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BACKGROUND: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. OBJECTIVES: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. DESIGN: Retrospective observational analysis of 5-year (July 2014 – June 2019) administrative dataset abstracted from medical records. SETTING: All 47 hospitals with on-site intensive care units (ICUs) in the State of Victoria. PARTICIPANTS: All adults (aged ≥ 18 years) stratified into planned or unplanned, surgical or medical, ICU or other ward, and by hospital peer group (tertiary referral, metropolitan, regional). MAIN OUTCOME MEASURES: HAC rates in ICU compared with ward, and mixed-effects regression estimates of the association between HAC and i) risk of clinical deterioration, and ii) admission hospital site (intraclass correlation coefficient [ICC] > 0.3). RESULTS: 211 120 adult ICU separations with mean hospital mortality of 7.3% (95% CI, 7.2–7.4%) reported 110 132 (42.6%) HAC events (commonly, delirium, infection, arrhythmia and respiratory failure) in 62 945 records (29.8%). Higher HAC rates were reported in elective (cardiac [50.3%] and non-cardiac [40.6%]) surgical subgroups compared with emergency medical subgroup (23.9%), and in tertiary (35.4%) compared with non-tertiary (22.7%) hospitals. HAC was strongly associated with on-admission patient characteristics (P < 0.001), but was weakly associated with hospital site (ICC, 0.08; 95% CI, 0.05–0.11). CONCLUSIONS: Critically ill patients have a high burden of HAC events, which appear to be associated with patient admission characteristics. HAC may an indicator of hospital admission complexity rather than hospital-acquired complications.

The purpose of this study is to compare cases of rapid response team (RRT) review for early deterioration (48 hours after admission), intermediate deterioration (48 to168 hours after admission), late deterioration (≥168 hours after admission), and cardiac arrest and to determine the association between duration of hospitalization before RRT review and mortality.This is a retrospective cohort study of RRT cases from a single hospital over 5 years (2009-2013) using administrative data and data for the first RRT attendance of each hospital episode.Of 2843 RRT cases, 971 (34.2%) were early deterioration, 917 (32.3%) intermediate, 775 (27.3%) late, and 180 (6.3%) cardiac arrest. Compared with early deterioration patients, late deterioration patients were older (median, 71 vs 69 years; P = .005), had a higher Charlson comorbidity index (median, 2 vs 1; P.001), more often had RRT review for respiratory distress (32.5% vs 23.5%; P.001), more often received RRT-initiated not for resuscitation orders (8.4% vs 3.9%; P.001), less often were discharged directly home (27.9% vs 58.4%; P.001), and more often died in hospital (30.6% vs 12.8%; P.001). Compared with early deterioration and adjusted for confounders, the odds ratio of death in hospital for late deterioration was 2.36 (1.81-3.08; P.001).Late deterioration is frequently encountered by the RRT and, compared with early deterioration, is associated with greater clinical complexity and a worse hospital outcome.

Background: To compare and contrast the coronary heart disease (CHD) risk factors of lower socio-economic status public hospital patients with those of privately insured CHD patients before and after six months of telephone delivered coaching using The COACH Program. Methods: A retrospective observational study which contrasts the lifestyle and biomedical coronary risk factor status of 2256 public hospital patients with the same risk factors of 3278 patients who had private health insurance. All patients received an average of 5 coach sessions over 6 months. Results: The public hospital patients were four years younger and had multiple measures confirming their lower socio-economic status than their private hospital counterparts. At entry to the program, the public hospital patients had worse risk factor levels than the privately insured patients for total and LDL-cholesterol, triglycerides, fasting glucose, smoking and physical activity levels (P < 0.0001) but better status for systolic and diastolic blood pressures and alcohol intake. At exit from the program, many of these differences had diminished or disappeared. The public hospital patients had greater improvements in their risk factor status for total and LDL-cholesterol, fasting glucose, body weight, smoking status and physical activity level than did the privately insured patients (P < 0.05). Conclusions: This paper demonstrates that a program of initiating contact with patients with CHD, identifying treatment gaps in their management and coaching to achieve guideline recommended risk factor targets can help reduce health inequalities in such patients and thus benefit all patients in the context of ongoing secondary prevention.

a b s t r a c t Background: Arterial carbon dioxide tension (PaCO2) affects neuronal function and cerebral blood flow. However, its association with outcome in patients admitted to intensive care unit (ICU) after cardiac arrest (CA) has not been evaluated. Methods and results: Observational cohort study using data from the Australian New Zealand (ANZ) Inten- sive Care Society Adult-Patient-Database (ANZICS-APD). Outcomes analyses were adjusted for illness severity, co-morbidities, hypothermia, treatment limitations, age, year of admission, glucose, source of admission, PaO2 and propensity score. We studied 16,542 consecutive patients admitted to 125 ANZ ICUs after CA between 2000 and 2011. Using the APD-PaCO2 (obtained within 24 h of ICU admission), 3010 (18.2%) were classified into the hypo- (PaCO2 45 mmHg) group. The hypocapnia group, compared with the normocapnia group, had a trend toward higher in-hospital mortality (OR 1.12 (95% CI 1.00-1.24, p = 0.04)), lower rate of discharge home (OR 0.81 (0.70-0.94, p < 0.01)) and higher likelihood of fulfilling composite adverse outcome of death and no discharge home (OR 1.23 (1.10-1.37, p < 0.001)). In contrast, the hypercapnia group had similar in- hospital mortality (OR 1.06 (0.97-1.15, p = 0.19)) but higher rate of discharge home among survivors (OR 1.16 (1.03-1.32, p = 0.01)) and similar likelihood of fulfilling the composite outcome (OR 0.97 (0.89-1.06, p = 0.52)). Cox-proportional hazards modelling supported these findings. Conclusions: Hypo- and hypercapnia are common after ICU admission post-CA. Compared with normocap- nia, hypocapnia was independently associated with worse clinical outcomes and hypercapnia a greater likelihood of discharge home among survivors.

a b s t r a c t We aimed to describe the characteristics of medical emergencies that occurred in the medical imaging department (MID) of a university hospital in Melbourne, Australia. A database of 'Respond Medical Emergency Team (MET)' and 'Respond Blue' calls was retrospectively examined for the period June 2003 to November 2010 in relation to events that occurred in the MID. The hospital medical imaging database was also examined in relation to these events and, where necessary, patients' notes were reviewed. Ethics approval was granted by the hospital ethics review board. There were 124 medical emergency calls in the MID during the study period, 28% Respond Blue and 72% Respond MET. Of these 124 calls, 26% occurred outside of usual work hours and 12% involved cardiac arrest. The most common reasons for the emergency calls were seizures (14%) and altered conscious state (13%). Contrast anaphylaxis precipitated the emergency in 4% of cases. In 83% of cases the emergency calls were for patients attending the MID for diagnostic imaging, the remainder being for a procedure. Of the scheduled imaging techniques, 45% were for computed tomog- raphy. The scheduled imaging was abandoned due to the emergency in 12% of cases. When performed, imaging informed patient management in 34% of cases in diagnostic imaging and in all cases in the context of image-guided procedures. Medical emergency calls in the MID often occurred outside usual work hours and were attributed to a range of medical problems. The emergencies occurred in relation to all imaging techniques and imaging informed patient management in many cases.

Community studies have demonstrated suboptimal achievement of lipid targets in the management of patients with coronary heart disease (CHD). An effective strategy is required for the application of evidence-based prevention therapy for CHD. The objective of this study was to test coaching as a technique to assist patients in achieving the target cholesterol level of

Objective: To compare the emotional state during the first 3 days after coronary artery surgery of patients who had undergone early versus conventional extubation. Design: A prospective, randomized, controlled trial. Setting: University hospital, single center. Participants: Eligible patients (n = 100) presenting for elective coronary artery surgery, randomized to an early extubation group or a conventional extubation group. Interventions: Emotional status was measured by the Hospital Anxiety and Depression Scale (HAD), the Self Assessment Manikin (SAM), and the Multiple Affect Adjective Check List-Revised (MAACL-R). Tests were administered preoperatively and on the 1st and 3rd days postoperatively. Measurements and Main Results: Of patients in the conventional extubation group, 30% showed moderate-to-severe depressive symptoms (HAD score >10) on day 3 postoperatively compared with 8% of patients in the early extubation group (p = 0.02). There was a clinically insignificant increase in MAACL-R depression score on the 1st postoperative day within both groups but no other differences within or between groups in SAM or MAACL-R scores. Conclusion: Early extubation results in fewer patients displaying depressive symptoms on the 3rd postoperative day but appears to have little effect on other measurements of emotional status. Anesthetic management during coronary artery bypass graft surgery may play an important role in the overall well-being of the patient by decreasing the incidence of postoperative depression. Copyright © 2001 by W.B. Saunders Company

Study objectives To determine the safety of early extubation (EE) after coronary artery surgery. Design Prospective randomized controlled trial. Setting The cardiac surgery operating room and ICU of a university-affiliated teaching hospital. Patients One hundred eligible patients presenting for elective coronary artery surgery. Interventions Patients randomized to the EE group were administered a reduced dose of fentanyl (15 μg/kg) and an anesthetic compatible with EE, while patients randomized to the conventional extubation (CE) group were given fentanyl (50 μg/kg). Measurements and results The time to extubation in the EE group (median, 240 min; range, 30 to 930 min) was significantly less than the CE group (median, 420 min; range, 125 to 1,140 min) (p Conclusions By using an appropriate anesthetic technique and postoperative management, EE can be achieved following coronary artery bypass surgery without major complications.

and statistically significant in the Quebec general population. Mortality rates for digestive neoplasms and colorectal cancer in particular had a small but significant decrease in both CD and UC, whereas in the Quebec general population we observed a significant increase with calendar year (data available from ISQ for 2003-2008). Conclusions All-cause mortality was significantly increased in both CD and UC patients compared to the Quebec general population. Lung cancer mortality showed a significant increase with time in both CD and UC. Mortality from digestive neoplasms and colorectal cancer had a small but significant decrease with time in both CD and UC.

Preoperative EGFR and Rifle-Classified Postoperative AKI Predict Length of Stay Post Coronary Bypass Surgery in an Australian Setting Elizabeth Moore1, Julie Simpson2, Antony Tobin1, John Santamaria 1 1 St Vincent’s Hospital, Melbourne, Australia 2 University of Melbourne, Australia Introduction:Mortality rate, the preferred post CABGS outcome measure, may have decreased so much that it is no longer a useful marker of quality. Renal dysfunction is commonamongstCABGScandidates [1] andstudiesusing estimated glomerular filtration rate (eGFR), which is considered more reliable than serum creatinine, have shown that even mild degrees of preoperative renal dysfunction are associated with increased mortality and length of stay after cardiac surgery [1,2]. To classify change in renal function in the critically ill, the RIFLE criteria (acronym for degree of acute kidney injury (AKI): Risk, Injury, Failure, Loss, Endstage) have recently beenvalidated [3]. ThisAustralian study investigates the influence of preoperative eGFR and postoperative AKI on outcomes after CABGS, focusing on length of stay. Methods: A retrospective analysis of prospectively collected data for 3302 consecutive patients who underwent CABGS (June 1997–January 2007) at St Vincent’s Public Hospital, Melbourne. Preoperative eGFR was calculated a c m c f h o t a i f e P t P ( d i ( u i f d a T a t r Reference [1] Cooper WA, O’Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery – results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006;113:1063–70. [2] Hillis GS, Croal BL, Buchan KG, et al. Renal function and outcome fromcoronaryarterybypassgrafting – impact onmortality after a 2.3-year follow-up. Circulation 2006;113:1056–62. [3] Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int