Browsing by Author "Wollny, Krista"

Now showing 1 - 3 of 3
  • Thumbnail Image
    ItemOpen Access
    Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review
    (2021-05-12) Moss, Stephana J; Wollny, Krista; Poulin, Therese G; Cook, Deborah J; Stelfox, Henry T; Ordons, Amanda R d; Fiest, Kirsten M
    Abstract Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.
  • Thumbnail Image
    ItemOpen Access
    Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review
    (2022-12-02) Wollny, Krista; Cui, Sara; McNeil, Deborah; Benzies, Karen; Parsons, Simon J.; Sajobi, Tolulope; Metcalfe, Amy
    Abstract Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube and is an important quality indicator in pediatric critical care. The objective of this review was to comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children. Methods We included original, primary research on quality improvement interventions to reduce the rate of unplanned extubations in pediatric critical care. A search was conducted in MEDLINE (Ovid), Embase, and CINAHL from inception through April 29, 2021. Two reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data from included studies were abstracted using a tool created by the authors, and QI interventions were categorized using the Behavior Change Wheel. Vote counting based on the direct of effect was used to describe the effectiveness of quality improvement interventions. Study quality was assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Results were presented as descriptive statistics and narrative syntheses. Results Thirteen studies were included in the final review. Eleven described primary QI projects; two were sustainability studies that followed up on previously described QI interventions. Under half of the included studies were rated as high-quality. The median number of QI interventions described by each study was 5 [IQR 4–5], with a focus on guidelines, environmental restructuring, education, training, and communication. Ten studies reported decreased unplanned extubation rates after the QI intervention; of these, seven had statistically significant reductions. Both sustainability studies observed increased rates that were not statistically significant. Conclusions This review provides a comprehensive synthesis of QI interventions to reduce unplanned extubation. With only half the studies achieving a high-quality rating, there is room for improvement when conducting and reporting research in this area. Findings from this review can be used to support clinical recommendations to prevent unplanned extubations, and support patient safety in pediatric critical care. Systematic review registration This review was registered on PROSPERO (CRD42021252233) prior to data extraction.
  • Thumbnail Image
    ItemOpen Access
    Unplanned Extubations: Adverse Events in Pediatric Critical Care
    (2022-04-19) Wollny, Krista; Metcalfe, Amy; McNeil, Deborah; Sajobi, Tolulope; Benzies, Karen; Parsons, Simon J
    Unplanned extubations are the uncontrolled and accidental removal of an endotracheal tube and are an adverse event and quality indicator in pediatric intensive care units (PICUs). The literature on quality improvement (QI) interventions to prevent unplanned intubations in PICUs has not been comprehensively synthesized. Furthermore, large-scale studies of practices related to intubation and preventing unplanned extubations have not been conducted across multiple PICUs. Unplanned extubations are infrequent events, with recent studies reporting rates between 0.74-1.5 events/100 intubation days. This has contributed to small sample sizes in previous studies. Small sample sizes and single-centre studies limit the generalizability of findings and the ability to detect associations. These gaps are addressed in this dissertation. The overarching aim of this dissertation was to explore unplanned extubations in PICUs, applying theories and methodology from quality improvement, implementation science, knowledge translation, and epidemiology. In the first manuscript, we conducted a systematic review on quality improvement interventions to prevent unplanned extubations in PICUs. The median number of QI interventions described by the ten included studies was 4.5 [IQR 4-5], with a focus on guidelines, environmental restructuring, education, training, and communication. The second manuscript is an observational, cross-sectional study exploring care practices related to intubation and preventing unplanned extubations across PICUs. Data were gathered via a survey distributed to PICUs in the Virtual Pediatric Systems (VPS) database, and the analyses demonstrated substantial variability in clinical practice, including staffing, frequency of procedures, and treatment-related goals. The third manuscript is a retrospective observational study and prediction model that explored unplanned extubations requiring reintubation in PICUs using data from the VPS database. Of the 5,703 patients that experienced an unplanned extubation, 1,661 (29.1%) required reintubation. Variables associated with increased risk of reintubation were younger age and respiratory diagnosis. The multilevel least absolute shrinkage selection operator (LASSO) logistic regression model predicting reintubation resulted in an AUROC of 0.59 (95% CI: 0.57–0.61) with variables age, weight, diagnosis, and scheduled admission. The results of these three manuscripts contribute to the field of patient safety in PICUs, which is integrated into clinical recommendations and directions for future research.