Chung-Liang Shih

Who survives cardiac arrest in the intensive care units

OBJECTIVE The aim of this study was to evaluate the factors related to outcome regarding in-intensive care unit (ICU) cardiac arrest (IICA) in a university hospital. PATIENTS AND METHODS Adult nontraumatic ICU patients who sustained IICA were prospectively enrolled. Several patient and event-related variables, as well as outcomes, were recorded and summarized based on the revised Utstein-style template. RESULTS A total of 202 episodes of IICA happened during the study period. Return of spontaneous circulation (ROSC) was achieved in 127 patients (62.9%), whereas the overall survival-to-discharge rate was 15.3% (31 patients). In univariate analysis, a shorter duration of resuscitation and pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) as initial arrest rhythm represented better outcomes. Independent predictors of survival to hospital discharge were VT/VF as the initial rhythm (odds ratio [OR], 3.81; 95% confidence interval [CI], 1.50-9.67; P = .005), lower Acute Physiology and Chronic Health Evaluation II score (OR 0.92, 95% CI 0.87-0.98, P = .008), and shorter resuscitation durations (OR 0.91, 95% CI 0.87-0.96, P < .001). CONCLUSION Shorter resuscitation duration and initial VT/VF are predictors for both ROSC and hospital survival, whereas lower Acute Physiology and Chronic Health Evaluation II scores predict the latter.

Effects of ambient temperature on volume, specialty composition and triage levels of emergency department visits

Aim: To evaluate the effects of change of ambient temperature on emergency department (ED) patient visits. Methods: This prospective observational study was conducted in the ED of National Taiwan University Hospital from January 2002 to January 2007. The daily ED patient numbers of different triage levels in different service specialties were collected and correlated with the daily average temperature (T) and change in temperature (ΔT) compared with the previous day. A univariate analysis was performed with the Pearson correlation and a multivariate analysis with multiple linear regression analysis. Results: A total of 505 224 patient visits were included in this study. On univariate analysis, there was no significant correlation between T and the ED volume (r = 0.012, p = 0.608), but there was a significant correlation between ΔT and ED volume (r = 0.109, p<0.001). On multivariate analysis, ΔT and holidays were identified as independent predictors of ED volume. We established the following formula in predicting the ED patient number: y = 265.42+(0.06×T)+(2.57×ΔT)+(59.77×holiday). There was a positive association between T and the trauma patient number, while there was a negative association between T and medical and paediatric patient numbers. On the triage level, a low T was associated with increased patient triage level, while no significant association was noted between ΔT and the proportion in any triage level. Conclusions: Our study demonstrated that ambient temperature had differential effects on ED patient visits of different specialties and severities.

Disaster coordination and management: summary and action plans

INTRODUCTION Disaster is a collective responsibility requiring coordinated response from all parts of society. This theme focused on coordination and management issues in a diverse range of scenarios. METHODS Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Although the main points developed in Themes 1 and 4 were different from each other (as reported in the Results section), their implementation was similar. Therefore, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates. RESULTS The main points developed during the presentations and discussions included: (1) the need for evidence-based assessments and planning, (2) the need for a shift in focus to health-sector readiness, (3) empowerment of survivors, (4) provision of relief for the caregivers, (5) address the incentives and disincentives to attain readiness, (6) engage in joint preparation, response, and training, (7) focus on prevention and mitigation of the damage from events, and (8) improve media relations. There exists a need for institutionalization of processes for learning from experiences obtained from disasters. DISCUSSION Action plans presented include: (1) creation of an Information and Data Clearinghouse on Disaster Management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) act on lessons learned from evidence-based research and practical experience. CONCLUSIONS There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.

Intraperitoneal vascular endothelial growth factor C level is related to peritoneal dialysis ultrafiltration.

Background: Local inflammation and neovascularization have a negative influence on peritoneal dialysis (PD). Patients with higher peritoneal transport have higher interleukin-6 (IL-6) and vascular endothelial growth factor-A (VEGF-A) levels in their dialysate. However, the relationship of other members of the VEGF family, such as VEGF-C, to peritoneal transport or ultrafiltration (UF) is yet to be studied. Methods: Peritoneal cytokine and growth factor levels were determined during the peritoneal equilibration test (PET). Ultrafiltration, peritoneal clearance and residual renal function were also considered. Results: Forty-two PD patients were enrolled. They had been on PD for at least 1 month and free of peritonitis for at least 1 month prior to the study. Patients with high or high average PET had higher dialysate IL-6 and VEGF-C. Dialysate IL-6 and VEGF-C correlated negatively with PET and UF. Conclusions: Dialysate VEGF-C is related to higher transport rate and poorer UF. The role of VEGF-C in PD deserves further study.

Application of wireless network in a medical emergency service network

Life is priceless, so pre-hospital evaluation and management is important in emergency medical service. To enhance the quality of emergency medical service, the mobile hospital emergency medical system (MHMES) is designed to provide for e-prepared services. This system could improve the communication among the ambulance, the dispatch and mission control center and the emergency department of the hospital via a wireless network, and provide comprehensive service during pre-hospital resuscitation and transportation of the patients. The MHMES consists of three sub-systems located in three sites respectively, dispatch and mission control center, emergency department of hospital and ambulance. It includes electrical map to track the ambulances and transfer patients situation and histories with the hospital to follow the symptom. Therefore, this system would be able to reduce the mortality during transportation and enhance the safety and quality of emergency medical service. It structures an emergency informatics system of National Taiwan University Hospital to provide a application of wireless network in a medical emergency service network.

Learning from Taiwan patient-safety reporting system

OBJECTIVE The aim of this study is to create a national database to record incidents that endanger patient safety. We try to identify systemic problems in hospitals in order to avoid safety incidents in the future and improve the quality of healthcare. METHOD The Taiwan Patient Safety Reporting System employs a voluntary notification model. We define 13 types of patient safety incidents, and the reports of different types of incidents are recorded using common terminology. Statistical analysis is used to identify the incident type, time of occurrence, location, person who reported the incident, and possible reasons for frequently occurring incidents. RESULTS There were 340 hospitals that joined this program from 2005 to 2010. Over 128,271 incident events were reported and analyzed. The three most common incidents were drug-related incidents, falls, and endo tube related incidents. By analyzing the time of occurrence of incidents, we found that drug-related incidents usually occurred between 8 and 10 am. Falls and endo tube incidents usually occurred between 4 and 6 am. The most common location was wards (57.6%), followed by intensive care areas (13.5%), and pharmacies (9.1%). Among hospital staff, nurses reported the highest number of incidents (68.9%), followed by pharmacists (14.5%) and administrative staff (5.5%). The number of incidents reported by doctors was much lower (1.2%). Most staff members who reported incidents had been working for less than five years (58.1%). CONCLUSION The unified reporting system was found to improve the recording and analysis of patient safety incidents. To encourage hospital staff to report incidents, hospitals need to be assisted in establishing an internal report and management system for safety incidents. Hospitals also need a protection mechanism to allow staff members to report incidents without the fear of punishment. By identifying the root causes of safety incidents and sharing the lessons learned across hospitals is the only way such incidents can be stopped from happening again.

Is it enough to set national patient safety goals? An empirical evaluation in Taiwan

OBJECTIVE In 2004, the Taiwan Department of Health set the national patient safety goals. To date, however, there has been no evaluation of these goals. This study aimed to develop a method to evaluate the status of the national patient safety goals in Taiwan. DESIGN A cross-sectional questionnaire surveys to measure achievements on Taiwans national patient safety goals. This survey was also followed up with an onsite audit to ensure accuracy. SETTING All hospitals in Taiwan. PARTICIPANTS A total of 361 hospitals in Taiwan respond to questionnaire survey and 80 randomly selected hospitals for onsite audit. INTERVENTIONS None. MAIN OUTCOME MEASURES Average scores on achievements of the national patient safety goals. RESULTS Among the 516 hospitals to which the questionnaire was sent, 361 (70%) responded. A total of 80 hospitals were randomly selected according to geographic location and size for onsite audit. The results show that the longer the period of implementation, the higher the average scores on achievements of the goals. After stratified analysis by hospital size, the large hospitals were found to have a higher average score in every goal, especially in the new goals. Furthermore, in terms of the difference between self-report results and the onsite audit, the score in the self-report was higher than the score given by experts upon onsite audit; however, they were similar. Most items were approximately the same in the self-report score and the onsite judgment, and those that differed were merely either one rank higher or lower. CONCLUSION The self-report questionnaire combined with an onsite audit appears to be a promising approach for measuring scores on achievements of the national patient safety goals. The Department of Health could conduct this program annually to evaluate the progress and propose coping strategies.