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1. Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems

Author

Subbe, CP, Bannard-Smith, J, Bunch, J, Champunot, R, Devita, MA, Durham, L, Edelson, DP, Gonzalez, I, Hancock, C, Haniffa, R, Hartin, J, Haskell, H, Hogan, H, Jones, DA, Kalkman, CJ, Lighthall, GK, Malycha, J, Ni, MZ, Phillips, AV, Rubulotta, F, So, RK, Welch, J, and Systems, International Society For Rapid Response

Subjects
Quality management, Critical Care, Quality Assurance, Health Care, Process (engineering), media_common.quotation_subject, Psychological intervention, Organizational culture, 030204 cardiovascular system & hematology, Emergency Nursing, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Quality (business), Rapid response, media_common, Clinical Deterioration, business.industry, Consensus conference, 030208 emergency & critical care medicine, medicine.disease, Heart Arrest, Practice Guidelines as Topic, Emergency Medicine, Metric (unit), Medical emergency, Cardiology and Cardiovascular Medicine, business, Hospital Rapid Response Team
Abstract

Background Clinically significant deterioration of patients admitted to general wards is a recognized complication of hospital care. Rapid Response Systems(RRS) aim to reduce the number of avoidable adverse events. The authors aimed to develop a core quality metric for the evaluation of RRS. Methods We conducted an international consensus process. Participants included patients, carers, clinicians, research scientists, and members of the International Society for Rapid Response Systems with representatives from Europe, Australia, Africa, Asia and the US. Scoping reviews of the literature identified potential metrics. We used a modified Delphi methodology to arrive at a list of candidate indicators that were reviewed for feasibility and applicability across a broad range of healthcare systems including low and middle-income countries. The writing group refined recommendations and further characterized measurement tools. Results Consensus emerged that core outcomes for reporting for quality improvement should include ten metrics related to structure, process and outcome for RRS with outcomes following the domains of the quadruple aim. The conference recommended that hospitals should collect data on cardiac arrests and their potential predictability, timeliness of escalation, critical care interventions and presence of written treatment goals for patients remaining on general wards. Unit level reporting should include the presence of patient activated rapid response and metrics of organizational culture. We suggest two exploratory cost metrics to underpin urgently needed research in this area. Conclusion A consensus process was used to develop ten metrics for better understanding the course and care of deteriorating ward patients. Others are proposed for further development.

Published
2019

2. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial

Author

Davidson, Aj, Frawley, G, Hardy, P, Arnup, Sj, Schuster, T, Lee, K, Hunt, Rw, Stargatt, R, Sheppard, S, Ormond, Gd, Hartmann, Pl, Takagi, Mj, Malarbi, S, Doyle, M, Ragg, P, Backstrom, M, Costi, D, von Ungern Sternberg, Bs, Wilton, Nc, Knottenbelt, G, Disma, NICOLA MASSIMO, Montobbio, G, Mameli, L, Tuo, P, Girbaldi, G, PINI PRATO, Alessio, Mattioli, Girolamo, Wolfler, A, Izzo, F, Salvo, I, Sonzogni, V, Locatelli, Bg, Khotcholava, M, de Graaff, Jc, van Gool, Jt, Numan, Sc, van Veldhuijzen, D, Kalkman, Cj, van Baar, Al, Steenis, Lj, Hagenaars, Jh, Absalom, Ar, Hoekstra, Fm, Volkers, M, Withington, D, Furue, K, Gaudreault, J, Mccann, Me, Berde, C, Soriano, S, Young, V, Sethna, N, Kovatsis, P, Cravero, J, Bellinger, D, Marmor, J, Lynn, A, Ivanova, I, Hunyady, A, Verma, S, Polaner, D, Thomas, J, Mueller, M, Haret, D, Szmuk, P, Steiner, J, Kravitz, B, Surantham, S, Hays, S, Taenzer, A, Maxwell, L, Williams, Rk, Morton, Ns, Bell, G, Dorris, L, Adey, C, Pownall, J, Bagshaw, O, Chisakuta, A, Eissa, A, Stoddart, P, Davis, A, Myles, P, Withngton, De, Degraaff, Jc, Bellinger, Dc, Wolf, A, Mcintosh, N, Carlin, J, Leslie, K, de Lima, J, Hammer, G, Field, D, Gebski, V, Tibboel, D., Development and Treatment of Psychosocial Problems, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Subjects
Male, Pediatrics, Hernia, Research Support, U.S. Gov't, P.H.S, CHILDREN, P.H.S, Bayley Scales of Infant Development, law.invention, Child Development, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, Medicine, Anesthesia, General anaesthesia, Non-U.S. Gov't, Child, BIRTH COHORT, Wechsler Preschool and Primary Scale of Intelligence, Research Support, Non-U.S. Gov't, Medicine (all), CHILDHOOD EXPOSURE, Age Factors, Wechsler Scales, Brain, Gestational age, General Medicine, Multicenter Study, Inguinal, Randomized Controlled Trial, Cohort, CLINICAL-RESEARCH, Female, Cohort study, medicine.medical_specialty, Spinal, Gestational Age, Anesthesia, General, Anesthesia, Spinal, Child, Preschool, Double-Blind Method, Hernia, Inguinal, Herniorrhaphy, Humans, Infant, Research Support, ACADEMIC-PERFORMANCE, N.I.H, DEVELOPING BRAIN, 03 medical and health sciences, Research Support, N.I.H., Extramural, EARLY EXPOSURE, 030225 pediatrics, Journal Article, Toddler, General, Preschool, business.industry, Extramural, LEARNING-DISABILITIES, CELL-DEATH, NEUROTOXICITY, U.S. Gov't, business
Abstract

Background Preclinical data suggest that general anaesthetics affect brain development. There is mixed evidence from cohort studies that young children exposed to anaesthesia can have an increased risk of poor neurodevelopmental outcome. We aimed to establish whether general anaesthesia in infancy has any effect on neurodevelopmental outcome. Here we report the secondary outcome of neurodevelopmental outcome at 2 years of age in the General Anaesthesia compared to Spinal anaesthesia (GAS) trial.Methods In this international assessor-masked randomised controlled equivalence trial, we recruited infants younger than 60 weeks postmenstrual age, born at greater than 26 weeks ' gestation, and who had inguinal herniorrhaphy, from 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand. Infants were randomly assigned (1:1) to receive either awake-regional anaesthesia or sevoflurane-based general anaesthesia. Web-based randomisation was done in blocks of two or four and stratified by site and gestational age at birth. Infants were excluded if they had existing risk factors for neurological injury. The primary outcome of the trial will be the Wechsler Preschool and Primary Scale of Intelligence Third Edition (WPPSI-III) Full Scale Intelligence Quotient score at age 5 years. The secondary outcome, reported here, is the composite cognitive score of the Bayley Scales of Infant and Toddler Development III, assessed at 2 years. The analysis was as per protocol adjusted for gestational age at birth. A difference in means of five points (1/3 SD) was predefined as the clinical equivalence margin. This trial is registered with ANZCTR, number ACTRN12606000441516 and ClinicalTrials.gov, number NCT00756600.Findings Between Feb 9, 2007, and Jan 31, 2013, 363 infants were randomly assigned to receive awake-regional anaesthesia and 359 to general anaesthesia. Outcome data were available for 238 children in the awake-regional group and 294 in the general anaesthesia group. In the as-per-protocol analysis, the cognitive composite score (mean [SD]) was 98.6 (14.2) in the awake-regional group and 98.2 (14.7) in the general anaesthesia group. There was equivalence in mean between groups (awake-regional minus general anaesthesia 0.169, 95% CI-2.30 to 2.64). The median duration of anaesthesia in the general anaesthesia group was 54 min.Interpretation For this secondary outcome, we found no evidence that just less than 1 h of sevoflurane anaesthesia in infancy increases the risk of adverse neurodevelopmental outcome at 2 years of age compared with awake-regional anaesthesia.Funding Australia National Health and Medical Research Council (NHMRC), Health Technologies Assessment-National Institute for Health Research UK, National Institutes of Health, Food and Drug Administration, Australian and New Zealand College of Anaesthetists, Murdoch Childrens Research Institute, Canadian Institute of Health Research, Canadian Anesthesiologists ' Society, Pfizer Canada, Italian Ministry of Heath, Fonds NutsOhra, and UK Clinical Research Network (UKCRN).

Published
2016
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4. Connecting undergraduate and postgraduate medical education through an elective EPA-based transitional year in acute care: an early project report

Author

Jonker, G, Hoff, RG, Max, S, Kalkman, CJ, ten Cate, O, Jonker, G, Hoff, RG, Max, S, Kalkman, CJ, and ten Cate, O

Abstract

Objective: A well-designed final year may ease the transition from medical school to postgraduate training, if it has enough depth to enable the acquisition of early specialty expertise, while keeping enough breadth to support the graduation as all-round physician. Aim of this article is to describe the design of a multidisciplinary dedicated transitional year (DTY) around the theme of recognition and initial treatment of vitally threatened patients.Methods: Undergraduate and postgraduate training directors from the departments of Anaesthesiology, Cardiology, Emergency Medicine, Intensive Care Medicine and Respiratory Medicine at UMC Utrecht and partnering hospitals have collaboratively developed and implemented a curriculum for a final year focusing on three entrustable professional activities (EPAs) in the domain of acute care. These EPAs represent authentic tasks of starting residents in each of the participating specialties, align student training objectives with postgraduate expectations, and are the primary focus of learning, teaching, and assessment throughout the year. Students are developmentally supported by a mentor and educationally supported by monthly academic half days.Results: Between October 2014 and November 2016,, 47 students chose DTY Acute Care. The set-up of our DTY is inspiring other specialties to develop multidisciplinary DTYs. Attainment of clinical competence, experience of students and staff, and exploration of graduates' early careers are subjects of current research projects.Conclusion: This multidisciplinary dedicated transitional year aims to graduate students with profile-specific competence in acute care. It prepares for residency in a range of specialties., Zielsetzung: Ein gut gestaltetes letztes Studienjahr ("praktisches Jahr" oder "Übergangsjahr") kann den Übergang von Studium zu Facharztweiterbildung vereinfachen, wenn es ausreichend fachliche Tiefe zur frühen Aneignung von fachspezifischer Erfahrung bietet, ohne dabei die vollständige Bandbreite medizinischer Ausbildung zum praktischen Arzt zu vernachlässigen. Ziel dieses Artikels ist es, die Gestaltung eines multidisziplinären letzten Studienjahres ("dedicated transitional year", DTY) rund um die Erkennung und Erstbehandlung von vital bedrohten Patienten zu beschreiben.Methoden: Die Lehrbeauftragten für Studenten- und Facharztausbildung der Anästhesiologie, Kardiologie, Notfallmedizin, Intensivmedizin und Pulmologie der Uniklinik Utrecht (Universitätsmedizinisches Zentrum, UMC) und seiner Lehrkrankenhäuser entwickelten und implementierten gemeinsam ein Curriculum für ein letztes Studienjahr, welches sich auf drei APT ("anvertraubare professionelle Tätigkeit", engl. "entrustable professional activity", EPA) aus der Akutmedizin stützt. Diese APT repräsentieren tatsächliche Tätigkeiten beginnender Ärzte der teilnehmenden Fächer, gleichen die Lernziele der Studenten an diese zukünftigen Tätigkeiten an, und sind der Kern für Lernen, Lehre und Beurteilung während dieses Jahres. Die Studenten werden in ihrer Entwicklung durch einen Mentor unterstützt, und es findet monatlicher Unterricht statt.Ergebnisse: Zwischen Oktober 2014 und November 2016 haben sich 47 Studenten für das DTY Akutmedizin entschieden. Die Einrichtung unseres DTY inspiriert andere Fachrichtungen, ebenfalls multidisziplinäre DTYs zu entwickeln. Die erlangte klinische Kompetenz, die Erfahrungen von Studenten und Mitarbeitern sowie die beginnenden Karrieren der Absolventen sind Gegenstand aktueller Forschungsprojekte.Fazit: Dieses multidisziplinäre letzte Studienjahr soll Studenten ermöglichen, ihr Studium mit spezifischen Kompetenzen der Akutmedizin abzuschließen, und bereitet auf die Facharztweiterbild

Published
2017

7. The role of fibrinogen in cardiac surgery

Author

Moons, K. (Carl) G.M., Kalkman, CJ, Nierich, A.P., de Groot, JAH, Bilecen, S, Moons, K. (Carl) G.M., Kalkman, CJ, Nierich, A.P., de Groot, JAH, and Bilecen, S

Published
2016

13. Postoperative patients' perspectives on rating pain: A qualitative study

Author

Pijn Centrum, Afdeling Interne Geneeskunde, Infection & Immunity, Medische staf Anesthesiologie, Other research (not in main researchprogram), Epi Methoden Team 1, Circulatory Health, Brain, Hersenen-Medisch 2, van Dijk, J.F.M., Vervoort, Sigrid, van Wijck, Albert J.M., Kalkman, CJ, Schuurmans, Marieke, Pijn Centrum, Afdeling Interne Geneeskunde, Infection & Immunity, Medische staf Anesthesiologie, Other research (not in main researchprogram), Epi Methoden Team 1, Circulatory Health, Brain, Hersenen-Medisch 2, van Dijk, J.F.M., Vervoort, Sigrid, van Wijck, Albert J.M., Kalkman, CJ, and Schuurmans, Marieke

Published
2016

14. Barriers and facilitators perceived by physicians when using prediction models in practice

Author

Kappen, TH, van Loon, K, Kappen, MAM, van Wolfswinkel, L, Vergouwe, Yvonne, Van Klei, WA, Moons, KGM, Kalkman, CJ, Kappen, TH, van Loon, K, Kappen, MAM, van Wolfswinkel, L, Vergouwe, Yvonne, Van Klei, WA, Moons, KGM, and Kalkman, CJ

Abstract

Objectives: Prediction models may facilitate risk-based management of health care conditions. In a large cluster-randomized trial, presenting calculated risks of postoperative nausea and vomiting (PONV) to physicians (assistive approach) increased risk-based management of PONV. This increase did not improve patient outcome that is, PONY incidence. This prompted us to explore how prediction tools guide the decision-making process of physicians. Study Design and Setting: Using mixed methods, we interviewed eight physicians to understand how predicted risks were perceived by the physicians and how they influenced decision making. Subsequently, all 57 physicians of the trial were surveyed for how the presented risks influenced their perceptions. Results: Although the prediction tool made physicians more aware of PONY prevention, the physicians reported three barriers to use predicted risks in their decision making. PONY was not considered an outcome of utmost importance; decision making on PONY prophylaxis was mostly intuitive rather than risk based; prediction models do not weigh benefits and risks of prophylactic drugs. Conclusion: Combining probabilistic output of the model with their clinical experience may be difficult for physicians, especially When their decision-making process is mostly intuitive. Adding recommendations to predicted risks (directive approach) was considered an important step to facilitate the uptake of a prediction tool. (C) 2016 Elsevier Inc. All rights reserved.

Published
2016

17. The effect of a preoperative educational film on patients' postoperative pain in relation to their request for opioids

Author

Pijn Centrum, Medische staf Anesthesiologie, Other research (not in main researchprogram), Epi Methoden Team 3, JC onderzoeksprogramma Methodologie, Epi Methoden Team 1, Hersenen-Medisch 2, van Dijk, Jacqueline F M, van Wijck, Albert J M, Kappen, TH, Peelen, Linda M., Kalkman, CJ, Schuurmans, Marieke J., Pijn Centrum, Medische staf Anesthesiologie, Other research (not in main researchprogram), Epi Methoden Team 3, JC onderzoeksprogramma Methodologie, Epi Methoden Team 1, Hersenen-Medisch 2, van Dijk, Jacqueline F M, van Wijck, Albert J M, Kappen, TH, Peelen, Linda M., Kalkman, CJ, and Schuurmans, Marieke J.

Published
2015

18. Optimal Technique in Cardiac Anesthesia Recovery

Author

Kalkman, CJ, Moons, K. (Carl) G.M., van Dijk, Diederik, Nierich, A.P., Svircevic, V., Kalkman, CJ, Moons, K. (Carl) G.M., van Dijk, Diederik, Nierich, A.P., and Svircevic, V.

Published
2014

21. The BIS inverse problem and pharmacodynamics - In reply

Author

Kuizenga, K, Proost, JH, Wierda, JM, Kalkman, CJ, Faculteit Medische Wetenschappen/UMCG, Biopharmaceuticals, Discovery, Design and Delivery (BDDD), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and Center for Liver, Digestive and Metabolic Diseases (CLDM)

Published
2002

24. Incident reporting in general practice

Author

Verheij, Theo, Kalkman, CJ, van Rensen, Liesbeth, Zwart, D.L.M., Verheij, Theo, Kalkman, CJ, van Rensen, Liesbeth, and Zwart, D.L.M.

Published
2011

25. Intraoperative hypotension

Author

Kalkman, CJ, Moons, K. (Carl) G.M., van Klei, Wilton A., Bijker, J.B., Kalkman, CJ, Moons, K. (Carl) G.M., van Klei, Wilton A., and Bijker, J.B.

Published
2011

33. A Dutch guideline for the treatment of scoliosis in neuromuscular disorders

Author

Mullender, MG, primary, Blom, NA, additional, De Kleuver, M, additional, Fock, JM, additional, Hitters, WMGC, additional, Horemans, AMC, additional, Kalkman, CJ, additional, Pruijs, JEH, additional, Timmer, RR, additional, Titarsolej, PJ, additional, Van Haasteren, NC, additional, Jager, MJ Van Tol-de, additional, Van Vught, AJ, additional, and Van Royen, BJ, additional

Published
2008
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36. The Effect of Simultaneous Cardiopulmonary Bypass and Cerebral Embolization on Neurocognitive Outcome in the Rat

Author

Blezer Ela, Kalkman Cj, Dieleman Jm, Nijsen Jfw, and de Lange F

Subjects
medicine.medical_specialty, business.industry, Outcome (game theory), law.invention, Anesthesiology and Pain Medicine, law, Internal medicine, Cardiopulmonary bypass, medicine, Cardiology, Surgery, Neurology (clinical), Cerebral embolization, business, Neurocognitive
Published
2004
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38. Central or local incident reporting? A comparative study in Dutch GP out-of-hours services.

Author

Zwart DL, Van Rensen ELj, Kalkman CJ, Verheij TJ, Zwart, Dorien L M, Van Rensen, Elizabeth L J, Kalkman, Cor J, and Verheij, Theo J M

Abstract

Background: Centralised incident reporting in a Dutch collaboration of nine out-of-hours services yielded very few incident reports. To improve incident reporting and the awareness of primary caregivers about patient safety issues, a local incident-reporting procedure was implemented.Aim: To compare the number and nature of incident reports collected in a local incident-reporting procedure (intervention) versus the currently used centralised incident-reporting procedure.Design Of Study: Quasi experiment.Setting: Three GPs' out-of-hours services (OHSs) in the centre of the Netherlands participated over 2 years before and 2 years after the intervention.Method: A local incident-reporting procedure was implemented in OHS1, in which participants were encouraged to report all occurring incidents. A local committee with peers analysed the reported incidents fortnightly in order to initiate improvements if necessary. In OHS2 and OHS3, the current centralised incident-reporting procedure was continued, where incidents were reported to an advisory committee of the board of directors of the OHSs collaboration and were assessed every 2 months. The main outcome measures were the number and nature of incidents reported.Results: At baseline, participants reported fewer than 10 incidents per year each. In the follow-up period, the number of incidents reported in OHS1 increased 16-fold compared with the controls. The type of incidents reported did not alter. In the local incident-reporting procedure, improvements were implemented in a shorter time frame, but reports in the centralised incident-reporting procedure led to a more systematic addressing of general and recurring safety problems.Conclusion: It is likely that a local incident-reporting procedure increases the willingness to report and facilitates faster implementation of improvements. In contrast, the central procedure, by collating reports from many settings, seems better at addressing generic and recurring safety issues. The advantages of both approaches should be combined. [ABSTRACT FROM AUTHOR]

Published
2011
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43. Validation of a new arterial pulse contour-based cardiac output device.

Author

de Waal EEC, Kalkman CJ, Rex S, and Buhre WF

Abstract

OBJECTIVE: To evaluate the accuracy and precision of an arterial pulse contour-based continuous cardiac output device (Vigileo). Vigileo cardiac output (VigileoCO) was compared with intermittent transpulmonary thermodilution cardiac output (TPCO) and an established arterial pulse contour-based cardiac output (PCCO). DESIGN: Prospective clinical study. SETTING: University hospital. PATIENTS: Twenty-two patients undergoing coronary artery bypass graft surgery. INTERVENTIONS: Defined volume load during surgery and in the postoperative period. MEASUREMENTS AND MAIN RESULTS: We obtained 184 pairs of VigileoCO and TPCO, 140 pairs of VigileoCO and PCCO, and 140 pairs of PCCO and TPCO. Measurements were performed after induction of anesthesia (T1), after sternotomy (T2), immediately after (T3) and 20 mins after volume challenge with 10 mL.kg[-1] hydroxyethyl starch 6% (T4), 15 mins after coronary pulmonary bypass (T5), after retransfusion of autologous blood (T6), after arrival at the intensive care unit (T7), and immediately after (T8) and 20 mins after (T9) a second volume load with 10 mL.kg[-1] hydroxyethyl starch 6%. TPCO was used to calibrate PCCO. For pooled data, including uncalibrated PCCO data immediately after weaning from coronary pulmonary bypass (T5), the correlation coefficient of TPCO vs. VigileoCO, PCCO vs. VigileoCO, and TPCO vs. PCCO was 0.75, 0.60, and 0.75 respectively. Bland-Altman analysis showed a bias of 0.00, -0.01, and 0.02 L.min[-1], the precision (=sd) was 0.87, 1.08, and 0.93 L.min[-1], and the mean error was 33%, 40%, and 35%. When we compared calibrated PCCO values (T2-T4, T6, T7-9), the correlation coefficients of PCCO-VigileoCO and TPCO-PCCO were 0.72 and 0.85, bias was -0.16 and 0.19 L.min[-1], and mean error was 33% and 27%, respectively. Best correlations and the least differences between TPCO and VigileoCO were observed in postbypass closed-chest conditions and in the intensive care unit. CONCLUSIONS: Our results showed that VigileoCO enables clinically acceptable assessment of cardiac output in postbypass closed-chest conditions and during stable conditions in the intensive care unit. [ABSTRACT FROM AUTHOR]

Published
2007
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