Pub Date : 2025-11-01Epub Date: 2025-08-14DOI: 10.1016/j.aucc.2025.101308
Hongmei Liang RD, MSN , Xiaoqin Wang RD, MSN , Xingmei Zhou RD, MSN , Ji Wang RD, MSN , Chuanfeng Pei RD, MSN , Long Liu MD, PhD
Background
Peripherally inserted central catheters (PICCs) are commonly used in patients with traumatic brain injury (TBI) in neurosurgical intensive care units. A frequent complication of this procedure is upper-extremity venous thrombosis (UEVT), which can lead to adverse outcomes.
Objectives
The objective of this study was to evaluate the effectiveness of intermittent pneumatic compression (IPC) in reducing the incidence of UEVT in patients with TBI undergoing PICC placement.
Methods
Patients with TBI admitted to our neurosurgical intensive care unit between 2021 and 2023 were included in the study. All patients underwent PICC placement and were randomly assigned to a control or intervention group. The intervention group received IPC on the upper limb. Doppler ultrasound was used to detect venous thrombosis and measure blood flow in the upper extremity. Differences in blood flow velocities between the groups at specified time points were analysed using the Mann–Whitney U and Wilcoxon signed-rank tests.
Results
The intervention group showed significantly lower rates of UEVT (4.1% vs. 18.6%, P = 0.001), deep vein thrombosis (1.0% vs. 8.2%, P = 0.018), and superficial vein thrombosis (3.1% vs. 10.3%, P = 0.042) than the control group. Venous flow velocities on days 14 and 28 after catheterisation were significantly higher in the intervention group (all P < 0.001), while no significant differences were observed on days 0 and 7.
Conclusion
IPC can reduce the incidence of UEVT and improve blood flow in the catheterised upper extremity in patients with TBI after PICC placement.
{"title":"Intermittent pneumatic compression can reduce the incidence of upper extremity venous thrombosis after peripherally inserted central catheter placement in traumatic brain injury patients: A randomised controlled trial","authors":"Hongmei Liang RD, MSN , Xiaoqin Wang RD, MSN , Xingmei Zhou RD, MSN , Ji Wang RD, MSN , Chuanfeng Pei RD, MSN , Long Liu MD, PhD","doi":"10.1016/j.aucc.2025.101308","DOIUrl":"10.1016/j.aucc.2025.101308","url":null,"abstract":"<div><h3>Background</h3><div>Peripherally inserted central catheters (PICCs) are commonly used in patients with traumatic brain injury (TBI) in neurosurgical intensive care units. A frequent complication of this procedure is upper-extremity venous thrombosis (UEVT), which can lead to adverse outcomes.</div></div><div><h3>Objectives</h3><div>The objective of this study was to evaluate the effectiveness of intermittent pneumatic compression (IPC) in reducing the incidence of UEVT in patients with TBI undergoing PICC placement.</div></div><div><h3>Methods</h3><div>Patients with TBI admitted to our neurosurgical intensive care unit between 2021 and 2023 were included in the study. All patients underwent PICC placement and were randomly assigned to a control or intervention group. The intervention group received IPC on the upper limb. Doppler ultrasound was used to detect venous thrombosis and measure blood flow in the upper extremity. Differences in blood flow velocities between the groups at specified time points were analysed using the Mann–Whitney U and Wilcoxon signed-rank tests.</div></div><div><h3>Results</h3><div>The intervention group showed significantly lower rates of UEVT (4.1% vs. 18.6%, <em>P</em> = 0.001), deep vein thrombosis (1.0% vs. 8.2%, <em>P</em> = 0.018), and superficial vein thrombosis (3.1% vs. 10.3%, <em>P</em> = 0.042) than the control group. Venous flow velocities on days 14 and 28 after catheterisation were significantly higher in the intervention group (all <em>P</em> < 0.001), while no significant differences were observed on days 0 and 7.</div></div><div><h3>Conclusion</h3><div>IPC can reduce the incidence of UEVT and improve blood flow in the catheterised upper extremity in patients with TBI after PICC placement.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101308"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intensive care nurses frequently request clinical debriefing with a goal to learn, develop, and process the sometimes confronting and distressing work environment. The literature and application of clinical debriefing can be confusing and difficult to navigate with a paucity of evidence in the intensive care environment. This creates uncertainty for how and what events should be debriefed and what would be beneficial for nurses working in the intensive care unit (ICU).
Aims
The aim of this study was to explore the perceptions, attitudes, and experiences of clinical debriefing for nurses working in an ICU.
Study design
This study utilised an interpretative qualitative design involving semistructured focus groups. Nurses employed within the ICU of a large metropolitan hospital in Australia were invited to participate. The focus groups were audio-recorded, transcribed verbatim, and analysed using an inductive thematic approach.
Results
A total of 31 ICU nurses participated in five semistructured focus groups. Four themes were identified: (i) uncertainty of definition and logistics; (ii) clinical debriefing requires psychological safety; (iii) the value of clinical debriefing; and (iv) clinical debriefing as a form of organisational acknowledgement.
Conclusion
This study identified four themes that outlined the potential importance and meaning of clinical debriefing for ICU nurses. Despite several perceived barriers to implementing regular clinical debriefing, ICU nurses advocated for the opportunity participate in regular clinical debriefing for learning and support.
{"title":"Intensive care unit nurses’ understanding and experience of clinical debriefing: A focus group","authors":"Annabel Levido BSN, M Applied Management (Nurs), RN , Fiona Coyer RN, PhD , Samantha Keogh RN, PhD , Liz Crowe BSocWk, PhD","doi":"10.1016/j.aucc.2025.101439","DOIUrl":"10.1016/j.aucc.2025.101439","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care nurses frequently request clinical debriefing with a goal to learn, develop, and process the sometimes confronting and distressing work environment. The literature and application of clinical debriefing can be confusing and difficult to navigate with a paucity of evidence in the intensive care environment. This creates uncertainty for how and what events should be debriefed and what would be beneficial for nurses working in the intensive care unit (ICU).</div></div><div><h3>Aims</h3><div>The aim of this study was to explore the perceptions, attitudes, and experiences of clinical debriefing for nurses working in an ICU.</div></div><div><h3>Study design</h3><div>This study utilised an interpretative qualitative design involving semistructured focus groups. Nurses employed within the ICU of a large metropolitan hospital in Australia were invited to participate. The focus groups were audio-recorded, transcribed verbatim, and analysed using an inductive thematic approach.</div></div><div><h3>Results</h3><div>A total of 31 ICU nurses participated in five semistructured focus groups. Four themes were identified: (i) uncertainty of definition and logistics; (ii) clinical debriefing requires psychological safety; (iii) the value of clinical debriefing; and (iv) clinical debriefing as a form of organisational acknowledgement.</div></div><div><h3>Conclusion</h3><div>This study identified four themes that outlined the potential importance and meaning of clinical debriefing for ICU nurses. Despite several perceived barriers to implementing regular clinical debriefing, ICU nurses advocated for the opportunity participate in regular clinical debriefing for learning and support.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101439"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital admission can be a stressful experience for patients and their families. Although healthcare professionals can also be patients, there is limited understanding of nurses’ experiences when caring for them in hospital settings.
Aim
The aims of this study were to explore the challenges nurses encounter while caring for hospitalised healthcare professionals and to compare experiences between participants in intensive care unit and acute care settings.
Methods
A cross-sectional exploratory study was conducted in July 2022 using an online survey via Research Electronic Data Capture (REDCap) with registered nurses who had cared for a healthcare professional-patient within the previous 3 years.
Results
Sixty-nine participants were included, with a mean age of 44.8 years and a mean of 18.8 years of experience as a registered nurse; 49% worked in intensive care and 51% in acute care settings, including surgery, emergency, and cardiology. A substantial 63.7% reported that caring for healthcare professional-patients was more challenging, while 49.3% found it more stressful than caring for non–healthcare professional-patients. Only 3% had received prior education that supported them in this role, despite 87% feeling prepared to deliver care and 75% feeling comfortable doing so. Open-ended questions reflecting on their experience caring for healthcare professional-patients generated three themes: enhanced support and knowledge needed to facilitate the role reversal of healthcare professionals becoming patients, recognising and respecting the evolving dynamics in caring for healthcare professionals as patients, and tailoring communication to align with individual needs and prior knowledge. There were no differences between intensive care unit participants and acute care participants regarding feeling prepared, experiencing stress, or feeling challenged caring for health professional-patients.
Conclusion
In conclusion, many nurses face significant challenges and heightened stress while caring for hospitalised healthcare professionals, whether in intensive care or acute care environments. The findings highlight a critical need for enhanced training and support to address the unique dynamics and communication requirements of these situations.
{"title":"The experiences and challenges of caring for a healthcare professional patient in intensive and acute care settings: A cross-sectional exploratory survey","authors":"Lynne Hunt RN, BN(Hons), Melissa Riegel RN, PhD, Robyn Gallagher RN, PhD, Thomas Buckley RN, PhD","doi":"10.1016/j.aucc.2025.101453","DOIUrl":"10.1016/j.aucc.2025.101453","url":null,"abstract":"<div><h3>Background</h3><div>Hospital admission can be a stressful experience for patients and their families. Although healthcare professionals can also be patients, there is limited understanding of nurses’ experiences when caring for them in hospital settings.</div></div><div><h3>Aim</h3><div>The aims of this study were to explore the challenges nurses encounter while caring for hospitalised healthcare professionals and to compare experiences between participants in intensive care unit and acute care settings.</div></div><div><h3>Methods</h3><div>A cross-sectional exploratory study was conducted in July 2022 using an online survey via Research Electronic Data Capture (REDCap) with registered nurses who had cared for a healthcare professional-patient within the previous 3 years.</div></div><div><h3>Results</h3><div>Sixty-nine participants were included, with a mean age of 44.8 years and a mean of 18.8 years of experience as a registered nurse; 49% worked in intensive care and 51% in acute care settings, including surgery, emergency, and cardiology. A substantial 63.7% reported that caring for healthcare professional-patients was more challenging, while 49.3% found it more stressful than caring for non–healthcare professional-patients. Only 3% had received prior education that supported them in this role, despite 87% feeling prepared to deliver care and 75% feeling comfortable doing so. Open-ended questions reflecting on their experience caring for healthcare professional-patients generated three themes: enhanced support and knowledge needed to facilitate the role reversal of healthcare professionals becoming patients, recognising and respecting the evolving dynamics in caring for healthcare professionals as patients, and tailoring communication to align with individual needs and prior knowledge. There were no differences between intensive care unit participants and acute care participants regarding feeling prepared, experiencing stress, or feeling challenged caring for health professional-patients.</div></div><div><h3>Conclusion</h3><div>In conclusion, many nurses face significant challenges and heightened stress while caring for hospitalised healthcare professionals, whether in intensive care or acute care environments. The findings highlight a critical need for enhanced training and support to address the unique dynamics and communication requirements of these situations.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101453"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-08-07DOI: 10.1016/j.aucc.2025.101301
Jessica M Hampton, Elizabeth C Ward, Lynette Morrison, Kellie Sosnowski, James Banham, Marilia Libera, Chanelle Louwen, Hayden White, Rachael Watson, Melissa A Day
Background: Psychological distress is common among intensive care unit (ICU) patients and can lead to long-term adverse psychological sequelae. While early psychological interventions may help mitigate these effects, their feasibility within critical care settings remains largely unexplored. Additionally, the role of psychologists in delivering such interventions in Australia remains unclear, particularly given inconsistencies in workforce availability and integration into standard care.
Aims/objectives: The aim of this study was to (i) outline the development of a psychologist-led screening and intervention protocol in an Australian ICU and (ii) evaluate its preliminary feasibility. It also examined the suitability of a potential outcome measure to inform future trial design.
Methods: The Medical Research Council's framework for developing complex interventions in health was applied. The intervention was designed for an Australian metropolitan ICU. It consisted of a modular-based psychological intervention tailored to the patient's level of psychological distress. A single-arm prospective pilot study was conducted, and 30 patients were recruited. Feasibility was assessed based on recruitment rates, patient engagement, and outcome measure completion.
Results: Recruitment challenges were observed, with a low eligibility screening rate. Staffing constraints and consent-related barriers further limited recruitment. Intervention engagement was high, with 96% of consenting participants completing at least one intervention component. Outcome measure completion rates supported the feasibility of a larger trial, with preliminary findings suggesting a significant reduction in negative emotional affect over time. Consistent with the Medical Research Council's framework, refinements to the intervention are recommended.
Conclusions: The findings support the feasibility of a psychologist-led intervention in the ICU, though refinements are necessary to improve recruitment, streamline delivery, and enhance engagement. This study highlights the potential of early psychological interventions to improve patients' emotional well-being. Addressing staffing limitations and consent barriers could enhance accessibility and effectiveness in future trials.
Registration: This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000619640), with the first participant recruited on 4/07/2023.
{"title":"The development and feasibility of a psychologist-led screening and modular-based psychological intervention in an Australian intensive care unit: A pilot study.","authors":"Jessica M Hampton, Elizabeth C Ward, Lynette Morrison, Kellie Sosnowski, James Banham, Marilia Libera, Chanelle Louwen, Hayden White, Rachael Watson, Melissa A Day","doi":"10.1016/j.aucc.2025.101301","DOIUrl":"10.1016/j.aucc.2025.101301","url":null,"abstract":"<p><strong>Background: </strong>Psychological distress is common among intensive care unit (ICU) patients and can lead to long-term adverse psychological sequelae. While early psychological interventions may help mitigate these effects, their feasibility within critical care settings remains largely unexplored. Additionally, the role of psychologists in delivering such interventions in Australia remains unclear, particularly given inconsistencies in workforce availability and integration into standard care.</p><p><strong>Aims/objectives: </strong>The aim of this study was to (i) outline the development of a psychologist-led screening and intervention protocol in an Australian ICU and (ii) evaluate its preliminary feasibility. It also examined the suitability of a potential outcome measure to inform future trial design.</p><p><strong>Methods: </strong>The Medical Research Council's framework for developing complex interventions in health was applied. The intervention was designed for an Australian metropolitan ICU. It consisted of a modular-based psychological intervention tailored to the patient's level of psychological distress. A single-arm prospective pilot study was conducted, and 30 patients were recruited. Feasibility was assessed based on recruitment rates, patient engagement, and outcome measure completion.</p><p><strong>Results: </strong>Recruitment challenges were observed, with a low eligibility screening rate. Staffing constraints and consent-related barriers further limited recruitment. Intervention engagement was high, with 96% of consenting participants completing at least one intervention component. Outcome measure completion rates supported the feasibility of a larger trial, with preliminary findings suggesting a significant reduction in negative emotional affect over time. Consistent with the Medical Research Council's framework, refinements to the intervention are recommended.</p><p><strong>Conclusions: </strong>The findings support the feasibility of a psychologist-led intervention in the ICU, though refinements are necessary to improve recruitment, streamline delivery, and enhance engagement. This study highlights the potential of early psychological interventions to improve patients' emotional well-being. Addressing staffing limitations and consent barriers could enhance accessibility and effectiveness in future trials.</p><p><strong>Registration: </strong>This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000619640), with the first participant recruited on 4/07/2023.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"101301"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-09-18DOI: 10.1016/j.aucc.2025.101419
Lili Pan RN, BN (Registered Nurse, Bachelor of Nursing), Xia Luo RN, BN (Registered Nurse, Bachelor of Nursing), Jie Peng Associate Chief Physician, MB (Bachelor of Medicine)
{"title":"Letter to “Incidence of pressure injuries and effectiveness of a prevention care bundle in critically ill Vietnamese patients: A prospective cohort study”","authors":"Lili Pan RN, BN (Registered Nurse, Bachelor of Nursing), Xia Luo RN, BN (Registered Nurse, Bachelor of Nursing), Jie Peng Associate Chief Physician, MB (Bachelor of Medicine)","doi":"10.1016/j.aucc.2025.101419","DOIUrl":"10.1016/j.aucc.2025.101419","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101419"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-09-20DOI: 10.1016/j.aucc.2025.101436
Rachael Parke RN, PhD , Louise Rose RN, PhD , Thomas Buckley RN, PhD , Alexis Tabah MD , Jeffrey Presneill MBBS, PhD , Kathleen Mason BHSc , Kyly Mills PhD , Andrea P. Marshall RN, PhD
Background
Family members of patients admitted to an intensive care unit (ICU) may experience adverse physical, psychological, and social impacts. Although flexible in-person visiting aims to reduce these adverse family experiences, some families encounter challenges due to geographical distances and their own frailty and work/caregiving commitments. Virtual visiting (VV), as an adjunct or alternative to in-person visiting, is a strategy that could address inequities of access.
Objectives
To inform future research, our objectives were to document current (post-COVID-19 pandemic) ICU visiting practices and policies specific to VV in ICUs across Australia and New Zealand (ANZ).
Methods
We conducted a multicentre, cross-sectional, self-administered electronic survey sent to the lead medical director or nurse unit manager of adult/mixed ICUs in public and private hospitals across ANZ. Survey development was informed by the evidence base, our experience, and surveys conducted during the pandemic. Descriptive statistics were used to report survey results.
Results
In total, survey responses were received from 51 ICUs, comprising 26 of 31 (84%) of requested New Zealand sites and 25 of 162 (15%) of Australian sites (overall 26% ANZ response rate). While unrestricted visiting (no restriction on time or duration of visit) occurred in 53% of ICUs, only six (12%) offered 24 h/day family access. Thirty ICUs (59%) reported some use of VV although 15 of 30 (50%) reported this occurred only rarely. Ten ICUs that used VV during the pandemic now no longer provide this option. Challenges to VV included limited availability of hardware, organisational restrictions on software, and limited access to training on how to conduct a VV.
Conclusions
Currently, in Australian and New Zealand ICUs, in-person visiting is often restricted by duration of visiting hours. The use of VV to support patients and their families in adult/mixed ICUs appears limited and may be declining. The impact of reduced access and whether use of VV improves patient- and family-centred outcomes, addresses access inequities, and should be part of future pandemic preparedness should be explored in future research.
{"title":"Intensive care virtual visiting practices in Australia and New Zealand following the COVID-19 pandemic: A binational survey","authors":"Rachael Parke RN, PhD , Louise Rose RN, PhD , Thomas Buckley RN, PhD , Alexis Tabah MD , Jeffrey Presneill MBBS, PhD , Kathleen Mason BHSc , Kyly Mills PhD , Andrea P. Marshall RN, PhD","doi":"10.1016/j.aucc.2025.101436","DOIUrl":"10.1016/j.aucc.2025.101436","url":null,"abstract":"<div><h3>Background</h3><div>Family members of patients admitted to an intensive care unit (ICU) may experience adverse physical, psychological, and social impacts. Although flexible in-person visiting aims to reduce these adverse family experiences, some families encounter challenges due to geographical distances and their own frailty and work/caregiving commitments. Virtual visiting (VV), as an adjunct or alternative to in-person visiting, is a strategy that could address inequities of access.</div></div><div><h3>Objectives</h3><div>To inform future research, our objectives were to document current (post-COVID-19 pandemic) ICU visiting practices and policies specific to VV in ICUs across Australia and New Zealand (ANZ).</div></div><div><h3>Methods</h3><div>We conducted a multicentre, cross-sectional, self-administered electronic survey sent to the lead medical director or nurse unit manager of adult/mixed ICUs in public and private hospitals across ANZ. Survey development was informed by the evidence base, our experience, and surveys conducted during the pandemic. Descriptive statistics were used to report survey results.</div></div><div><h3>Results</h3><div>In total, survey responses were received from 51 ICUs, comprising 26 of 31 (84%) of requested New Zealand sites and 25 of 162 (15%) of Australian sites (overall 26% ANZ response rate). While unrestricted visiting (no restriction on time or duration of visit) occurred in 53% of ICUs, only six (12%) offered 24 h/day family access. Thirty ICUs (59%) reported some use of VV although 15 of 30 (50%) reported this occurred only rarely. Ten ICUs that used VV during the pandemic now no longer provide this option. Challenges to VV included limited availability of hardware, organisational restrictions on software, and limited access to training on how to conduct a VV.</div></div><div><h3>Conclusions</h3><div>Currently, in Australian and New Zealand ICUs, in-person visiting is often restricted by duration of visiting hours. The use of VV to support patients and their families in adult/mixed ICUs appears limited and may be declining. The impact of reduced access and whether use of VV improves patient- and family-centred outcomes, addresses access inequities, and should be part of future pandemic preparedness should be explored in future research.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101436"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-08-13DOI: 10.1016/j.aucc.2025.101307
Melanie L. McIntyre BHSc SpPath, GradCertClinEd , Yuxi Liu BEng, PhD , Joanne Murray PhD, BAppSc(Speech Pathology), CPSP , Shaowen Qin BEng, MEng, MS(Applied Mathematics), PhD , Timothy Chimunda MBChB, FCICM, AMC, MCC, MACEM , Sebastian H. Doeltgen MSLT, PhD
Background
Machine learning offers opportunities to identify complex risk patterns in large data sets. We explored the methodological feasibility, and proof of concept, of applying machine learning techniques to dysphagia (swallowing difficulty) risk identification for adult patients who required endotracheal intubation within an intensive care unit (ICU).
Aim
The aim of this study was to explore the methodological feasibility and proof of concept of developing machine learning models for dysphagia risk identification for adult patients who required endotracheal intubation within an ICU.
Methods
In this cohort study, two large healthcare databases were linked using deterministic logic. All participants received invasive mechanical ventilation in an ICU. Several machine learning model candidates were explored. Insights into the model decision-making have been provided using SHapley Additive exPlanation values.
Results
A total of 59 811 patients from 42 sites were included in the study. The top five most influential factors in determining the presence or absence of dysphagia at a cohort level were duration of mechanical ventilation, age, cardiac admission, neurological admission, and Acute Physiology and Chronic Health Evaluation III score.
Conclusion
There is a promising prospect of machine learning in dynamic dysphagia risk screening, which we propose should be considered for clinical use in the future. The patient-specific influence of each risk factor in determining the presence or absence of dysphagia highlights the importance of determining risk based on the individual patient's unique combination of risk factors, and not on cohort means, as has been done previously.
{"title":"Exploring explainable machine learning techniques to aid dysphagia risk identification: A feasibility study","authors":"Melanie L. McIntyre BHSc SpPath, GradCertClinEd , Yuxi Liu BEng, PhD , Joanne Murray PhD, BAppSc(Speech Pathology), CPSP , Shaowen Qin BEng, MEng, MS(Applied Mathematics), PhD , Timothy Chimunda MBChB, FCICM, AMC, MCC, MACEM , Sebastian H. Doeltgen MSLT, PhD","doi":"10.1016/j.aucc.2025.101307","DOIUrl":"10.1016/j.aucc.2025.101307","url":null,"abstract":"<div><h3>Background</h3><div>Machine learning offers opportunities to identify complex risk patterns in large data sets. We explored the methodological feasibility, and proof of concept, of applying machine learning techniques to dysphagia (swallowing difficulty) risk identification for adult patients who required endotracheal intubation within an intensive care unit (ICU).</div></div><div><h3>Aim</h3><div>The aim of this study was to explore the methodological feasibility and proof of concept of developing machine learning models for dysphagia risk identification for adult patients who required endotracheal intubation within an ICU.</div></div><div><h3>Methods</h3><div>In this cohort study, two large healthcare databases were linked using deterministic logic. All participants received invasive mechanical ventilation in an ICU. Several machine learning model candidates were explored. Insights into the model decision-making have been provided using SHapley Additive exPlanation values.</div></div><div><h3>Results</h3><div>A total of 59 811 patients from 42 sites were included in the study. The top five most influential factors in determining the presence or absence of dysphagia at a cohort level were duration of mechanical ventilation, age, cardiac admission, neurological admission, and Acute Physiology and Chronic Health Evaluation III score.</div></div><div><h3>Conclusion</h3><div>There is a promising prospect of machine learning in dynamic dysphagia risk screening, which we propose should be considered for clinical use in the future. The patient-specific influence of each risk factor in determining the presence or absence of dysphagia highlights the importance of determining risk based on the individual patient's unique combination of risk factors, and not on cohort means, as has been done previously.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101307"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-08-14DOI: 10.1016/j.aucc.2025.101310
Natalie A. Kondos RN, BNurs, BBiomedSci(Hons) , Jonathan Barrett MBBs, MPH, FRACP, FCICM , Jo McDonall RN, PhD , Tracey Bucknall RN, FAAN, GAICD, PhD
Introduction
Decisions to end a medical emergency team (MET) call have been infrequently studied. Premature ending of MET calls may compromise patient outcomes. The aim of the study was to describe clinicians' documentation practices upon ending MET calls and to compare patients with single and repeat MET call activation on the initial call.
Methods
A retrospective review was conducted at a metropolitan hospital in Melbourne, Victoria, from Oct 1st, 2018, to September 30th, 2019. From a total of 8648 initial MET calls, 500 were included in the sample, 250 single and 250 repeated (≥2) MET calls. Data from patients’ index MET call were analysed using univariate analyses and descriptive statistics. Variables included documentation of the MET call stand-down decision and associated decision-making elements, demographic and admission characteristics, and patient outcomes. We compared documentation of MET call stand-down decision-making with expert consensus on essential MET call stand-down decision-making elements.
Results
Key differences in the documentation of the essential MET call stand-down decision-making elements were that repeat MET patients had a higher proportion of care outcomes (post-MET call) documented (72%) than single MET patients (48.8%). Treatment decisions were documented over 75% of the time and an escalation plan was documented less than 50% of the time for both MET call patient groups. Repeat MET call patients were twice as likely to die in hospital (15.2% versus 7.6%, p = 0.01), had double the hospital length of stay (21 versus 10 days, p = 0.031), and were three times more likely to be discharged to rehabilitation services rather than home (28% versus 9.6%, p = 0.001).
Conclusion
There were differences at the index MET call in documentation and outcomes between patients who required a single MET call and those who required repeat MET calls. Prospective observational research is recommended to better understand the MET call stand-down decision-making process at the patient bedside, environmental influences, and the impact on further patient deterioration.
{"title":"Medical emergency team stand-down decision-making: Characteristics, documented decisions, and outcomes documented between single and repeat medical emergency team patients—A retrospective review","authors":"Natalie A. Kondos RN, BNurs, BBiomedSci(Hons) , Jonathan Barrett MBBs, MPH, FRACP, FCICM , Jo McDonall RN, PhD , Tracey Bucknall RN, FAAN, GAICD, PhD","doi":"10.1016/j.aucc.2025.101310","DOIUrl":"10.1016/j.aucc.2025.101310","url":null,"abstract":"<div><h3>Introduction</h3><div>Decisions to end a medical emergency team (MET) call have been infrequently studied. Premature ending of MET calls may compromise patient outcomes. The aim of the study was to describe clinicians' documentation practices upon ending MET calls and to compare patients with single and repeat MET call activation on the initial call.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted at a metropolitan hospital in Melbourne, Victoria, from Oct 1st, 2018, to September 30th, 2019. From a total of 8648 initial MET calls, 500 were included in the sample, 250 single and 250 repeated (≥2) MET calls. Data from patients’ index MET call were analysed using univariate analyses and descriptive statistics. Variables included documentation of the MET call stand-down decision and associated decision-making elements, demographic and admission characteristics, and patient outcomes. We compared documentation of MET call stand-down decision-making with expert consensus on essential MET call stand-down decision-making elements.</div></div><div><h3>Results</h3><div>Key differences in the documentation of the essential MET call stand-down decision-making elements were that repeat MET patients had a higher proportion of care outcomes (post-MET call) documented (72%) than single MET patients (48.8%). Treatment decisions were documented over 75% of the time and an escalation plan was documented less than 50% of the time for both MET call patient groups. Repeat MET call patients were twice as likely to die in hospital (15.2% versus 7.6%, <em>p</em> = 0.01), had double the hospital length of stay (21 versus 10 days, <em>p</em> = 0.031), and were three times more likely to be discharged to rehabilitation services rather than home (28% versus 9.6%, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>There were differences at the index MET call in documentation and outcomes between patients who required a single MET call and those who required repeat MET calls. Prospective observational research is recommended to better understand the MET call stand-down decision-making process at the patient bedside, environmental influences, and the impact on further patient deterioration.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 6","pages":"Article 101310"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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