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1. Improving the use of the ‘COUGH’ bundle in Surgical High Dependency Unit, Ninewells Hospital, Dundee

Author

Victoria Livie, Jennifer Livie, and Sharon Hilton-Christie

Subjects
Medicine (General), R5-920
Abstract

Developing respiratory complications postoperatively is one of the major determinants of longer hospital stay, morbidity, mortality and increased healthcare costs. The incidence of postoperative respiratory complications varies from 1% to 23%. Given that postoperative respiratory complications are relatively common and costly, there have been various studies which look at ways to reduce the risk of these occurring. One such protocol is the ICOUGH bundle which stands for Incentive spirometry, Coughing and deep breathing, Oral care, patient Understanding, Getting out of bed and Head of bed elevation. This has been adapted locally to the Coughing and deep breathing, Oral care, patient Understanding, Getting out of bed and Head of bed elevation (COUGH) bundle which consists of these components excluding incentive spirometry. Within our surgical high dependency unit (HDU), the COUGH bundle should be implemented in patients who have a moderate or high risk of developing postoperative respiratory complications with an Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score of 26 or above. Studies have shown that the ICOUGH bundle has reduced rates of pneumonia and unplanned intubation in general surgical and vascular patients. Baseline data taken from surgical HDU showed that the COUGH bundle was not well implemented. One out of eight patients who had an ARISCAT score greater than 26 had the COUGH bundle implemented on admission to the unit. Three out of eight patients had the ARISCAT score documented in their admission medical review. One patient who should have received the bundle, but did not, developed a hospital acquired pneumonia postoperatively. To address this issue, we aimed to increase awareness surrounding the COUGH bundle and to increase the number of patients who had the COUGH bundle started on admission. This quality improvement project had four cycles (plan, do, study, act) and after these, 100% of patients who had an ARISCAT score of 26 or more had the COUGH bundle implemented.

Published
2020
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3. Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand

Author

Swarna Baskar Sharma, Mansoor Sange, Michael Girgis, Joanne Humphreys, Vishal Patil, Nick Greenwood, Sai Tim Yam, Santhana Kannan, Marc Slorach, Julian Giles, Suman Shrestha, Philippa Marshall, Vinanti Cherian Mcivor, Moore Joanna, Elizabeth Thomas, Stuart M. White, James Hanison, Suhail Zaidi, Andrew Burtenshaw, Douglas Campbell, Jaya Nariani, Ross Freebairn, Omar Alex Pemberton, Davina Ross-Anderson, Lisa M. Barneto, Shabir Qadri, Giles Bond-Smith, Pallavi Kumar, Khaled Razouk, M. Amir Rafi, Dermot Moloney, Ashok Raj, Kirtida Mukherjee, Vasheya Naidoo, Sonia Sathe, Jason Cupitt, Priya Shanmuganathan, Andrew Brammar, David Saunders, Anna Batchelor, James R. Anderson, Hew D.T. Torrance, Catriona Barr, Helen Melsom, Adrian Taylor, Jon Bramall, Sumant Shanbhag, Jenny Ritzema, Winston Cheung, Alexandra Frankpitt, David Shan, Killian McCourt, Chiraag Talati, Richard Kennedy, Ravishankar Jakkala Saibaba, Abigail Hine, Cathryn Matthews, Christian Frey, Laurin Allen, Gary Minto, Thomas Fitzgerald, James Bain, Dominik Teisseyre, Stephen Hill, M. Dickinson, Subhamay Ghosh, J.A. Ezihe-Ejiofor, Vincent Hamlyn, Karuna Kotur, Joyce Yeung, Helen Roberts, Johann Harten, Stefan Schraag, Jonathan Aldridge, Alexander Garden, Carol McArthur, Louis Guy, John Orr, Tom Pettigrew, Atideb Mitra, Cindy Persad, Abhinav Kant, Robin Alston, Nicolas Price, Sarang Puranik, Jacqueline Howes, Ritoo Kapoor, Peter Knowlden, Mai Wakatsuki, Charles Allen, Deepa Jumani, Mark MacGregor, Prashant Kakodkar, Dhir Bhattacharya, Valerie J. Page, Narendra Siddaiah, Dick Ongley, Vandana Goel, Sibtain Anwar, Bronwyn Posselt, Rebecca Sutton, David Scott, Danny J.N. Wong, Austin Rattray, Paul S. Myles, Mrutyunjaya Rao Rambhatla, Richard Dobson, Kathryn Jenkins, Tim J. Smith, Helen Bromhead, Zhana Ignatova, Katheryn Fogg, Lynne Williams, Sanjeev Garg, Nikhil Patel, Gary Lau, Sock Huang Koh, Stephen Merron, David Robinson, Nagendra Natarajan, Seema Charters, Mark Welch, Laura Farmer, Simon Young, Susan Kirby, Madhushankar Balasubramaniam, Robert Wonders, Paul Glyn Jones, Satyanarayana Jakkampudi, Mizan Khondoker, Paul Rowe, Andrew Jones, Monica Diczbalis, Manju Agarwal, Andrew Robinson, Emert White, Catherine Hunter, Stephen T. Webb, Srikanth Chukkambotla, Jenny Henry, Catriona Ferguson, Manish Kakkar, Waisun Kok, Colin Williams, Vijayakumar Gopal, Vidhya Nagaratnam, Shafi Ahmed, Melinda Same, Doug Campbell, Stuart P. D. Gill, Scott Popham, Gabor Debreceni, Dancho Ignatov, D. L. Williams, I.J. Wrench, Andrew Claxton, Eleanor Ford, Shondipon Laha, Laurie Dwyer, Christopher Littler, Stephan Clements, David Gillespie, Ceri Lynch, Lillian Coventry, Paul Clements, Paul Foley, Claire Ireland, Vikramjit Singh, M. H. Nathanson, R. Jonathan T. Wilson, Shilpa Rawat, Pieter Bothma, David Pritchard, Victor Birioukov, Robert Campbell, Brien Hennessy, Stephanie Bell, Robert Smith, Muhammad Usman Latif, Nicolas Hooker, Anand Kulkarni, Chelsea Hicks, Steve Harris, Caroline Reavley, Claire Botfield, Christopher Nutt, Andrew Gorman, Peter J O'Brien, Murray Geddes, Carlos Kidel, Samar Al-Rawi, atyas Andorka, John John, Stephen Washington, Peter Csabi, Anil Hormis, Emily Dana, Sharon Hilton-Christie, Brian Spain, Suganthi Joachim, Richard Partridge, Tony Miller-Greenman, Andrew Marshall Wilson, Samuel Perrin, Carol Bradbury, Christopher Goddard, Paul Cooper, Simon Williams, Iain K. Moppett, Han Truong, Stephen J. Brett, Robert Orme, Alexandra Matson, Michael P.W. Grocott, Sunita Agarwal, Jonathan Chambers, Georgina Prassas, Rachel Markham, Kevin Hamilton, Jane Wright, Julian Sonksen, Robert Spencer, James Limb, Tehal Kooner, James Tozer, Sujesh Bansal, Fiona Graham, Suresh Singaravelu, Adrienne Stewart, Sophie Gormack, Buzz Shephard, Julian Berry, Nick Spittle, Philip Blackie, Richard Stewart, R. Sneyd, Laura Kwan, Ben Chandler, Helen Lindsay, Wendy Lum Hee, Vivien Edwards, David Highton, Helen A. Lindsay, Tendai Ramhewa, Daphne Varveris, Liam McLoughlin, Duncan Brown, Justin Woods, Annabelle Whapples, Jonathan Panckhurst, Garry Henry, Kate Campbell, Jeremy Henning, Stephanie Sim, Baigel Gary, Nam Le, Joellene Mitchell, Laura Tasker, Geoff Wright, Con Papageorgiou, Simon Whiteley, Richard Pugh, Joel Matthews, Suneetha Ramani Moonesinghe, Andrew M. Wilson, Sandeep Varma, Chris Hargreaves, Malcolm Gunning, Agnieszka Kubisz-Pudelko, Richard Shawyer, N. M. Wharton, Janette Moss, Gurunath Hosdurga, Catherine Plowright, Jane Montgomery, Stuart McLellan, Emma Gent, Patrick Dill-Russell, James Craig, Nirav Shah, Julius Dale-Gandar, Geoff Thorning, Lawrence Wilson, Roddy Chapman, Andrew Gratrix, Kate Bailey, Sunil kumar Chaurasia, Sophie Wallace, Rob Dawson, Richard Siviter, Christine Range, Helen McNamara, Tim Cook, Khong Tan, Michael Brett, Alan Kakos, Samuel Armanious, Liana Zucco, Sam Clark, Laura Troth, Rajeev Jha, Michael Weisz, James Pennington, Chris Bowden, Jeremy Drake, David Rogerson, Ritesh Maharaj, Alison Jackson, Sophie van Oudenaaren, Rohit Juneja, and Naomi Goodwin

Subjects
medicine.medical_specialty, Critical Care, Population, Staffing, Care provision, Patient safety, Postoperative Complications, medicine, Per capita, Humans, education, Postoperative Care, Response rate (survey), education.field_of_study, Tertiary Healthcare, business.industry, Australia, Health services research, Emergency department, United Kingdom, Intensive Care Units, Anesthesiology and Pain Medicine, Hospital Bed Capacity, Health Care Surveys, Emergency medicine, Health Services Research, business, New Zealand
Abstract

Background Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional ‘high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment. Methods We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities. Results We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively. Conclusions Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.

Published
2019
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4. Improving the use of the ‘COUGH’ bundle in Surgical High Dependency Unit, Ninewells Hospital, Dundee

Author

Sharon Hilton-Christie, Victoria Livie, and Jennifer Livie

Subjects
Male, Respiratory complications, medicine.medical_specialty, Respiratory Therapy, Leadership and Management, Quality Improvement Report, medicine.medical_treatment, Iatrogenic Disease, Respiratory Tract Diseases, Diaphragmatic breathing, Hospital-acquired pneumonia, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, 030202 anesthesiology, medicine, Intubation, Humans, 030212 general & internal medicine, Respiratory system, Intensive care medicine, lcsh:R5-920, business.industry, Health Policy, Incidence (epidemiology), Public Health, Environmental and Occupational Health, Pneumonia, Length of Stay, Middle Aged, medicine.disease, Quality Improvement, critical care, patient-centred care, Cough, Scotland, Bundle, Female, business, healthcare quality improvement, PDSA, lcsh:Medicine (General), Patient Care Bundles
Abstract

Developing respiratory complications postoperatively is one of the major determinants of longer hospital stay, morbidity, mortality and increased healthcare costs. The incidence of postoperative respiratory complications varies from 1% to 23%. Given that postoperative respiratory complications are relatively common and costly, there have been various studies which look at ways to reduce the risk of these occurring. One such protocol is the ICOUGH bundle which stands for Incentive spirometry, Coughing and deep breathing, Oral care, patient Understanding, Getting out of bed and Head of bed elevation. This has been adapted locally to the Coughing and deep breathing, Oral care, patient Understanding, Getting out of bed and Head of bed elevation (COUGH) bundle which consists of these components excluding incentive spirometry. Within our surgical high dependency unit (HDU), the COUGH bundle should be implemented in patients who have a moderate or high risk of developing postoperative respiratory complications with an Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score of 26 or above. Studies have shown that the ICOUGH bundle has reduced rates of pneumonia and unplanned intubation in general surgical and vascular patients. Baseline data taken from surgical HDU showed that the COUGH bundle was not well implemented. One out of eight patients who had an ARISCAT score greater than 26 had the COUGH bundle implemented on admission to the unit. Three out of eight patients had the ARISCAT score documented in their admission medical review. One patient who should have received the bundle, but did not, developed a hospital acquired pneumonia postoperatively. To address this issue, we aimed to increase awareness surrounding the COUGH bundle and to increase the number of patients who had the COUGH bundle started on admission. This quality improvement project had four cycles (plan, do, study, act) and after these, 100% of patients who had an ARISCAT score of 26 or more had the COUGH bundle implemented.

Published
2020

5. Impact of serum procalcitonin on antibiotic stewardship in surgical high-dependency unit and intensive care unit settings

Author

Laura Meney, Helge C. Dorfmueller, Benjamin Parcell, Aaron Taylor, Sharon Hilton-Christie, John Shone, and Azul Zorzoli

Subjects
medicine.medical_specialty, business.industry, medicine.drug_class, Antibiotics, Antimicrobial, Intensive care unit, Procalcitonin, Discontinuation, law.invention, law, medicine, Antimicrobial stewardship, Antibiotic Stewardship, General Materials Science, Medical prescription, Intensive care medicine, business
Abstract

Background Procalcitonin (PCT) testing is used as a biomarker for bacterial infection. We assessed the impact of using a PCT-guided algorithm in Ninewells hospital & Medical School (Dundee, Scotland, UK). Methods We conducted a retrospective analysis of the use of PCT-testing to evaluate the escalation or de-escalation of antibiotic therapy. For this, we analysed patients admitted to the intensive care unit (ICU) and surgical high dependency unit (SHDU) from November 2018 to April 2019. Results We analysed a dataset of 235 adult patients, 23% of which were at the hospital’s ICU and 77% at the SHDU. Within the ICU, 49% of admitted patients were already on antibacterial therapy, compared to 93% at SHDU. The PCT results influenced the prescription of antibiotics in 33% of total patients (89% and 16% of all ICU and SHDU patients, respectively). Escalation of the antimicrobial therapy was prescribed to 34% of ICU patients after PCT testing, compared to 20% of SHDU patients. Continuation of the previously-established antibacterial scheme was more pronounced in SHDU patients (43% against 23% ICU). In contrast, while discontinuation of the therapy was observed in similar levels on both units (27% SHDU, 28% ICU). Conclusion PCT has become a useful tool in antimicrobial stewardship. Its use aided the prescription of antibiotics in 33% of the overall total cases in ICU and SHDU. Further work should be carried out to assess its role in other clinical environments.

Published
2020
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7. High-performance water-based barrier coatings for the corrosion protection of structural steel

Author

Brendan Duffy, B. Thomas, Joseph L. Keddie, Franck D'Agosto, Véronique Dehan, Malin Schulz, Morgan Sibbald, Michelle Lee, Sharon Hilton, Douglas P. Mazeffa, Muriel Lansalot, Kalliopi Krassa, Ming Liang Koh, Andrea Fortini, Elodie Bourgeat-Lami, Brian Skerry, Jennifer Lesage de la Haye, Christos Mantzaridis, Ignacio Martín-Fabiani, Richard P. Sear, ECCS - European Convention for Constructional Steelwork (ECCS), Laboratoire de Chimie, Catalyse, Polymères et Procédés, R 5265 (C2P2), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-École Supérieure de Chimie Physique Électronique de Lyon (CPE)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Dublin Institute of Technology, University of Surrey (UNIS), Sherwin-Williams Protective and Marine Coatings Tower Works, Megara Resins, Dublin Institute of Technology (DIT), Department of Physics, University of Surrey, European Project: 304758,EC:FP7:SME,FP7-SME-2012,BARRIER PLUS(2014), Centre National de la Recherche Scientifique (CNRS)-École supérieure de Chimie Physique Electronique de Lyon (CPE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut de Chimie du CNRS (INC), and Department of Physics, University of Surrey, Guildford

Subjects
Materials science, 02 engineering and technology, engineering.material, 010402 general chemistry, 01 natural sciences, Corrosion, Coating, Forensic engineering, Composite material, ComputingMilieux_MISCELLANEOUS, Civil and Structural Engineering, chemistry.chemical_classification, Environmental profile, Metals and Alloys, Building and Construction, Polymer, 021001 nanoscience & nanotechnology, Moisture resistance, Water based, 0104 chemical sciences, [CHIM.POLY]Chemical Sciences/Polymers, chemistry, Mechanics of Materials, engineering, 0210 nano-technology, Dispersion (chemistry)
Abstract

This article provides an overview of the outcomes of a European-funded project called BarrierPlus. A new type of water-based barrier coating was developed for structural steel applications. The advantages of this coating include enhanced moisture resistance, low volatile organic compounds (VOCs) and one-component self-crosslinking free of isocyanates. To enable this performance, a latex polymer binder was uniquely designed without using soap-like molecules, known as surfactants, to form the dispersion. By minimizing surfactants in the coating, the barrier properties were significantly enhanced. The latex was successfully scaled up to 15 kg quantities by an SME, coating formulations were scaled to pilot quantities and a variety of characterization and coating performance tests were completed. A life cycle assessment found that the BarrierPlus coating has a better environmental profile than an industry benchmark solvent-borne coating and showed promising results relative to commercial waterborne benchmarks.

Published
2017
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