Frequency and Characteristics of Medical Complications in Rehabilitation Settings: A Scoping Review.

OBJECTIVE: To synthesize the available evidence on medical complications occurring in adult patients in subacute inpatient rehabilitation, and to describe the impact on subacute length of stay and readmission to acute care. DESIGN: Scoping review. SUBJECTS: Adult patients, within the inpatient rehabilitation environment, who experienced medical complications, clinical deterioration and/or the requirement of transfer to acute care. METHODS: A systematic search of MEDLINE and CINAHL electronic databases was undertaken to identify primary research studies published in English and French during the period 2000-2021. Study reporting followed the standards indicated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist (PRISMA-ScR). RESULTS: A total of 47 studies were identified for inclusion. Key results included differences in the type and frequency of complications according to admission type, the proportion of patients experiencing at least 1 complication, and complications associated with transfer to acute care. CONCLUSION: Patients admitted for inpatient rehabilitation are at high risk of medical complications and may not be medically stable during their admission, requiring care by clinicians with expertise in functional rehabilitation, and ongoing management by members of the multidisciplinary team with expertise in acute general medicine, infectious diseases and recognition and response to clinical deterioration.

A systematic scoping review of the cost-impact of ventilator-associated pneumonia (VAP) intervention bundles in intensive care.

BACKGROUND: Evidence-based economic decision making is key in health care. Presently, however, studies reporting financial outcomes of ventilator-associated pneumonia (VAP) care bundles have not been systematically evaluated. METHOD: This scoping review investigated the characteristics and findings of studies of the economic impact of VAP bundle implementation. A systematic search of electronic databases (MEDLINE, CINAHL) for relevant English language studies was undertaken (January 2000-February 2020). Methodological quality was evaluated using a Joanna Briggs Institute quality appraisal checklist. Article screening and quality appraisals were performed by 2 reviewers. Reference lists of included studies were hand-searched for additional articles. Reporting followed PRISMA Extension for Scoping Reviews (PRISMA-ScR) standards. RESULTS: From 181 citations, 10 articles met inclusion criteria. Eight studies evaluated cost impacts on acute care and there were 2 cost-modeling studies. Results consistently indicated that effective VAP bundle implementation decreased healthcare costs. However, studies were heterogeneous with respect to research methods and objectives and were judged to have a moderate-to-high risk of bias. DISCUSSION: Effective implementation of VAP care bundles was associated with superior clinical and economic outcomes. However, despite finding a moderate volume of research, study heterogeneity inhibited strong conclusions being drawn regarding the degree of associated cost savings. CONCLUSION: Additional research involving multisite/multijurisdiction studies using experimental designs are needed to progress the field and overcome gaps in the existing literature.

Lessons learned from a rapid implementation of a ventilator-associated pneumonia prevention bundle.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common avoidable healthcare associated infection in ventilated critical care patients that can have a detrimental impact on patient recovery. To increase uptake at a local level, care bundles should be designed and implemented in collaboration with the end-users who will implement the bundle into practice. AIM/OBJECTIVE: The aim in this study was to evaluate critical care nurses' perceptions of the usability of a respiratory care bundle as an effective approach to VAP prevention. METHODS: An exploratory descriptive qualitative study was conducted. A respiratory care bundle consisting of five components was implemented over a 4-week period. Following implementation, a focus group and semi-structured interviews were conducted to obtain nurses' feedback on the useability of the care bundle. Seven intensive care nurses caring for ventilated patients participated in the study. FINDINGS/RESULTS: Participants confirmed that using a care bundle provided a structured approach to nursing care of a ventilated patient and that the use of checklist reminders at the bedside was useful in a busy practice environment. Barriers to uptake and implementation of the bundle were that the unit culture did not prioritise preventative care and the need for a structured interdisciplinary approach to sedation and weaning of mechanical ventilation. DISCUSSION: To successfully imbed all elements of a respiratory care bundle into practice; an interdisciplinary approach is needed in which there is a strong emphasis on preventative care. These findings highlight the advantages of involving end-users in the development of strategies to decrease VAP.