Patients hospitalized with a life-limiting illness, along with their loved ones, frequently experience anxiety, stress, and pain. Legacy building through storytelling and music may alleviate emotional strain and provide comfort. Musical Rounds is a novel music medicine program designed to reduce distress and support legacy building for adult patients receiving palliative care and their loved ones.

This multisite, mixed-methods, pre–post feasibility study was conducted across 3 hospitals in California, USA. Participants engaged in live bedside recording sessions in which personal stories were shared with real-time musical improvisation provided by a clinician-musician. Afterward, participants received a personalized edited recording combining voice and improvised music. Pain, stress, anxiety, and comfort were assessed before and after each session using a 0–10 numeric rating scale. Perceived mood changes were assessed through directed qualitative content analysis.

We invited 100 adult patients hospitalized with a life-limiting illness and their loved ones to participate. If patients were unable to respond, loved ones participated on their behalf. Patients (n = 79) demonstrated statistically significant within-group differences between pre- and post-session assessments, including lower pain (−1.58, p < .001), stress (−2.89, p < .001), and anxiety (−2.73, p < .001), and higher comfort (+1.61, p < .001). Loved ones (n = 42) reported lower stress (−3.14, p < .001) and anxiety (−2.86, p < .001), and higher comfort (+1.83, p = .004). Directed content analysis indicated perceived mood improvement in 59% (47/80) of patients and 68% (30/44) of loved ones.

Musical Rounds, a personalized music and storytelling session for hospitalized patients with life-limiting illness and their loved ones, was associated with lower self-reported stress, pain (patients only), and anxiety, and higher comfort and perceived mood across 3 hospitals. Findings demonstrate the feasibility and suggest potential benefits of music medicine–supported legacy building in palliative care. Controlled studies with independent assessors are needed to further evaluate efficacy.

Fires are among the most feared incidents that can occur in a hospital. Hospital fires will disrupt care continuity, may require the evacuation of patients and have the potential to result in injuries or even deaths. The aim of this study is to gain insight into hospital fires in the Netherlands over a 20-year period.

Systematic scoping review of news articles mentioning hospital fires in the Netherlands retrieved from the LexisNexis database, Google, Google News, PubMed, and EMBASE between 2000 and 2020. Hospital fires were included if they were associated with the closure of hospital departments or intervention units and/or evacuations. The cause, location, involved departments, need for evacuation, and the number of casualties were evaluated.

Twenty-four major hospital fires were identified. More than half of these were caused by technical failures, and in 6 cases (25%), the fires were attributed to patients. In 71% of the incidents, acute care departments were affected by the fire. Twenty fires (83%) resulted in the evacuation of patients. In 2 cases, the fire resulted in the death of a patient.

Patient-attributed fires are a significant cause of major hospital fires in the Netherlands. Prevention and mitigation measures should be implemented accordingly.

Although evidence supports the improved safety profile of direct oral anticoagulants (DOACs) over warfarin (WF), outcomes among elderly traumatic brain injury (TBI) patients on this regimen remain unclear. This study describes the association between anticoagulation status (DOAC vs. WF use) and the rates of occurrence of intracranial hemorrhage (ICH), hematoma progression, need for surgical intervention and mortality in elderly TBI cases.

This retrospective cohort study from 2014 to 2019 included all trauma patients > 65 years on either WF or DOACs at the time of injury. The primary outcome was the rate of ICH after TBI. Multivariable regression analysis identified independent predictors of functional dependency and mortality.

A total of 501 elderly TBI patients (mean age = 82 years old) were included. WF users had higher CT Marshall scores (p = 0.007), more severe TBI (GCS < 8) (p = 0.003) and higher rates of subdural hematomas compared to the DOAC group (p = 0.003). Patients on DOACs had lower rates of ICH (42% vs. 57%, p = 0.001) and hospitalization (30% vs. 41%, p = 0.013) and better Glasgow outcome scale-extended scores at hospital discharge (mean 6.98 vs. 6.41, p = 0.005). Multicompartment ICH (OR 2.30, p = 0.027) and longer hospitalization (OR 0.04, p < 0.001) were associated with higher functional dependency rates, while higher CT Marshall scores (OR 1.09, p < 0.001) and poorer baseline frailty status (OR 0.62, p = 0.026) predicted increased mortality risk.

Elderly TBI patients on DOACs have lower rates of ICH, lower need for hospitalization and better functional outcomes at discharge compared to those taking WF. These findings need further confirmation using prospective multicenter studies.

Central venous lines (CVLs) are frequently utilized in critically ill patients and confer a risk of central line-associated bloodstream infections (CLABSIs). CLABSIs are associated with increased mortality, extended hospitalization, and increased costs. Unnecessary CVL utilization contributes to CLABSIs. This initiative sought to implement a clinical decision support system (CDSS) within an electronic health record (EHR) to quantify the prevalence of potentially unnecessary CVLs and improve their timely removal in six adult intensive care units (ICUs).

Intervention components included: (1) evaluating existing CDSS’ effectiveness, (2) clinician education, (3) developing/implementing an EHR-based CDSS to identify potentially unnecessary CVLs, (4) audit/feedback, and (5) reviewing EHR/institutional data to compare rates of removal of potentially unnecessary CVLs, device utilization, and CLABSIs pre- and postimplementation. Data was evaluated with statistical process control charts, chi-square analyses, and incidence rate ratios.

Preimplementation, 25.2% of CVLs were potentially removable, and the mean weekly proportion of these CVLs that were removed within 24 hours was 20.0%. Postimplementation, a greater proportion of potentially unnecessary CVLs were removed (29%, p < 0.0001), CVL utilization decreased, and days between CLABSIs increased. The intervention was most effective in ICUs staffed by pulmonary/critical care physicians, who received monthly audit/feedback, where timely CVL removal increased from a mean of 18.0% to 30.5% (p < 0.0001) and days between CLABSIs increased from 17.3 to 25.7.

A significant proportion of active CVLs were potentially unnecessary. CDSS implementation, in conjunction with audit and feedback, correlated with a sustained increase in timely CVL removal and an increase in days between CLABSIs.

This umbrella review will summarize palliative and end-of-life care practices in peri-intensive care settings by reviewing systematic reviews in intensive care unit (ICU) settings. Evidence suggests that integrating palliative care into ICU management, initiating conversations about care goals, and providing psychological and emotional support can significantly enhance patient and family outcomes.

The Joanna Briggs Institute (JBI) methodology for umbrella reviews will be followed. The search will be carried out from inception until 30 September 2023 in the following databases: Cochrane Library, SCOPUS, Web of Science, CINAHL Complete, Medline, EMBASE, and PsycINFO. Two reviewers will independently conduct screening, data extraction, and quality assessment, and to resolve conflicts, adding a third reviewer will facilitate the consensus-building process. The quality assessment will be carried out using the JBI Critical Appraisal Checklist. The review findings will be reported per the guidelines outlined in the Preferred Reporting Items for Overviews of Reviews statement.

This umbrella review seeks to inform future research and practice in critical care medicine, helping to ensure that end-of-life care interventions are optimized to meet the needs of critically ill patients and their families.