
H. Patel, J. Banks, A. Davis, J. Cadigan, B. Forcier, C. Orantes, K. Dover, K. Patel
{"title":"Resident Burnout, Moral Distress, and Resilience in the Medical Intensive Care Unit in an Academic Tertiary Care Center","authors":"H. Patel, J. Banks, A. Davis, J. Cadigan, B. Forcier, C. Orantes, K. Dover, K. Patel","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1536","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1536","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128575736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1541
P. Morejón, B. Seth, J. Vivanco-Suarez, W. Checkley, M. Grunauer, Ecuador Covid-19 Consortium
Rationale: Ecuador was among the top fifth of countries affected by the COVID-19 pandemic worldwide. Intensive care units (ICUs), and health system resilience form key elements of the health system to prepare for meeting needs of its population, both during surge needs, and for postpandemic planning. There is limited evaluation of the existing ICU infrastructure, processes and protocols within ICUs. Our study sought to perform an assessment of the ICU practices across Ecuador. Methods: During December, 2020, we conducted an observational, cross-sectional study using questionnaires developed in Spanish, that were deployed in 42 Ecuadorian medical facilities, using trained physicians. The questionnaires were developed by experts, covering domains including hospital characteristics, utilization, and structural factors, such as human resources, and staffing practices. ICUs were categorized by the degree of global resource availability. The primary outcomes were availability and access to equipment, personnel, protocols, and therapies relevant to the practice of critical care. Secondary outcomes were mortality, admissions in the emergency department and ICU annually. Results: Thirty-six hospitals (85.7%) agreed to participate and were enrolled in the study. Annual average ICU mortality in 2019 was 20% (IQR: 14-30), which in 2020 increased to 40.5% (IQR 28.9-49.8), in the facilities evaluated. Annual average ICU admissions were 311 (154-404), with an average annual bed capacity of 120 (82-221.5). Sepsis, deep venous thromboprophylaxis, and glucose monitoring protocols were most commonly reported (96%), while protocols for massive transfusion (48%), targeted temperature management (41%), and palliative care (30%) were less common. In a multivariable linear regression adjusting for ICU level, annual ICU mortality was significantly lower in hospitals that reported higher use of respiratory protocols (- 3.4%, 95% CI-5.4 to -1.3;p=0.003) and sepsis protocols (-8.4%, 95% CI -14.1 to -2.7);p= 0.006). Conclusions: To our knowledge, this is the first study describing the ICU structure, process and components of different facilities across Ecuador. These may help guide decision-making policymakers, and health service communities to understand Ecuador's health system resilience, and key avenues for improvement and planning.
{"title":"ICU Structures and Protocols in Ecuador: A Peri-Pandemic Nationwide Assessment","authors":"P. Morejón, B. Seth, J. Vivanco-Suarez, W. Checkley, M. Grunauer, Ecuador Covid-19 Consortium","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1541","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1541","url":null,"abstract":"Rationale: Ecuador was among the top fifth of countries affected by the COVID-19 pandemic worldwide. Intensive care units (ICUs), and health system resilience form key elements of the health system to prepare for meeting needs of its population, both during surge needs, and for postpandemic planning. There is limited evaluation of the existing ICU infrastructure, processes and protocols within ICUs. Our study sought to perform an assessment of the ICU practices across Ecuador. Methods: During December, 2020, we conducted an observational, cross-sectional study using questionnaires developed in Spanish, that were deployed in 42 Ecuadorian medical facilities, using trained physicians. The questionnaires were developed by experts, covering domains including hospital characteristics, utilization, and structural factors, such as human resources, and staffing practices. ICUs were categorized by the degree of global resource availability. The primary outcomes were availability and access to equipment, personnel, protocols, and therapies relevant to the practice of critical care. Secondary outcomes were mortality, admissions in the emergency department and ICU annually. Results: Thirty-six hospitals (85.7%) agreed to participate and were enrolled in the study. Annual average ICU mortality in 2019 was 20% (IQR: 14-30), which in 2020 increased to 40.5% (IQR 28.9-49.8), in the facilities evaluated. Annual average ICU admissions were 311 (154-404), with an average annual bed capacity of 120 (82-221.5). Sepsis, deep venous thromboprophylaxis, and glucose monitoring protocols were most commonly reported (96%), while protocols for massive transfusion (48%), targeted temperature management (41%), and palliative care (30%) were less common. In a multivariable linear regression adjusting for ICU level, annual ICU mortality was significantly lower in hospitals that reported higher use of respiratory protocols (- 3.4%, 95% CI-5.4 to -1.3;p=0.003) and sepsis protocols (-8.4%, 95% CI -14.1 to -2.7);p= 0.006). Conclusions: To our knowledge, this is the first study describing the ICU structure, process and components of different facilities across Ecuador. These may help guide decision-making policymakers, and health service communities to understand Ecuador's health system resilience, and key avenues for improvement and planning.","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113955853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1538
S. Fatima, O. Haider, M. Khan, I. Ratnani
{"title":"ICU Physicians Turning to Social Media to Mitigate Burnout - A Quantitative Study","authors":"S. Fatima, O. Haider, M. Khan, I. Ratnani","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1538","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1538","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117062793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1545
M. Freedman, K. Hess, K. Miller, M. Kashiouris
{"title":"The Cost of Re-Consultation: Outcomes of Patients Who Require Repeat Intensive Care Unit Consults","authors":"M. Freedman, K. Hess, K. Miller, M. Kashiouris","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1545","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1545","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122079465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1528
J. Channick, L. Wisk, R. Buhr
Introduction: COVID-19 magnified the importance of health systems' readiness for scarce resource allocation during times of potential crisis-related shortages. Understanding how ethical values of laypeople differ from that of healthcare workers (HCW) is crucial to ensure a widely accepted policy. We intended to better understand how the values of laypeople, licensed independent practitioners (LIP), and non-LIP HCW align and differ regarding scarce resource allocation, particularly on exemptions and adjustments to ICU triage decisions, which could otherwise undermine public trust if not appropriately understood. Methods: Data were collected from a web-based national survey aimed at understanding the effects of the COVID-19 pandemic. We analyzed 1934 adult respondents, including 1353 lay-people, 200 LIPs and 381 non-LIP HCW. Respondents' values were assessed by 9- point Likert scale, (1= should be less likely to receive, 5 = should not influence, 9 = should be much more likely to receive ICU care), comparing responses using Kruskal-Wallis tests. Results: All groups equally prioritized ICU care for pregnant persons in first trimester. Agreement on prioritization was stronger for 3rd trimester pregnancy, where LIP rated agreement higher than other HCW (P=0.020). Laypeople favored a principle of reciprocity, prioritizing front-line health workers more than either LIP or other HCW (8 vs 7 vs 6, respectively, P<0.001). Laypersons rated their trust that health systems would apply SRA policy in a fair and consistent way slightly lower compared to either LIP or other HCW, but this was not significant (6 vs 7 vs 7, P=0.5). All groups felt similarly anxious and worried when thinking about policies like this (median score 7 where 9 = “I feel very anxious when thinking about this”, P=0.9). Discussion/Conclusions: In creating policies for scarce resource allocation, it is important to consider the nuanced values of all groups affected by these policies. In particular, while concern may exist that systems using non-healthrelated factors in treatment decisions may be less agreeable, we found similar levels of agreement when prioritizing on two key groups: pregnancy and at-risk health worker status. While our survey showed all groups lean towards trusting the healthcare system to fairly allocate resources, the range of responses and the consistent anxiety surrounding these policies emphasizes the importance of trying to understand and accommodate the priorities of affected groups as able. (Table Presented).
导言:2019冠状病毒病凸显了卫生系统在与危机相关的潜在短缺时期为稀缺资源分配做好准备的重要性。了解外行人的道德价值观与卫生保健工作者(HCW)的道德价值观有何不同，对于确保政策得到广泛接受至关重要。我们打算更好地了解外行人、有执照的独立执业医师(LIP)和非LIP HCW在稀缺资源分配方面的价值观是如何一致和不同的，特别是在豁免和调整ICU分诊决定方面，如果不能适当理解，这可能会破坏公众的信任。方法:数据来自一项基于网络的全国性调查，旨在了解COVID-19大流行的影响。我们分析了1934名成人受访者，其中包括1353名非专业人士，200名lip和381名非lip HCW。受访者的价值采用9分李克特量表评估，(1=应该不太可能接受，5 =不应该影响，9 =应该更有可能接受ICU护理)，使用Kruskal-Wallis测试比较回答。结果:所有组对妊娠早期患者的ICU护理同等重视。在妊娠晚期，优先级的一致性更强，LIP评分一致性高于其他HCW (P=0.020)。外行人支持互惠原则，优先考虑一线卫生工作者，而不是LIP或其他HCW(分别为8、7和6,P<0.001)。与LIP或其他HCW相比，外行人对卫生系统将以公平和一致的方式实施SRA政策的信任度略低，但这并不显著(6 vs 7 vs 7, P=0.5)。所有群体在考虑此类政策时都感到类似的焦虑和担忧(中位数得分为7，其中9 =“想到这一点时我感到非常焦虑”，P=0.9)。讨论/结论:在制定稀缺资源分配政策时，重要的是要考虑受这些政策影响的所有群体的细微差别。特别是，虽然可能存在在治疗决策中使用非健康相关因素的系统可能不太令人满意的担忧，但我们发现，在优先考虑两个关键群体时，同意程度相似:怀孕和高危卫生工作者状态。虽然我们的调查显示，所有群体都倾向于相信医疗保健系统能够公平分配资源，但对这些政策的反应范围和持续的焦虑强调了尽可能理解和适应受影响群体优先事项的重要性。(表)。
{"title":"Opinions on Scare Resource Allocation Policy Exemptions and Adjustments Among Laypeople and Healthcare Workers by License Type","authors":"J. Channick, L. Wisk, R. Buhr","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1528","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1528","url":null,"abstract":"Introduction: COVID-19 magnified the importance of health systems' readiness for scarce resource allocation during times of potential crisis-related shortages. Understanding how ethical values of laypeople differ from that of healthcare workers (HCW) is crucial to ensure a widely accepted policy. We intended to better understand how the values of laypeople, licensed independent practitioners (LIP), and non-LIP HCW align and differ regarding scarce resource allocation, particularly on exemptions and adjustments to ICU triage decisions, which could otherwise undermine public trust if not appropriately understood. Methods: Data were collected from a web-based national survey aimed at understanding the effects of the COVID-19 pandemic. We analyzed 1934 adult respondents, including 1353 lay-people, 200 LIPs and 381 non-LIP HCW. Respondents' values were assessed by 9- point Likert scale, (1= should be less likely to receive, 5 = should not influence, 9 = should be much more likely to receive ICU care), comparing responses using Kruskal-Wallis tests. Results: All groups equally prioritized ICU care for pregnant persons in first trimester. Agreement on prioritization was stronger for 3rd trimester pregnancy, where LIP rated agreement higher than other HCW (P=0.020). Laypeople favored a principle of reciprocity, prioritizing front-line health workers more than either LIP or other HCW (8 vs 7 vs 6, respectively, P<0.001). Laypersons rated their trust that health systems would apply SRA policy in a fair and consistent way slightly lower compared to either LIP or other HCW, but this was not significant (6 vs 7 vs 7, P=0.5). All groups felt similarly anxious and worried when thinking about policies like this (median score 7 where 9 = “I feel very anxious when thinking about this”, P=0.9). Discussion/Conclusions: In creating policies for scarce resource allocation, it is important to consider the nuanced values of all groups affected by these policies. In particular, while concern may exist that systems using non-healthrelated factors in treatment decisions may be less agreeable, we found similar levels of agreement when prioritizing on two key groups: pregnancy and at-risk health worker status. While our survey showed all groups lean towards trusting the healthcare system to fairly allocate resources, the range of responses and the consistent anxiety surrounding these policies emphasizes the importance of trying to understand and accommodate the priorities of affected groups as able. (Table Presented).","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128694171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1532
J. Mbae, M. Reddy, M. Kaul, I. Imayama, T. F. Ferrer Marrero
{"title":"Preliminary Assessment of a Formalized Airway Curriculum in Adult Pulmonary and Critical Care Fellowship Program","authors":"J. Mbae, M. Reddy, M. Kaul, I. Imayama, T. F. Ferrer Marrero","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1532","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1532","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"217 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122441794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1539
B. Noureddine, J. Aliotta, N. Ward
{"title":"Inter-Hospital ICU Transfers to a Tertiary Care Center: A Qualitative Analysis","authors":"B. Noureddine, J. Aliotta, N. Ward","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1539","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1539","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122685838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1534
S. Hyder, S. R. Russell
{"title":"Disconnect Between Provider Expectations and Delivered Therapy: Implications for Patients with Artificial Airways","authors":"S. Hyder, S. R. Russell","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1534","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1534","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129877623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1540
H. Soh, R. Fiter, N. Goel, V. Astha, Y. Li, E. Benn, K. Mathews
{"title":"Outcomes Associated with Intensive Care Unit Discharge During Times of High Unit Occupancy","authors":"H. Soh, R. Fiter, N. Goel, V. Astha, Y. Li, E. Benn, K. Mathews","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1540","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a1540","url":null,"abstract":"","PeriodicalId":264442,"journal":{"name":"A44. ICU CURRICULUM AND SYSTEMS","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133210618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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