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2019-20 Courses


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  • Non-clinical delays in transfer out of the surgical ICU are associated with increased hospital length of stay and delayed progress of care JOURNAL OF CRITICAL CARE Safavi, K., Furtado, J., Langle, A., Scheinker, D., Schmidt, U., Daily, B., Levi, R., Dunn, P. 2019; 50: 126–31

    Abstract

    The impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care.This was a single center retrospective study in the United States of patients admitted to the surgical and neurosurgical ICUs during 2013 and 2015. The primary outcome was hospital LOS after transfer request. The secondary outcome was the timing of provider orders representing care decisions (milestones) that would advance the patient's care. Patient, surgery, and bed covariates were accounted for in a multivariate regression and propensity matching analysis.Out of the cohort of 4,926 patients, 1,717 met inclusion criteria. 670 (39%) experienced ≥12 hours of TD. For each day of TD, there was an average increase of 0.70 days in LOS (P < 0.001). The last milestone occurred on average 0.35 days later (P < 0.001). Propensity matching analyses were confirmatory (P < 0.001, P < 0.001).TD is associated with longer LOS and delays in milestone clinical decisions that progress care. Eliminating delays in milestones could mitigate TD's impact on LOS.

    View details for DOI 10.1016/j.jcrc.2018.11.025

    View details for Web of Science ID 000458375800021

    View details for PubMedID 30530264

  • Constrained extremum seeking stabilization of systems not affine in control INTERNATIONAL JOURNAL OF ROBUST AND NONLINEAR CONTROL Scheinker, A., Scheinker, D. 2018; 28 (2): 568–81

    View details for DOI 10.1002/rnc.3886

    View details for Web of Science ID 000418409100012