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Halpern NA, Tan KS, Bothwell LA, Boyce L, Dulu AO. Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010-2020. Crit Care Med 2024; 52:223-236. [PMID: 38240506 DOI: 10.1097/ccm.0000000000005984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The Society of Critical Care Medicine last published an intensivist definition in 1992. Subsequently, there have been many publications relating to intensivists. Our purpose is to assess how contemporary studies define intensivist physicians. DESIGN Systematic search of PubMed, Embase, and Web of Science (2010-2020) for publication titles with the terms intensivist, and critical care or intensive care physician, specialist, or consultant. We included studies focusing on adult U.S. intensivists and excluded non-data-driven reports, non-U.S. publications, and pediatric or neonatal ICU reports. We aggregated the study title intensivist nomenclatures and parsed Introduction and Method sections to discern the text used to define intensivists. Fourteen parameters were found and grouped into five definitional categories: A) No definition, B) Background training and certification, C) Works in ICU, D) Staffing, and E) Database related. Each study was re-evaluated against these parameters and grouped into three definitional classes (single, multiple, or no definition). The prevalence of each parameter is compared between groups using Fisher exact test. SETTING U.S. adult ICUs and databases. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 657 studies, 105 (16%) met inclusion criteria. Within the study titles, 17 phrases were used to describe an intensivist; these were categorized as intensivist in 61 titles (58%), specialty intensivist in 30 titles (29%), and ICU/critical care physician in 14 titles (13%). Thirty-one studies (30%) used a single parameter (B-E) as their definition, 63 studies (60%) used more than one parameter (B-E) as their definition, and 11 studies (10%) had no definition (A). The most common parameter "Works in ICU" (C) in 52 studies (50%) was more likely to be used in conjunction with other parameters rather than as a standalone parameter (multiple parameters vs single-parameter studies; 73% vs 17%; p < 0.0001). CONCLUSIONS There was no consistency of intensivist nomenclature or definitions in contemporary adult intensivist studies in the United States.
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Affiliation(s)
- Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Critical Care Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lilly A Bothwell
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lindsay Boyce
- MSK Library, Technology Division, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alina O Dulu
- Department of Anesthesiology and Critical Care Medicine, Critical Care Center, Memorial Sloan Kettering Cancer Center, New York, NY
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Bolesta S, Burry L, Perreault MM, Gélinas C, Smith KE, Eadie R, Carini FC, Saltarelli K, Mitchell J, Harpel J, Stewart R, Riker RR, Fraser GL, Erstad BL. International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU. Crit Care Med 2023; 51:1502-1514. [PMID: 37283558 DOI: 10.1097/ccm.0000000000005951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Iatrogenic withdrawal syndrome (IWS) associated with opioid and sedative use for medical purposes has a reported high prevalence and associated morbidity. This study aimed to determine the prevalence, utilization, and characteristics of opioid and sedative weaning and IWS policies/protocols in the adult ICU population. DESIGN International, multicenter, observational, point prevalence study. SETTING Adult ICUs. PATIENTS All patients aged 18 years and older in the ICU on the date of data collection who received parenteral opioids or sedatives in the previous 24 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS ICUs selected 1 day for data collection between June 1 and September 30, 2021. Patient demographic data, opioid and sedative medication use, and weaning and IWS assessment data were collected for the previous 24 hours. The primary outcome was the proportion of patients weaned from opioids and sedatives using an institutional policy/protocol on the data collection day. There were 2,402 patients in 229 ICUs from 11 countries screened for opioid and sedative use; 1,506 (63%) patients received parenteral opioids, and/or sedatives in the previous 24 hours. There were 90 (39%) ICUs with a weaning policy/protocol which was used in 176 (12%) patients, and 23 (10%) ICUs with an IWS policy/protocol which was used in 9 (0.6%) patients. The weaning policy/protocol for 47 (52%) ICUs did not define when to initiate weaning, and the policy/protocol for 24 (27%) ICUs did not specify the degree of weaning. A weaning policy/protocol was used in 34% (176/521) and IWS policy/protocol in 9% (9/97) of patients admitted to an ICU with such a policy/protocol. Among 485 patients eligible for weaning policy/protocol utilization based on duration of opioid/sedative use initiation criterion within individual ICU policies/protocols 176 (36%) had it used, and among 54 patients on opioids and/or sedatives ≥ 72 hours, 9 (17%) had an IWS policy/protocol used by the data collection day. CONCLUSIONS This international observational study found that a small proportion of ICUs use policies/protocols for opioid and sedative weaning or IWS, and even when these policies/protocols are in place, they are implemented in a small percentage of patients.
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Affiliation(s)
- Scott Bolesta
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA
| | - Lisa Burry
- Departments of Pharmacy and Medicine, Sinai Health System, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Marc M Perreault
- Department of Pharmacy, McGill University Health Center and Faculty of Pharmacy, University of Montréal, Montréal, QC, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, and Centre for Nursing Research/Lady Davis Institute, Jewish General Hospital-CIUSSS West-Central-Montréal, Montréal, QC, Canada
| | | | - Rebekah Eadie
- Critical Care/Pharmacy, Ulster Hospital, Dundonald, United Kingdom
| | - Federico C Carini
- MS-ICU, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Jamie Harpel
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA
| | - Ryan Stewart
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA
| | - Richard R Riker
- Department of Critical Care/Pulmonary Medicine, Maine Medical Center, Portland, ME
| | | | - Brian L Erstad
- Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ
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Machut KZ, Gilbart C, Murthy K, Michelson KN. A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care. Adv Neonatal Care 2023; 23:467-477. [PMID: 37499687 PMCID: PMC10544817 DOI: 10.1097/anc.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Families and staff in neonatal intensive care units (NICUs) value continuity of care (COC), though definitions, delivery, and impacts of COC are incompletely described. Previously, we used parental perspectives to define and build a conceptual model of COC provided by neonatologists. Nursing perspectives about COC remain unclear. PURPOSE To describe nursing perspectives on neonatologist COC and revise our conceptual model with neonatal nurse input. METHODS This was a qualitative study interviewing NICU nurses. The investigators analyzed transcripts with directed content analysis guided by an existing framework of neonatologist COC. Codes were categorized according to previously described COC components, impact on infants and families, and improvements for neonatologist COC. New codes were identified, including impact on nurses, and codes were classified into themes. RESULTS From 15 nurses, 5 themes emerged: (1) nurses validated parental definitions and benefits of COC; (2) communication is nurses' most valued component of COC; (3) neonatologist COC impact on nurses; (4) factors that modulate the delivery of and need for COC; (5) conflict between the need for COC and the need for change. Suggested improvement strategies included optimizing staffing and transition processes, utilizing clinical guidelines, and enhancing communication at all levels. Our adapted conceptual model describes variables associated with COC. IMPLICATIONS FOR PRACTICE AND RESEARCH Interdisciplinary NICU teams need to develop systematic strategies tailored to their unit's and patients' needs that promote COC, focused to improve parent-clinician communication and among clinicians. Our conceptual model can help future investigators develop targeted interventions to improve COC.
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Affiliation(s)
- Kerri Z. Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University (Chicago, IL)
- Ann & Robert H. Lurie Children’s Hospital of Chicago (Chicago, IL)
| | | | - Karna Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University (Chicago, IL)
- Ann & Robert H. Lurie Children’s Hospital of Chicago (Chicago, IL)
| | - Kelly N. Michelson
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University (Chicago, IL)
- Ann & Robert H. Lurie Children’s Hospital of Chicago (Chicago, IL)
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Pluenneke JC, Semler MW, Casey JD, Qian ET, Rice TW, Stollings JL. Quantifying Critical Care Pharmacist Interventions in COVID-19. J Intensive Care Med 2023; 38:651-656. [PMID: 36755415 PMCID: PMC9912037 DOI: 10.1177/08850666231156551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
Purpose/Background: Pharmacists have been shown to play an important role in the medication management of critically ill patients. Pharmacist interventions in the care of critically ill patients with coronavirus disease 2019 (COVID-19) have not been quantitatively described. Methodology: A single center, retrospective, observational study was conducted at Vanderbilt University Medical Center in Nashville, Tennessee. All adult patients admitted to the COVID-19 intensive care unit (ICU) or Medical ICU with a COVID-19 diagnosis between March 1, 2020, and June 30, 2021, were included. All interventions made by pharmacists were documented electronically, collected, categorized, and analyzed. The primary outcome of this study was the median number of interventions by pharmacists per patient. The secondary outcome was the number of different types of interventions performed. Results: A total of 768 patients were included in the analysis. The median age was 63 years old; 63% of patients were male and 71% were Caucasian. Median hospital length of stay (LOS) was 12 days (interquartile range (IQR) 7-21) and ICU LOS was 5 days (IQR 1-11). The median Sequential Organ Failure Assessment score was 4 (IQR 2-7) and Charlson Comorbidity Index was 3 (IQR 2-5). Mortality at 60 days occurred in 352 patients (46%). Pharmacists performed a total of 7027 interventions for 655 patients with a median number of pharmacist interventions per patient of 6 (IQR 3-14). The most common pharmacist interventions were medication discontinuation (24%), completion of components of the ICU liberation bundle (19%), medication dose adjustment (18%), therapeutic drug monitoring (15%), and medication initiation (10%). Conclusions: Pharmacists made multiple interventions related to medication use and management in critically ill patients with COVID-19. This study adds important information of the evolving role clinical pharmacists play in the care of critical illness, specifically during the COVID-19 pandemic.
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Affiliation(s)
- Jack C. Pluenneke
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew W. Semler
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D. Casey
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward T. Qian
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W. Rice
- Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joanna L. Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness Brain Dysfunction Survivorship Center, Nashville, TN, USA
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5
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Jacobi J, Harvey M, Schorr C, Thompson A, Bekes C, Spevetz A. Women as a Growing Force in Critical Care Medicine-the Journal, Profession, and Society. Crit Care Med 2023; 51:555-562. [PMID: 37052434 DOI: 10.1097/ccm.0000000000005823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
| | | | - Christa Schorr
- Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, NJ
| | - Ann Thompson
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carolyn Bekes
- Cooper Medical School of Rowan University, Camden, NJ
| | - Antoinette Spevetz
- Cooper Medical School of Rowan University, Graduate Medical Education, Intermediate Care Unit, Section of Critical Care Medicine, Cooper University Healthcare, Camden, NJ
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Dahmer M, Jennings A, Parker M, Sanchez-Pinto LN, Thompson A, Traube C, Zimmerman JJ. Pediatric Critical Care in the Twenty-first Century and Beyond. Crit Care Clin 2023; 39:407-425. [PMID: 36898782 DOI: 10.1016/j.ccc.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric critical care addresses prevention, diagnosis, and treatment of organ dysfunction in the setting of increasingly complex patients, therapies, and environments. Soon burgeoning data science will enable all aspects of intensive care: driving facilitated diagnostics, empowering a learning health-care environment, promoting continuous advancement of care, and informing the continuum of critical care outside the intensive care unit preceding and following critical illness/injury. Although novel technology will progressively objectify personalized critical care, humanism, practiced at the bedside, defines the essence of pediatric critical care now and in the future.
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Affiliation(s)
- Mary Dahmer
- Division of Critical Care, Department of Pediatrics, University of Michigan, 1500 East Medical Center Drive, F6790/5243, Ann Arbor, MI, USA
| | - Aimee Jennings
- Division of Critical Care Medicine, Advanced Practice, FA.2.112, Seattle Children's Hospital, 4800 Sandpoint Way Northeast, Seattle, WA 98105, USA
| | - Margaret Parker
- Department of Pediatrics, Stony Brook University, 7762 Bloomfield Road, Easton, MD 21601, USA
| | - Lazaro N Sanchez-Pinto
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 73, Chicago, IL 60611-2605, USA
| | - Ann Thompson
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Chani Traube
- Department of Pediatrics, Weill Cornell Medicine, 525 East 68th Street, Box 225, New York, NY 10065, USA
| | - Jerry J Zimmerman
- Department of Pediatrics, FA.2.300B Seattle Children's Hospital, 4800 Sandpoint Way Northeast, Seattle, WA 98105, USA; Pediatric Critical Care Medicine, Seattle Children's Hospital, Harborview Medical Center, University of Washington, School of Medicine, FA.2.300B, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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7
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Greenwood JC, Gutierrez K, McDermott M. Results of a Pilot Study for a Pharmacy Discharge Review in Neurosurgical Patients: A Quality-Safety Initiative. Cureus 2023; 15:e36067. [PMID: 37056529 PMCID: PMC10092899 DOI: 10.7759/cureus.36067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Objective A multidisciplinary collaboration between the neurosurgical team and the pharmacy was established to conduct a pilot study in which discharged neurosurgical patients from a community hospital would receive medication reconciliation services and counseling by a pharmacy specialist to determine the impact on patient safety, readmission rates, and medication compliance. Methods Pharmacists reviewed discharge medication reconciliations of neurosurgical patients to address any discrepancies with the nurse practitioners or physicians prior to discharge and provided discharge medication counseling to the patient/families at the bedside. The service was provided on weekdays during the eight-hour pharmacist shift in addition to other daily responsibilities. Data were analyzed by type and the total number of pharmacy interventions encountered during the discharge medication reconciliation process, time to complete services, and readmission rates. Lastly, the discharged neurosurgical patients that were not seen by pharmacists during the one-month pilot study were reviewed retrospectively to determine potential interventions. Results A total of 48 neurosurgical patients were discharged during the one-month pilot study; 27 patients received discharge medication reconciliation services and counseling from the pharmacy specialists. Sixty-three pharmacy interventions were accepted with prevention of medication errors/adverse drug reactions (21%, n=21) and addition of missing medication (21%, n=21) being the most common intervention types. The mean time to complete the services was 27 minutes and there was one non-medication-related readmission of the 27 patients seen. Twenty-one neurosurgical patients who were discharged without receiving services were reviewed retrospectively. It was determined that there was a potential for another 64 pharmacy interventions in which clarification of indication (33%, n=21) was the most common intervention type, followed by prevention of medication errors/adverse drug reactions (25%, n=16) and addition of missing medication (22%, n=14). There was a total of one medication-related readmission of the 21 patients not seen by the pharmacist during the pilot study. Conclusion The collaboration of pharmacists in the discharge process benefits neurosurgical patients by reducing the number of discrepancies when transitioning home and provides an additional layer of safety to reduce medication errors and/or prevent adverse events.
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Alizadeh B, Alibabaei A, Ahmadi S, Maroufi SF, Ghafouri-Fard S, Nateghinia S. Designing predictive models for appraisal of outcome of neurosurgery patients using machine learning-based techniques. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Rodriquez J. Reconfiguring the social organization of work in the intensive care unit: Changed relationships and new roles during COVID-19. Soc Sci Med 2023; 317:115600. [PMID: 36538836 PMCID: PMC9721201 DOI: 10.1016/j.socscimed.2022.115600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic caused hospitals to make changes to workflow that exacerbated emotional exhaustion and burnout among health care workers. This article examines one of those changes, restricted visitation, showing how it changed the social organization of work by upending established interactional patterns and relationships between health care workers, patients, and patients' families. Based on 40 interviews with intensive care unit (ICU) workers in units that were full of COVID-19 patients and had fully restricted visitation, study findings show that staff took on emotional support roles with patients that had typically been done by families at the bedside. They also faced increased anger, distrust, and misunderstandings from families who were not allowed to see their dying loved one. With each other, staff bonded together with dark humor and candid talk about the scale of deaths, constructing a shared understanding and solidarity amidst the tragedy of the pandemic.
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Affiliation(s)
- Jason Rodriquez
- Department of Sociology, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02115, USA.
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10
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Laudanski K, Huffenberger AM, Scott MJ, Williams M, Wain J, Jablonski J, Hanson CW. Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers. Front Med (Lausanne) 2022; 9:883126. [PMID: 35991667 PMCID: PMC9388902 DOI: 10.3389/fmed.2022.883126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Our study addresses the gaps in knowledge of the characterizations of operations by remote tele-critical care medicine (tele-CCM) service providers interacting with the bedside team. The duration of engagements, the evolution of the tele-CCM service over time, and the distress during interactions with the bedside team have not been characterized systematically. These characteristics are critical for planning the deployment of teleICU services and preventing burnout among remote teleICU providers. Methods REDCap self-reported activity logs collected engagement duration, triggers (emergency button, tele-CCM software platform, autonomous algorithm, asymmetrical communication platform, phone), expediency, nature (proactive rounding, predetermined task, response to medical needs), communication modes, and acceptance. Seven hospitals with 16 ICUs were overseen between 9/2020 and 9/2021 by teams consisting of telemedicine medical doctors (eMD), telemedicine registered nurses (eRN), and telemedicine respiratory therapists (eRT). Results 39,915 total engagements were registered. eMDs had a significantly higher percentage of emergent and urgent engagements (31.9%) vs. eRN (9.8%) or eRT (1.7%). The average tele-CCM intervention took 16.1 ± 10.39 min for eMD, 18.1 ± 16.23 for eRN, and 8.2 ± 4.98 min for eRT, significantly varied between engagement, and expediency, hospitals, and ICUs types. During the observation period, there was a shift in intervention triggers with an increase in autonomous algorithmic ARDS detection concomitant with predominant utilization of asynchronous communication, phone engagements, and the tele-CCM module of electronic medical records at the expense of the share of proactive rounding. eRT communicated more frequently with bedside staff (% MD = 37.8%; % RN = 36.8, % RT = 49.0%) but mostly with other eRTs. In contrast, the eMD communicated with all ICU stakeholders while the eRN communicated chiefly with other RN and house staff at the patient's bedside. The rate of distress reported by tele-CCM staff was 2% among all interactions, with the entity hospital being the dominant factor. Conclusions Delivery of tele-CCM services has to be tailored to the specific beneficiary of tele-CCM services to optimize care delivery and minimize distress. In addition, the duration of the average intervention must be considered while creating an efficient workflow.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Healthcare Economics, Philadelphia, PA, United States
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Krzysztof Laudanski
| | - Ann Marie Huffenberger
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael J. Scott
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Maria Williams
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Justin Wain
- Campbell University School of Osteopathic Medicine, Lillington, NC, United States
| | - Juliane Jablonski
- University of Pennsylvania Health System, Philadelphia, PA, United States
| | - C. William Hanson
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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11
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Bethel C, Rainbow JG, Johnson K. A qualitative descriptive study of the COVID-19 pandemic: Impacts on nursing care delivery in the critical care work system. APPLIED ERGONOMICS 2022; 102:103712. [PMID: 35278827 PMCID: PMC8882402 DOI: 10.1016/j.apergo.2022.103712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 05/05/2023]
Abstract
The COVID-19 pandemic drastically changed the delivery of nursing care in U.S. critical care settings. The purpose of this study was to describe nurses' perceptions of the critical care work system during the COVID-19 pandemic in the U.S. We conducted interviews with experienced critical care nurses who worked during the pandemic and analyzed these data using deductive content analysis framed by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. Concepts include the critical care work system structures, nursing care processes, outcomes, and adaptations during the pandemic. Our findings revealed a description of the critical care work system framed by the SEIPS 2.0 model. We suggest how human factors engineers can utilize a human factors and engineering approach to maximize the adaptations critical care nurses made to their work system during the pandemic.
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12
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Geltmeyer K, Neyrinck D, Benoit D, Malfait S, Goedertier H, Duprez V. Implementing mixed nursing care teams in intensive care units during COVID-19: A rapid qualitative descriptive study. J Adv Nurs 2022; 78:3345-3357. [PMID: 35765249 PMCID: PMC9349646 DOI: 10.1111/jan.15334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/15/2022] [Accepted: 05/15/2022] [Indexed: 12/03/2022]
Abstract
Aims The goal of this study was to gain insight into the views and experiences of an intensive care team working in a new nursing‐care delivery model during the COVID‐19 waves. A new model of care was implemented to augment nursing capacity and provide sufficient intensive care beds. Design A qualitative monocentric study using rapid qualitative descriptive methods was reported in line with the COREQ checklist. Methods Nurse, ward manager and physician participants were purposively recruited between January and March 2021 in a tertiary university‐affiliated hospital in the Flemish‐speaking part of Belgium. Semistructured interviews were conducted and analysed using thematic analysis methods. Results The participants were seventeen expert nurses, twelve supporting nurses, seven ward managers and four physicians. A central theme of ensuring safe, high‐quality care emerged from the findings. There was a sense of losing one's grip on clinical practice when working in the mixed nursing‐care teams. Different underlying experiences played a part in this sense of losing control: dealing with unknown elements, experiencing role ambiguity, struggling with responsibility and the absence of trust. Several coping mechanisms were developed by the nursing‐care team to deal with those experiences, including attempts to create stability, to strike a balance between delegating and educating, to build in control and to communicate openly. Conclusion In this rapid qualitative descriptive study, the implementation of a new nursing‐care delivery model during a pandemic was seen to lead to several challenges for all members of the care team. Coping mechanisms were developed by the team to deal with these experienced challenges. Impact When rethinking nursing‐care delivery models, the findings of this study may help guide the process of implementing mixed nursing‐care teams. Special attention needs to be paid to clarifying roles, sharing responsibility and clinical leadership. Other significant influences (such as moral distress) should also be taken into account.
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Affiliation(s)
- Klara Geltmeyer
- Critical Care Units, Ghent University Hospital, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Dries Neyrinck
- Critical Care Units, Ghent University Hospital, Ghent, Belgium
| | - Dominique Benoit
- Critical Care Units, Ghent University Hospital, Ghent, Belgium.,Department of Medicine and Public Health, Ghent University, Ghent, Belgium
| | - Simon Malfait
- Nursing Department, Ghent University Hospital, Ghent, Belgium.,Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | | | - Veerle Duprez
- Nursing Department, Ghent University Hospital, Ghent, Belgium
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Mirzakhani F, Sadoughi F, Hatami M, Amirabadizadeh A. Which model is superior in predicting ICU survival: artificial intelligence versus conventional approaches. BMC Med Inform Decis Mak 2022; 22:167. [PMID: 35761275 PMCID: PMC9235201 DOI: 10.1186/s12911-022-01903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background A disease severity classification system is widely used to predict the survival of patients admitted to the intensive care unit with different diagnoses. In the present study, conventional severity classification systems were compared with artificial intelligence predictive models (Artificial Neural Network and Decision Tree) in terms of the prediction of the survival rate of the patients admitted to the intensive care unit. Methods This retrospective cohort study was performed on the data of the patients admitted to the ICU of Ghaemshahr’s Razi Teaching Care Center from March 20th, 2017, to September 22nd, 2019. The required data for calculating conventional severity classification models (SOFA, SAPS II, APACHE II, and APACHE IV) were collected from the patients’ medical records. Subsequently, the score of each model was calculated. Artificial intelligence predictive models (Artificial Neural Network and Decision Tree) were developed in the next step. Lastly, the performance of each model in predicting the survival of the patients admitted to the intensive care unit was evaluated using the criteria of sensitivity, specificity, accuracy, F-measure, and area under the ROC curve. Also, each model was validated externally. The R program, version 4.1, was used to create the artificial intelligence models, and SPSS Statistics Software, version 21, was utilized to perform statistical analysis. Results The area under the ROC curve of SOFA, SAPS II, APACHE II, APACHE IV, multilayer perceptron artificial neural network, and CART decision tree were 76.0, 77.1, 80.3, 78.5, 84.1, and 80.0, respectively. Conclusion The results showed that although the APACHE II model had better results than other conventional models in predicting the survival rate of the patients admitted to the intensive care unit, the other conventional models provided acceptable results too. Moreover, the findings showed that the artificial neural network model had the best performance among all the studied models, indicating the discrimination power of this model in predicting patient survival compared to the other models.
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Affiliation(s)
- Farzad Mirzakhani
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Science, No. 4, Rashid Yasemi Street, Vali-e Asr Avenue, Tehran, 1996713883, Iran
| | - Farahnaz Sadoughi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Science, No. 4, Rashid Yasemi Street, Vali-e Asr Avenue, Tehran, 1996713883, Iran.
| | - Mahboobeh Hatami
- Antimicrobial Resistance Research Center, Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Adams CD, Brunetti L, Davidov L, Mujia J, Rodricks M. The impact of intensive care unit physician staffing change at a community hospital. SAGE Open Med 2022; 10:20503121211066471. [PMID: 35024141 PMCID: PMC8744200 DOI: 10.1177/20503121211066471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives A high-intensity staffing model has been defined as either mandatory intensivist consultation or a closed intensive care unit in which intensivists manage all aspects of patient care. In the current climate of limited healthcare resources, transitioning to a closed intensive care unit model may lead to significant improvements in patient care and resource utilization. Methods This is a single-center, retrospective cohort study of all mechanically ventilated intensive care unit admissions in the pre-intensive care unit closure period of 1 October 2014 to 30 September 2015 as compared with the post-intensive care unit closure period of 1 November 2015 to 31 October 2016. Patient demographics as well as outcome data (duration of mechanical ventilation, length of stay, direct costs, complications, and mortality) were abstracted from the electronic health record. All data were analyzed using descriptive and inferential statistics. Regression analyses were used to adjust outcomes for potential confounders. Results A total of 549 mechanically ventilated patients were included in our analysis: 285 patients in the pre-closure cohort and 264 patients in the post-closure cohort. After adjusting for confounders, there was no significant difference in mortality rates between the pre-closure (40.7%) and post-closure (38.6%) groups (adjusted odds ratio = 0.82; 95% confidence interval = 0.56-1.18; p = 0.283). The post-closure cohort was found to have significant reductions in duration of mechanical ventilation (3.71-1.50 days; p < 0.01), intensive care unit length of stay (5.8-2.7 days; p < 0.01), hospital length of stay (10.9-7.3 days; p < 0.01), and direct hospital costs (US $16,197-US $12,731; p = 0.009). Patient complications were also significantly reduced post-intensive care unit closure. Conclusion Although a closed intensive care unit model in our analysis did not lead to a statistical difference in mortality, it did demonstrate multiple beneficial outcomes including reduced ventilator duration, decreased intensive care unit and hospital length of stay, fewer patient complications, and reduced direct hospital costs.
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Affiliation(s)
- Christopher D Adams
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA.,Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Luigi Brunetti
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA.,Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Liza Davidov
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA
| | - Jose Mujia
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA
| | - Michael Rodricks
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ, USA.,Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Stefanou MI, Sulyok M, Koehnlein M, Scheibe F, Fleischmann R, Hoffmann S, Hotter B, Ziemann U, Meisel A, Mengel AM. Withholding or withdrawing life support in long-term neurointensive care patients: a single-centre, prospective, observational pilot study. JOURNAL OF MEDICAL ETHICS 2022; 48:50-55. [PMID: 32371594 DOI: 10.1136/medethics-2019-106027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Scarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting. MATERIALS AND METHODS A prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire. RESULTS 8 (25%) physicians and 24 (75%) nurses participated in the study by providing their 'treatment decisions' for 14 patients at several time points. EOLD was 'made' 44 (31%) times, while maintenance of life support 98 (69%) times. EOLD patterns were not significantly different between professional groups. The individual characteristics of the professionals (age, gender, religion, personal experience with death of family member and NICU experience) had no significant impact on decisions to forgo or maintain life-sustaining therapy. EOLD was patient-specific (intraclass correlation coefficient: 0.861), with the presence of acute life-threatening disease (OR (95% CI): 18.199 (1.721 to 192.405), p=0.038) and low expected patient quality of life (OR (95% CI): 9.276 (1.131 to 76.099), p=0.016) being significant and independent determinants for withholding or withdrawing life-sustaining treatment. CONCLUSIONS Our findings suggest that EOLD in NICU relies mainly on patient prognosis and not on the characteristics of the healthcare professionals.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Department of Neurology and Stroke and Hertie Institute of Clinical Brain Reseach, University Hospital Tübingen, Tübingen, Germany
| | - Mihaly Sulyok
- Department of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Koehnlein
- Department of Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Franziska Scheibe
- Department of Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Robert Fleischmann
- Department of Neurology, Universitätsklinik Greifswald, Greifswald, Germany
| | - Sarah Hoffmann
- Department of Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Benjamin Hotter
- Department of Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke and Hertie Institute of Clinical Brain Reseach, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Meisel
- Department of Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Annerose Maria Mengel
- Department of Neurology and Stroke and Hertie Institute of Clinical Brain Reseach, University Hospital Tübingen, Tübingen, Germany
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Smith SE, Shelley R, Newsome AS. Medication regimen complexity vs patient acuity for predicting critical care pharmacist interventions. Am J Health Syst Pharm 2021; 79:651-655. [PMID: 34864850 DOI: 10.1093/ajhp/zxab460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Quantifying and predicting critical care pharmacist (CCP) workload has significant ramifications for expanding CCP services that improve patient outcomes. Medication regimen complexity has been proposed as an objective, pharmacist-oriented metric that demonstrates relationships to patient outcomes and pharmacist interventions. The purpose of this evaluation was to compare the relationship of medication regimen complexity versus a traditional patient acuity metric for evaluating pharmacist interventions. SUMMARY This was a post hoc analysis of a previously completed prospective, observational study. Pharmacist interventions were prospectively collected and tabulated at 24 hours, 48 hours, and intensive care unit (ICU) discharge, and the electronic medical record was reviewed to collect patient demographics, medication data, and outcomes. The primary outcome was the relationship between medication regimen complexity-intensive care unit (MRC-ICU) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and pharmacist interventions at 24 hours, 48 hours, and ICU discharge. These relationships were determined by Spearman rank-order correlation (rS) and confirmed by calculating the beta coefficient (β) via multiple linear regression adjusting for patient age, gender, and admission type. Data on 100 patients admitted to a mixed medical/surgical ICU were retrospectively evaluated. Both MRC-ICU and APACHE II scores were correlated with ICU interventions at all 3 time points (at 24 hours, rS = 0.370 [P < 0.001] for MRC-ICU score and rS = 0.283 [P = 0.004] for APACHE II score); however, this relationship was not sustained for APACHE II in the adjusted analysis (at 24 hours, β = 0.099 [P = 0.001] for MRC-ICU and β = 0.031 [P = 0.085] for APACHE II score). CONCLUSION A pharmacist-oriented score had a stronger relationship with pharmacist interventions as compared to patient acuity. As pharmacists have demonstrated value across the continuum of patient care, these findings support that pharmacist-oriented workload predictions require tailored metrics, beyond that of patient acuity.
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Affiliation(s)
- Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Rachel Shelley
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
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Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, Kapadia FN, Sircar M, Sahu S, Bhattacharya PK, Myatra SN, Samavedam S, Dixit S, Pande RK, Mehta SN, Venkataraman R, Bajan K, Kumar V, Harne R, Thakur L, Rathod D, Sathe P, Gurav S, D'Silva C, Pasha SA, Todi SK. Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021; 25:1093-1107. [PMID: 34916740 PMCID: PMC8645819 DOI: 10.5005/jp-journals-10071-23965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010-2011. METHODS An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day. Adherence to selected compliance measures was determined. Data were analyzed for 4,669 adult patients from 132 ICUs. RESULTS On the study day, mean age, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were 56.9 ± 17.41 years, 16.7 ± 9.8, and 4.4 ± 3.6, respectively. Moreover, 24% and 22.2% of patients received mechanical ventilation (MV) and vasopressors or inotropes (VIs), respectively. On the study days, 1,195 patients (25.6%) were infected and 1,368 patients (29.3%) had sepsis during their ICU stay. ICU mortality was 1,092 out of 4,669 (23.4%), including 737 deaths and 355 terminal discharges (TDs) from ICU. Compliance for process measures related to MV ranged between 62.7 and 85.3%, 11.2 and 47.4% for monitoring delirium, sedation, and analgesia, and 7.7 and 25.3% for inappropriate transfusion of blood products. Only 34.8% of ICUs routinely used capnography. Large hospitals with ≥500 beds, closed ICUs, the APACHE II and SOFA scores, medical admissions, the presence of cancer or cirrhosis of the liver, the presence of infection on the study day, and the need for MV or VIs were independent predictors of mortality. CONCLUSIONS Hospital size and closed ICUs are independently associated with worse outcomes. The proportion of TDs remains high. There is a scope for improvements in processes of care.Registered at clinicaltrials.gov (NCT03631927). HOW TO CITE THIS ARTICLE Divatia JV, Mehta Y, Govil D, Zirpe K, Amin PR, Ramakrishnan N, et al. Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2021;25(10):1093-1107.
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Affiliation(s)
- Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Deepak Govil
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Kapil Zirpe
- Neurotrauma and Stroke Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Pravin R Amin
- Department of Critical Care Medicine, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | | | - Farhad N Kapadia
- Department of Intensive Care Medicine, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
| | - Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Samir Sahu
- Department of Critical Care and Pulmonology, AMRI Hospitals, Bhubaneswar, Odisha, India
| | - Pradip Kumar Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care Medicine, Virinchi Hospital, Hyderabad, Telangana, India
| | - Subhal Dixit
- Department of Critical Care, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Rajesh Kumar Pande
- Department of Critical Care Medicine, BLK Super Speciality Hospital, Delhi, India
| | - Sujata N Mehta
- Department of Medicine and Critical Care, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Khusrav Bajan
- Department of Intensive Care Medicine, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
| | - Vivek Kumar
- Critical Care and Emergency Medical Services, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rahul Harne
- Medanta Institute of Critical Care and Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Leelavati Thakur
- Department of Critical Care, IQ City Medical College and Narayana Multispecialty Hospital, Durgapur, West Bengal, India
| | - Darshana Rathod
- Department of Critical Care, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Prachee Sathe
- Department of Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma Gurav
- Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Carol D'Silva
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Shaik Arif Pasha
- Department of Critical Care Medicine, NRI Medical College, Guntur, Andhra Pradesh, India
| | - Subhash Kumar Todi
- Department of Critical Care Medicine, AMRI Dhakuria Hospital, Kolkata, West Bengal, India
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Schmidt LE, Patel S, Stollings JL. The pharmacist's role in implementation of the ABCDEF bundle into clinical practice. Am J Health Syst Pharm 2021; 77:1751-1762. [PMID: 32789461 DOI: 10.1093/ajhp/zxaa247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To summarize published data regarding implementation of the ABCDEF bundle, a multicomponent process for avoidance of oversedation and prolonged ventilation in intensive care unit (ICU) patients; discuss pertinent literature to support each bundle element; and discuss the role of the pharmacist in coordinating bundle elements and implementation of the ABCDEF bundle into clinical practice. SUMMARY Neuromuscular weakness and ICU-acquired weakness are common among critically ill patients and associated with significant cost and societal burdens. Recent literature supporting early liberation from mechanical ventilation and early mobilization has demonstrated improved short- and long-term outcomes. With expanded use of pharmacy services in the ICU setting, pharmacists are well positioned to advocate for best care practices in ICUs. A dedicated, interprofessional team is necessary for the implementation of the ABCDEF bundle in inpatient clinical practice settings. As evidenced by a number of studies, successful implementation of the ABCDEF bundle derives from involvement by motivated and highly trained individuals, timely completion of individual patient care tasks, and effective leadership to ensure proper implementation and ongoing support. Factors commonly identified by clinicians as barriers to bundle implementation in clinical practice include patient instability and safety concerns, lack of knowledge, staff concerns, unclear protocol criteria, and lack of interprofessional team care coordination. This narrative review discusses research on bundle elements and recommendations for application by pharmacists in clinical practice. CONCLUSIONS Despite the benefits associated with implementation of the ABCDEF bundle, evidence suggests that the recommended interventions may not be routinely used within the ICU. The pharmacist provides the expertise and knowledge for adoption of the bundle into everyday clinical practice.
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Affiliation(s)
- Lauren E Schmidt
- Department of Pharmacy, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Sneha Patel
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
| | - Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN.,Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
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The Society of Critical Care Medicine at 50 Years: Interprofessional Practice in Critical Care: Looking Back and Forging Ahead. Crit Care Med 2021; 49:2017-2032. [PMID: 34387239 PMCID: PMC8594495 DOI: 10.1097/ccm.0000000000005276] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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The Society of Critical Care Medicine at 50 Years: ICU Organization and Management. Crit Care Med 2021; 49:391-405. [PMID: 33555776 DOI: 10.1097/ccm.0000000000004830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Dubois R, Sorensen R, Buell B, Telenko T, West A. The Respiratory Therapy Practice-Based Outcomes Initiative (RT-PBOI): Developing a framework to explore the value added by respiratory therapists to health care in Alberta. ACTA ACUST UNITED AC 2021; 57:99-104. [PMID: 34350337 PMCID: PMC8291291 DOI: 10.29390/cjrt-2021-010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There exists a political imperative to have access to data that meets the needs of health care administrators, governments, and funding bodies to support evidence-informed decision making. It is incumbent upon respiratory therapists to examine how they can deliver the highest-quality patient care, but also that they add value to health systems that ensure the benefits of health innovations are shared equitably among all members of our communities. Purpose To explore the perceived value contributed by the respiratory therapy profession to health care and the health care system in the Province of Alberta at patient, team, and system levels. Research methods An interpretive descriptive approach was adopted, including the formation of a description and exploration of possible associations, relationships, and patterns within a field of practice. Conclusions The qualitative data analysis uncovered a framework that could inform research efforts of the respiratory therapy community in a way that contributes to the proposed mechanisms by which the profession generates value for the organization and patients. The RT-PBOI Conceptual Model identified five key concepts relating to the value contributed by respiratory therapists to health care: technical skills, practice across settings, strategic expertise, tools that leverage capacity, and growing value into the future.
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Affiliation(s)
- Roberta Dubois
- Provincial Respiratory Therapy, Alberta Health Services, Red Deer, Alberta, Canada
| | - Rena Sorensen
- Central Zone Allied Health, Alberta Health Services, Ponoka, Alberta, Canada
| | - Bryan Buell
- College and Association of Respiratory Therapists of Alberta, Calgary, Alberta, Canada
| | - Tracey Telenko
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, Ontario, Canada
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Abstract
OBJECTIVES To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. DESIGN The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.
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Farokhzadian J, Jouparinejad S, Fatehi F, Falahati-Marvast F. Improving nurses' readiness for evidence-based practice in critical care units: results of an information literacy training program. BMC Nurs 2021; 20:79. [PMID: 34001116 PMCID: PMC8130418 DOI: 10.1186/s12912-021-00599-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most important prerequisites for nurses' readiness to implement Evidence-Based Practice (EBP) is to improve their information literacy skills. This study aimed to evaluate the impact of a training program on nurses' information literacy skills for EBP in critical care units. METHODS In this interventional study, 60 nurses working in critical care units of hospitals affiliated to Kerman University of Medical Sciences were randomly assigned into the intervention or control groups. The intervention group was provided with information literacy training in three eight-hour sessions over 3 weeks. Data were collected using demographic and information literacy skills for EBP questionnaires before and 1 month after the intervention. RESULTS At baseline, the intervention and control groups were similar in terms of demographic characteristics and information literacy skills for EBP. The training program significantly improved all dimensions of information literacy skills of the nurses in the intervention group, including the use of different information resources (3.43 ± 0.48, p < 0.001), information searching skills and the use of different search features (3.85 ± 0.67, p < 0.001), knowledge about search operators (3.74 ± 0.14, p < 0.001), and selection of more appropriate search statement (x2 = 50.63, p = 0.001) compared with the control group. CONCLUSIONS Nurses can learn EBP skills and apply research findings in their nursing practice in order to provide high-quality, safe nursing care in clinical settings. Practical workshops and regular training courses are effective interventional strategies to equip nurses with information literacy skills so that they can apply these skills to their future nursing practice.
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Affiliation(s)
- Jamileh Farokhzadian
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Community Health Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Jouparinejad
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Farhad Fatehi
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Fatemeh Falahati-Marvast
- Health Information Sciences Department, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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Abate SM, Assen S, Yinges M, Basu B. Survival and predictors of mortality among patients admitted to the intensive care units in southern Ethiopia: A multi-center cohort study. Ann Med Surg (Lond) 2021; 65:102318. [PMID: 33996053 PMCID: PMC8091884 DOI: 10.1016/j.amsu.2021.102318] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The burden of life-threatening conditions requiring intensive care units has grown substantially in low-income countries related to an emerging pandemic, urbanization, and hospital expansion. The rate of ICU mortality varied from region to region in Ethiopia. However, the body of evidence on ICU mortality and its predictors is uncertain. This study was designed to investigate the pattern of disease and predictors of mortality in Southern Ethiopia. METHODS After obtaining ethical clearance from the Institutional Review Board (IRB), a multi-center cohort study was conducted among three teaching referral hospital ICUs in Ethiopia from June 2018 to May 2020. Five hundred and seventeen Adult ICU patients were selected. Data were entered in Statistical Package for Social Sciences version 22 and STATA version 16 for analysis. Descriptive statistics were run to see the overall distribution of the variables. Chi-square test and odds ratio were determined to identify the association between independent and dependent variables. Multivariate analysis was conducted to control possible confounders and identify independent predictors of ICU mortality. RESULTS The mean (±SD) of the patients admitted in ICU was 34.25(±5.25). The overall ICU mortality rate was 46.8%. The study identified different independent predictors of mortality. Patients with cardiac arrest were approximately 12 times more likely to die as compared to those who didn't, AOR = 11.9(95% CI:6.1 to 23.2). CONCLUSION The overall mortality rate in ICU was very high as compared to other studies in Ethiopia as well as globally which entails a rigorous activity from different stakeholders.
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Key Words
- ACLS, advanced cardiac life support
- AOR, Adjusted Odds Ratio
- APACHE, Acute Physiologic and Chronic Health Evaluation
- ARDS, Acute Respiratory Distress Syndrome
- BMI, Body Mass Index
- CI, Confidence Interval
- CT, Computerized Tomography
- DURH, Dilla University referral hospital
- GCS, Glasgow Coma Scale
- HURH, Hawassa university referral hospital
- Hospital
- ICU, Intensive Care Unit
- IQR, Inter Quartile e Range
- IRB, Institutional Review Board
- Intensive care unit
- LOS, Length of Stay
- Mortality
- Predictor
- SAPS, Simplified Acute Physiology Score
- SD, Standard Deviation
- SOFA, Sequential Organ Failure Assessment
- STROBE, Strengthening the Reporting of Observational Studies in Epidemiology
- WURH, Wolaita Sodo referral hospital
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Sofia Assen
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Mengistu Yinges
- Departemnt of Anesthesiology, College of Health Sciences and Medicine, Hawassa University, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
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Masjedi M, Mirjalili M, Mirzaei E, Mirzaee H, Vazin A. The effect of different intensivist staffing patterns on the rate of potential drug-drug interactions in adult trauma intensive care units. Ther Adv Drug Saf 2020; 11:2042098620980640. [PMID: 33447355 PMCID: PMC7780171 DOI: 10.1177/2042098620980640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Drug-drug interactions (DDIs) have created alarming challenges for public health, especially in those admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and decreases the treatment costs. The effect of academic versus non-academic (therapeutic) intensivist as well as hours of coverage and attendance of intensivist on potential DDIs (pDDIs) was evaluated in six adult trauma ICUs of a level one trauma center. METHODS In this 6-month cross-sectional study, 200 patients were included. The DDIs were classified into five groups, including type A, B, C, D, and X. pDDIs were defined as interactions belonged to C, D and X categories. Patients in six adult ICUs with three different patterns of intensivist staffing models including type A (once-daily therapeutic intensivist visit followed by 24 h on-call), B (twice-daily academic intensivist visit, 8 h of attendance in ICU and 16 h on-call) and C (all criteria just like ICU type B, except for the presence of therapeutic instead of academic intensivist) were screened for pDDIs. RESULTS In total, 3735 drug orders and 3869 drugs (193 different types) were screened and 1826 pDDIs were identified. Type C, D and X interactions accounted for 60.6%, 35.5%, and 3.9% of all pDDIs, respectively. The mean of pDDI per patient was significantly higher (p-value < 0.001) in the ICU type A than ICU types C and B. The frequency of pDDIs was the highest in the type A ICUs. A statistically significant relationship was observed between the number of prescribed drugs and ICU length of stay (p-value < 0.001 and p = 0.009, respectively). CONCLUSION Different patterns of intensivist staffing affect pDDIs to varying degrees. In the studied ICUs academic versus therapeutic intensivist, twice versus once-daily visit, and 8 h attendance with16 h on-call versus 24 h on-call were associated with more reductions in pDDIs. PLAIN LANGUAGE SUMMARY The impact of different intensivist staffing patterns in ICUs on the rate of potential drug-drug interactionsDrug-drug interactions (DDIs) have created alarming challenges for public health, especially in patients admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and limits the costs. Considering the high incidence of potential DDIs (pDDIs) occurring for critically ill patients and the importance of ADRs caused by pDDIs in ICUs, the effect of the presence of an academic versus therapeutic intensivist, as well as the hour of coverage of intensivist on prevalence of pDDIs was evaluated in six adult trauma ICUs of a level one trauma center in Shiraz, Iran. We also determined the prevalence of pDDIs and their associated risk factors. To the best of our knowledge, this is the first study that has assessed the effect of various ICU physician staffing models on the incidence and pattern of pDDIs.
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Affiliation(s)
- Mansoor Masjedi
- Department of Anesthesiology, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Fars, Iran
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Science, Shiraz, Fars, Iran
| | - Ehsan Mirzaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Science, Shiraz, Fars, Iran
| | - Hadis Mirzaee
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Science, Shiraz, Fars, Iran
| | - Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Karafarin Street, PO Box 7146864685, Shiraz, Iran
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Trotta RL, Rao AD, McHugh MD, Yoho M, Cunningham RS. Moving beyond the measure: Understanding patients' experiences of communication with nurses. Res Nurs Health 2020; 43:568-578. [PMID: 33141484 DOI: 10.1002/nur.22087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/12/2022]
Abstract
Under Medicare's Value-Based Purchasing Program, scores derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are used in the determination of incentive payments and financial penalties for healthcare organizations. Organizations, therefore, invest in approaches to improve the likelihood of positive patient responses. Evidence suggests that nurse communication as measured by HCAHPS influences overall patient satisfaction, yet little is known regarding what patients believe constitutes effective communication with nurses. In this qualitative descriptive study, we conducted phone interviews with 49 recently hospitalized patients to better understand patients' perceptions of their communication with nurses. Our findings indicate that patients perceived their communication with nurses to unfold via nurses' behaviors. Namely, nurses' engagement with patients, anticipation of patients' needs, responsiveness to patients' concerns, and teaching practices positively influence patient satisfaction with communication with nurses. These behaviors resonated most strongly with patients during particularly memorable moments of uncertainty and vulnerability over the course of a hospital stay. These findings suggest that focusing on the development of nurses' behaviors, ensuring processes are in place to support positive behaviors and creating organizational environments that position nurses to consistently apply these behaviors, can improve patients' perceptions of their communication with nurses. These findings also provide a foundation for further research focused on developing and testing specific behavioral interventions and their effect on communication perception.
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Affiliation(s)
- Rebecca L Trotta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Aditi D Rao
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Matthew D McHugh
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Margaret Yoho
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Regina S Cunningham
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Mohammad RA, Betthauser KD, Korona RB, Coe AB, Kolpek JH, Fritschle AC, Jagow B, Kenes M, MacTavish P, Slampak‐Cindric AA, Whitten JA, Jones C, Simonelli R, Rowlands I, Stollings JL. Clinical pharmacist services within intensive care unit recovery clinics: An opinion of the critical care practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Rima A. Mohammad
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | - Kevin D. Betthauser
- Department of Pharmacy Services Barnes‐Jewish Hospital Saint Louis Missouri USA
| | | | - Antoinette B. Coe
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | | | | | - Benjamin Jagow
- Department of Pharmacy MercyOne Des Moines Medical Center Des Moines Iowa USA
| | - Michael Kenes
- Department of Clinical Pharmacy University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | | | | | | | - Carol Jones
- Department of Pharmacy Guy's and St. Thomas' NHS Foundation Trust London UK
| | | | - Ian Rowlands
- Department of Pharmacy Barts Health NHS Trust London UK
| | - Joanna L. Stollings
- Department of Pharmacy and Critical Illness Brain Dysfunction, Survivorship (CIBS) Center, Vanderbilt University Medical Center Nashville Tennessee USA
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Implications of continuity of care on infant caloric intake in the neonatal intensive care unit. J Perinatol 2020; 40:1405-1411. [PMID: 32157220 DOI: 10.1038/s41372-020-0636-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the association of continuity of neonatologist care with caloric intake and growth velocity (GV) in very low birth weight (VLBW) infants. STUDY DESIGN We created a daily continuity index (DCI) defined as the number of days the neonatologist worked in the previous week. We estimated the independent associations between this index and infants' daily caloric intake (kcal/kg/day) and GV (g/kg/day) through the first 6 weeks of life using regression analyses. RESULTS Twenty-eight neonatologists cared for 115 infants over 4643 patient-days. The DCI was independently associated with increased caloric intake (β = 1.27 kcal/kg/day per each day of continuity, p < 10-4); this effect was magnified (β = 3.33, p < 10-4) in the first 2 weeks. No association was observed between the index and GV. CONCLUSIONS Neonatologist continuity may contribute to caloric intake in VLBW infants. Quality metrics focused on this area of health care delivery warrant further discovery.
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29
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Baudouin A, Herledan C, Poletto N, Guillemin MD, Maison O, Garreau R, Chillotti L, Parat S, Ranchon F, Rioufol C. Economic impact of clinical pharmaceutical activities in hospital wards: A systematic review. Res Social Adm Pharm 2020; 17:497-505. [PMID: 32819880 DOI: 10.1016/j.sapharm.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The positive impact of clinical pharmacy services (CPS) in improving clinical outcomes such as reduction of drug related problems is well demonstrated. Despite these results, the deployment of these activities is not systematically observed in the hospital setting. OBJECTIVES This systematic review first aimed to describe existing evidence regarding economic evaluation of ward-based CPS focusing on the entire treatment of a patient in a hospital setting. Secondly, the quality of economic evaluations of existing evidence was assessed. METHODS A comprehensive literature search was performed in PubMed/Medline, Science Direct and the NHS Economic Evaluation databases from January 2000 to March 2019. English or French language articles describing an economic evaluation of ward-based CPS on inpatients in hospital settings were included. Articles not describing a single study, dealing with a CPS not considering the entire medication regimen of the patient or presenting both inpatient and outpatient CPS were excluded. Selected articles were analyzed according to Drummond's check-list for assessing economic evaluations. RESULTS Forty-one studies were included. About one third were American publications. CPS implemented in ICU represented about half of the selected articles. Pharmacist-to-bed ratios varied according to countries and care unit type with the most favorable ratios in ICU and in American studies. Cost-avoidance was mostly used to express economic impact and ranged from €1579 to €3,089 328. Studies yielding the greater economic impact were conducted in the USA with implementation of full-time equivalents pharmacists or establishing of collaborative practice agreements. Only 6 articles dealt correctly with at least 7 of the 10 Drummond's checklist assessment criteria. CONCLUSION This review suggests that the existing evidence is not sufficient to conclude to a positive economic impact of CPS conducted according to clinical pharmacy guidelines. Funding resources, remuneration of clinical pharmacy activities and provision of standardized national clinical and economic databases appear to be essential evolutions to improve CPS development.
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Affiliation(s)
- Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Nicolas Poletto
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Marie-Delphine Guillemin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Ophélie Maison
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Romain Garreau
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Louis Chillotti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Stéphanie Parat
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France.
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France
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30
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Ramakrishnan N, Baronia AK, Divatia JV, Bhagwati A, Chawla R, Iyer S, Jani CK, Joad S, Kamat V, Kapadia F, Mehta Y, Myatra SN, Nagarkar S, Nayyar V, Padhy S, Rajagopalan R, Ray B, Sahu S, Sampath S, Todi S. Critical care delivery in intensive care units in India: Defining the functions, roles and responsibilities of a consultant intensivist. Indian J Crit Care Med 2020. [DOI: 10.5005/ijccm-17-s1-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Supplemental Digital Content is available in the text. Objectives: To examine whether and how step-down unit admission after ICU discharge affects patient outcomes. Design: Retrospective study using an instrumental variable approach to remove potential biases from unobserved differences in illness severity for patients admitted to the step-down unit after ICU discharge. Setting: Ten hospitals in an integrated healthcare delivery system in Northern California. Patients: Eleven-thousand fifty-eight episodes involving patients who were admitted via emergency departments to a medical service from July 2010 to June 2011, were admitted to the ICU at least once during their hospitalization, and were discharged from the ICU to the step-down unit or the ward. Interventions: None. Measurements and Main Results: Using congestion in the step-down unit as an instrumental variable, we quantified the impact of step-down unit care in terms of clinical and operational outcomes. On average, for ICU patients with lower illness severity, we found that availability of step-down unit care was associated with an absolute decrease in the likelihood of hospital readmission within 30 days of 3.9% (95% CI, 3.6–4.1%). We did not find statistically significant effects on other outcomes. For ICU patients with higher illness severity, we found that availability of step-down unit care was associated with an absolute decrease in in-hospital mortality of 2.5% (95% CI, 2.3–2.6%), a decrease in remaining hospital length-of-stay of 1.1 days (95% CI, 1.0–1.2 d), and a decrease in the likelihood of ICU readmission within 5 days of 3.6% (95% CI, 3.3–3.8%). Conclusions: This study shows that there exists a subset of patients discharged from the ICU who may benefit from care in an step-down unit relative to that in the ward. We found that step-down unit care was associated with statistically significant improvements in patient outcomes especially for high-risk patients. Our results suggest that step-down units can provide effective transitional care for ICU patients.
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Molling D, Vincent BM, Wiitala WL, Escobar GJ, Hofer TP, Liu VX, Rosen AK, Ryan AM, Seelye S, Prescott HC. Developing a template matching algorithm for benchmarking hospital performance in a diverse, integrated healthcare system. Medicine (Baltimore) 2020; 99:e20385. [PMID: 32541458 PMCID: PMC7302661 DOI: 10.1097/md.0000000000020385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Template matching is a proposed approach for hospital benchmarking, which measures performance based on matching a subset of comparable patient hospitalizations from each hospital. We assessed the ability to create the required matched samples and thus the feasibility of template matching to benchmark hospital performance in a diverse healthcare system.Nationwide Veterans Affairs (VA) hospitals, 2017.Observational cohort study.We used administrative and clinical data from 668,592 hospitalizations at 134 VA hospitals in 2017. A standardized template of 300 hospitalizations was selected, and then 300 hospitalizations were matched to the template from each hospital.There was substantial case-mix variation across VA hospitals, which persisted after excluding small hospitals, hospitals with primarily psychiatric admissions, and hospitalizations for rare diagnoses. Median age ranged from 57 to 75 years across hospitals; percent surgical admissions ranged from 0.0% to 21.0%; percent of admissions through the emergency department, 0.1% to 98.7%; and percent Hispanic patients, 0.2% to 93.3%. Characteristics for which there was substantial variation across hospitals could not be balanced with any matching algorithm tested. Although most other variables could be balanced, we were unable to identify a matching algorithm that balanced more than ∼20 variables simultaneously.We were unable to identify a template matching approach that could balance hospitals on all measured characteristics potentially important to benchmarking. Given the magnitude of case-mix variation across VA hospitals, a single template is likely not feasible for general hospital benchmarking.
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Affiliation(s)
- Daniel Molling
- VA Center for Clinical Management Research, Ann Arbor, MI
| | | | | | - Gabriel J. Escobar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Timothy P. Hofer
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Amy K. Rosen
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Andrew M. Ryan
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Sarah Seelye
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Hallie C. Prescott
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan
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Barcellos RDA, Chatkin JM. Impact of a multidisciplinary checklist on the duration of invasive mechanical ventilation and length of ICU stay. J Bras Pneumol 2020; 46:e20180261. [PMID: 32236341 PMCID: PMC7572285 DOI: 10.36416/1806-3756/e20180261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/30/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: To assess the impact that implementing a checklist during daily multidisciplinary rounds has on the duration of invasive mechanical ventilation (IMV) and length of ICU stay. Methods: This was a non-randomized clinical trial in which the pre-intervention and post-intervention duration of IMV and length of ICU stay were evaluated in a total of 466 patients, including historical controls, treated in three ICUs of a hospital in the city of Caxias do Sul, Brazil. We evaluated 235 and 231 patients in the pre-intervention and post-intervention periods, respectively. The following variables were studied: age; gender; cause of hospitalization; diagnosis on admission; comorbidities; the Simplified Acute Physiology Score 3; the Sequential Organ Failure Assessment score; days in the ICU; days on IMV; reintubation; readmission; in-hospital mortality; and ICU mortality. Results: After the implementation of the checklist, the median (interquartile range) for days in the ICU and for days on IMV decreased from 8 (4-17) to 5 (3-11) and from 5 (1-12) to 2 (< 1-7), respectively, and the differences were significant (p ≤ 0.001 for both). Conclusions: The implementation of the checklist during daily multidisciplinary rounds was associated with a reduction in the duration of IMV and length of ICU stay among the patients in our sample.
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Affiliation(s)
- Ruy de Almeida Barcellos
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - José Miguel Chatkin
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Coe AB, Bookstaver RE, Fritschle AC, Kenes MT, MacTavish P, Mohammad RA, Simonelli RJ, Whitten JA, Stollings JL. Pharmacists' Perceptions on Their Role, Activities, Facilitators, and Barriers to Practicing in a Post-Intensive Care Recovery Clinic. Hosp Pharm 2020; 55:119-125. [PMID: 32214446 PMCID: PMC7081480 DOI: 10.1177/0018578718823740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Complex medication regimen changes burden intensive care unit (ICU) survivors and their caregivers during the transition to home. Intensive care unit recovery clinics are a prime setting for pharmacists to address patients' and their caregivers' medication-related needs. The purpose of this study was to describe ICU recovery clinic pharmacists' activities, roles, and perceived barriers and facilitators to practicing in ICU recovery clinics across different institutions. Methods: An expert panel of ICU recovery clinic pharmacists completed a 15-item survey. Survey items addressed the pharmacists' years in practice, education and training, activities performed, their perceptions of facilitators and barriers to practicing in an ICU recovery clinic setting, and general ICU recovery clinic characteristics. Descriptive statistics were used. Results: Nine ICU recovery clinic pharmacists participated. The average number of years in practice was 16.5 years (SD = 13.5, range = 2-38). All pharmacists practiced in an interprofessional ICU recovery clinic affiliated with an academic medical center. Seven (78%) pharmacists always performed medication reconciliation and a comprehensive medication review in each patient visit. Need for medication education was the most prevalent item found in patient comprehensive medication reviews. The main facilitators for pharmacists' successful participation in an ICU recovery clinic were incorporation into clinic workflow, support from other health care providers, and adequate space to see patients. The ICU recovery clinic pharmacists perceived the top barriers to be lack of dedicated time and inadequate billing for services. Conclusions: The ICU recovery clinic pharmacists address ICU survivors' medication needs by providing direct patient care in the clinic. Strategies to mitigate pharmacists' barriers to practicing in ICU recovery clinics, such as lack of dedicated time and adequate billing for pharmacist services, warrant a multifaceted solution, potentially including advocacy and policy work by national pharmacy professional organizations.
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Affiliation(s)
- Antoinette B. Coe
- University of Michigan College of Pharmacy, Ann Arbor MI, USA,Antoinette B. Coe, PharmD, PhD, Department of Clinical Pharmacy, College of Pharmacy, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109, USA.
| | | | | | | | | | - Rima A. Mohammad
- University of Michigan College of Pharmacy, Ann Arbor MI, USA,Michigan Medicine, Ann Arbor, MI, USA
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Vail EA, Nadig NR, Sahetya SK, Vande Vusse LK, Walkey AJ, Liu V, Mathews KS. The Role of Professional Organizations in Fostering the Early Career Development of Academic Intensivists. Ann Am Thorac Soc 2020; 17:412-418. [PMID: 31800295 PMCID: PMC8174059 DOI: 10.1513/annalsats.201908-573ps] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Emily A. Vail
- Assembly on Critical Care Early Career Professionals Working Group, and
- Department of Anesthesiology, University of Texas Health San Antonio, San Antonio, Texas
| | - Nandita R. Nadig
- Assembly on Critical Care Early Career Professionals Working Group, and
- Members in Transition and Training Committee, American Thoracic Society, New York, New York
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sarina K. Sahetya
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lisa K. Vande Vusse
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Allan J. Walkey
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University, Boston, Massachusetts
| | - Vincent Liu
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Research, Kaiser Permanente, Oakland, California
| | - Kusum S. Mathews
- Assembly on Critical Care Early Career Professionals Working Group, and
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, and
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Rasmussen MB, Tolsgaard MG, Dieckmann P, Østergaard D, White J, Plenge P, Ringsted CV. Social ties influence teamwork when managing clinical emergencies. BMC MEDICAL EDUCATION 2020; 20:63. [PMID: 32131807 PMCID: PMC7057460 DOI: 10.1186/s12909-020-1953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Our current understanding of medical team competence is traditionally influenced by an individualistic perspective focusing on individual team members' knowledge, skills as well as on effective communication within the team. However, team dynamics may influence team performance more than previously anticipated. In particular, recent studies in other academic disciplines suggest that social ties between team members may impact team dynamics but this has not been explored for medical teams. We aimed to explore intensive care staff's perceptions about teamwork and performance in clinical emergencies focusing particularly on the teams' social ties. METHODS Semi-structured interviews were conducted with a purposive sample of intensive care staff. We used a thematic analysis approach to data interpretation. RESULTS Thematic saturation was achieved after three group interviews and eight individual interviews. Findings demonstrated that social ties influenced teamwork by affecting the teams' ability to co-construct knowledge, coordinate tasks, the need for hierarchy, the degree to which they relied on explicit or implicit communication, as well as their ability to promote adaptive behavior. CONCLUSIONS Social ties may be an important factor to consider and acknowledge in the design of future team training, as well as for work planning and scheduling of team activities during clinical practice. More research is needed into the causal effect of social ties on team performance and outcome.
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Affiliation(s)
- Maria B. Rasmussen
- Department of Obstetrics and Gynecology, University hospital Sealand, Roskilde Hospital. Sygehusvej 10, 4000 Roskilde, Denmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark Centre for Human Resource, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Jonathan White
- Intensive Care Unit 4131, University Hospital Rigshospitalet, Blegdamsvej 9. 2100, Købenahvn Ø, Denmark
| | - Pernille Plenge
- Intensive Care Unit 4131, University Hospital Rigshospitalet, Blegdamsvej 9. 2100, Købenahvn Ø, Denmark
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Lee LS, Clark AJ, Namburi N, Naum CC, Timsina LR, Corvera JS, Beckman DJ, Everett JE, Hess PJ. The presence of a dedicated cardiac surgical intensive care service impacts clinical outcomes in adult cardiac surgery patients. J Card Surg 2020; 35:787-793. [PMID: 32048378 DOI: 10.1111/jocs.14457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postoperative critical care management is an integral part of cardiac surgery that contributes directly to clinical outcomes. In the United States there remains considerable variability in the critical care infrastructure for cardiac surgical programs. There is little published data investigating the impact of a dedicated cardiac surgical intensive care service. METHODS A retrospective study examining postoperative outcomes in cardiac surgical patients before and after the implementation of a dedicated cardiac surgical intensive care service at a single academic institution. An institutional Society of Thoracic Surgeons database was queried for study variables. Primary endpoints were the postoperative length of stay, intensive care unit length of stay, and mechanical ventilation time. Secondary endpoints included mortality, readmission rates, and postoperative complications. The effect on outcomes based on procedure type was also analyzed. RESULTS A total of 1703 patients were included in this study-914 in the control group (before dedicated intensive care service) and 789 in the study group (after dedicated intensive care service). Baseline demographics were similar between groups. Length of stay, mechanical ventilation hours, and renal failure rate were significantly reduced in the study group. Coronary artery bypass grafting patients observed the greatest improvement in outcomes. CONCLUSIONS Implementation of a dedicated cardiac surgical intensive care service leads to significant improvements in clinical outcomes. The greatest benefit is seen in patients undergoing coronary artery bypass, the most common cardiac surgical operation in the United States. Thus, developing a cardiac surgical intensive care service may be a worthwhile initiative for any cardiac surgical program.
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Affiliation(s)
- Lawrence S Lee
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Aaron J Clark
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Niharika Namburi
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chris C Naum
- Division of Pulmonary and Critical Care Medicine, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lava R Timsina
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Joel S Corvera
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Daniel J Beckman
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jeffrey E Everett
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Philip J Hess
- Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
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Cvikl M, Sinkovič A. Interventions of a clinical pharmacist in a medical intensive care unit - A retrospective analysis. Bosn J Basic Med Sci 2020; 20:495-501. [PMID: 32070269 PMCID: PMC7664781 DOI: 10.17305/bjbms.2020.4612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/08/2020] [Indexed: 12/01/2022] Open
Abstract
Several studies demonstrated a significant decrease in prescription errors, adverse drug events, treatment costs and improved patient outcomes, when a clinical pharmacist (CP) was a full member of a multidisciplinary team in the intensive care unit (ICU). Our aim was to evaluate the activities of a CP, included in a 12-bed medical ICU team of a university hospital in the course of several months. We conducted a retrospective analysis of all the CP’s interventions from March 2017 to November 2017, carried out and documented after reviewing and discussing patients’ medical data with the treating ICU physicians. We identified four main categories of CP’s interventions: pharmacotherapy adjustments to kidney function (PAKF category), drug-drug interactions (DDIs category), therapeutic monitoring of drugs with narrow therapeutic index (TDM category), and drug administration by the nasogastric tube (NGT category). During the study period, 533 patients were admitted to the medical ICU. The CP reviewed the medical data of 321 patients and suggested 307 interventions in 95 patients. There were 147 interventions of the PAKF category, 57 interventions of the TDM category, 30 interventions of the NGT category, and 22 interventions of the DDIs category. Fifty-one interventions were unspecified. The majority of all interventions (203/307) were related to antimicrobial drugs. ICU physicians completely accepted 80.2% of the CP’s suggestions. We observed that regular participation of the CP in the medical ICU team contributed to more individualized and improved pharmacological treatment of patients. Therefore, ICU teams should be encouraged to include CPs as regular team members.
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Affiliation(s)
- Maja Cvikl
- Central Pharmacy, University Medical Centre Maribor, Maribor, Slovenia
| | - Andreja Sinkovič
- Department of Medical Intensive Care, University Medical Centre Maribor, Maribor, Slovenia
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Kim JH, Kim J, Bae S, Lee T, Ahn JJ, Kang BJ. Intensivists' Direct Management without Residents May Improve the Survival Rate Compared to High-Intensity Intensivist Staffing in Academic Intensive Care Units: Retrospective and Crossover Study Design. J Korean Med Sci 2020; 35:e19. [PMID: 31950776 PMCID: PMC6970079 DOI: 10.3346/jkms.2020.35.e19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/02/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Medical staff members are concentrated in the intensive care unit (ICU), and medical residents are essentially needed to operate the ICU. However, the recent trend has been to restrict resident working hours. This restriction may lead to a shortage of ICU staff, and there is a chance that regional academic hospitals will face running ICUs without residents in the near future. METHODS We performed a retrospective observational study (intensivist crossover design) of medical patients who were transferred to two ICUs from general wards between September 2017 and February 2019 at one academic hospital. We compared the ICU outcomes according to the ICU type (ICU with resident management under high-intensity intensivist staffing vs. ICU with direct management by intensivists without residents). RESULTS Of 314 enrolled patients, 70 were primarily managed by residents, and 244 were directly managed by intensivists. The latter patients showed better ICU mortality (29.9% vs. 42.9%, P = 0.042), lower cardiopulmonary resuscitation (CPR) (10.2% vs. 21.4%, P = 0.013), lower continuous renal replacement therapy (CRRT) (24.2% vs. 40.0%, P = 0.009), and more advanced care planning decisions before death (87.3% vs. 66.7%, P = 0.013) than the former patients. The better ICU mortality (hazard ratio, 1.641; P = 0.035), lower CPR (odds ratio [OR], 2.891; P = 0.009), lower CRRT (OR, 2.602; P = 0.005), and more advanced care planning decisions before death (OR, 4.978; P = 0.007) were also associated with intensivist direct management in the multivariate cox and logistic regression analysis. CONCLUSION Intensivist direct management might be associated with better ICU outcomes than resident management under the supervision of an intensivist. Further large-scale prospective randomized trials are required to draw a definitive conclusion.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Jihye Kim
- Intensive Care Nursing Team, Ulsan University Hospital, Ulsan, Korea
| | - SooHyun Bae
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Taehoon Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Joon Ahn
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Byung Ju Kang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, Mishra RC, Sharma J, Amin P, Rao BK, Khilnani GC, Mittal K, Bhattacharya PK, Baronia AK, Javeri Y, Myatra SN, Rungta N, Tyagi R, Dhanuka S, Mishra M, Samavedam S. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med 2020; 24:S43-S60. [PMID: 32205956 PMCID: PMC7085818 DOI: 10.5005/jp-journals-10071-g23185] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Indian Society of Critical Care Medicine (ISCCM) guidelines on Planning and Designing Intensive care (ICU) were first developed in 2001 and later updated in 2007. These guidelines were adopted in India, many developing Nations and major Institutions including NABH. Various international professional bodies in critical care have their own position papers and guidelines on planning and designing of ICUs; being the professional body of intensivists in India ISCCM therefore addresses the subject in contemporary context relevant to our clinical practice, its variability according to specialty and subspecialty, quality, resource limitation, size and location of the institution. Aim: To have a consensus document reflecting the philosophy of ISCCM to deliver safe & quality Critical Care in India, taking into consideration the requirement of regulatory agencies (national & international) and need of people at large, including promotion of training, education and skill upgradation. It also aiming to promote leadership and development and managerial skill among the critical care team. Material and Methods: Extensive review of literature including search of databases in English language, resources of regulatory bodies, guidelines and recommendations of international critical care societies. National Survey of ISCCM members and experts to understand their viewpoints on respective issues. Visiting of different types and levels of ICUs by team members to understand prevailing practices, aspiration and Challenges. Several face to face meetings of the expert committee members in big and small groups with extensive discussions, presentations, brain storming and development of initial consensus draft. Discussion on draft through video conferencing, phone calls, Emails circulations, one to one discussion Result: Based upon extensive review, survey and input of experts' ICUs were categorized in to three levels suitable in Indian setting. Level III ICUs further divided into sub category A and B. Recommendations were grouped in to structure, equipment and services of ICU with consideration of variation in level of ICU of different category of hospitals. Conclusion: This paper summarizes consensus statement of various aspect of ICU planning and design. Defined mandatory and desirable standards of all level of ICUs and made recommendations regarding structure and layout of ICUs. Definition of intensive care and intensivist, planning for strength of ICU and requirement of manpower were also described. HOW TO CITE THIS ARTICLE Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, et al. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med 2020;24(Suppl 1):S43-S60.
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Affiliation(s)
- Narendra Rungta
- Department of Critical Care Foundation, Critical Care, MJ Rajasthan Hospital, Jaipur, Rajasthan, India, e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, , 020-25531539 / 25539538, e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail ID:
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India, , e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Jeetendra Sharma
- Department of Critical Care, Artemis Health Institute, Gurgaon, Haryana, India, , e-mail:
| | - Pravin Amin
- JLN Medical College, Jaipur, Rajasthan, India, e-mail:
| | - B K Rao
- Department of Critical care & Emergency Medicine, Sir Ganga Ram Hospital, Delhi, India, e-mail:
| | - G C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India, , e-mail:
| | - Kundan Mittal
- Department of Pediatrics, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, e-mail:
| | | | - A K Baronia
- Department of Critical Care, SGPGI, Lucknow, Uttar Pradesh, India, e-mail:
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Sheila Nainan Myatra
- Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India, e-mail:
| | - Neena Rungta
- Department of Anesthesia, JLN Medical College, Jaipur, Rajasthan, India, e-mail:
| | - Ranvir Tyagi
- Department of Anaesthesia and Critical Care Medicine, Synergy Plus hospital, NH 2 Sikandra, Agra, Uttar Pradesh, India, e-mail:
| | - Sanjay Dhanuka
- Eminent Hospital, 6/1 Old Palasia, Opposite Barwani Plaza, Indore, Madhya Pradesh, India, e-mail:
| | - Mahesh Mishra
- Department of Surgery, Mahatma Gandhi University of Medical Sciences & Technology, Riico Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, India, e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
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Andrews LB, Roberts N, Ash C, Jones N, Rolston M, Hughes M, Pelligrino J, Taylor T. The LOTUS: A Journey to Value-Based, Patient-Centered Care. Creat Nurs 2019; 25:17-24. [PMID: 30808781 DOI: 10.1891/1078-4535.25.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In response to the merger of our 248-bed community hospital with a new health system, a multidisciplinary team began a journey of holistic transformation via the evolution of a new rounding process called Leadership, Ownership, Transformation, Unity, and Sustainability (LOTUS) in the 20-bed ICU. Morphing from a hierarchical practice structure with limited engagement of multidisciplinary members, the LOTUS initiative (named for the blossom whose petals surround its core, the patient) afforded each discipline (petal) an equal voice and allowed a once-fragmented team to work cohesively, collaboratively, and at the highest level of the scope of practice for each discipline, thus affording expert guidance during care planning while providing a method to collect quality metrics. LOTUS allows us to view our patients in a new way as we refocused goal determination on patients and their families. The restructuring and evolution into a high-functioning team was targeted with the goal of enhancing quality critical care for patients, which, in the literature, has correlated with improved patient safety and decreased mortality and ICU length of stay.
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Kosilek RP, Baumeister SE, Ittermann T, Gründling M, Brunkhorst FM, Felix SB, Abel P, Friesecke S, Apfelbacher C, Brandl M, Schmidt K, Hoffmann W, Schmidt CO, Chenot JF, Völzke H, Gensichen JS. The association of intensive care with utilization and costs of outpatient healthcare services and quality of life. PLoS One 2019; 14:e0222671. [PMID: 31539397 PMCID: PMC6754134 DOI: 10.1371/journal.pone.0222671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Background Little is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample. Methods Cross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding. Results ICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment. Conclusions Our findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.
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Affiliation(s)
- Robert P. Kosilek
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
- * E-mail:
| | - Sebastian E. Baumeister
- Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Gründling
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Frank M. Brunkhorst
- Integrated Research and Treatment Center Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Stephan B. Felix
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Peter Abel
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Sigrun Friesecke
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Magdalena Brandl
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Carsten O. Schmidt
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jean-François Chenot
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- German Center for Diabetes Research, Site Greifswald, Greifswald, Germany
| | - Jochen S. Gensichen
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
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Abstract
OBJECTIVES We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. STUDY SELECTION Original articles, review articles, and systematic reviews were considered. DATA EXTRACTION Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. DATA SYNTHESIS "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. CONCLUSIONS A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
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Impact of Telemonitoring of Critically Ill Emergency Department Patients Awaiting ICU Transfer*. Crit Care Med 2019; 47:1201-1207. [DOI: 10.1097/ccm.0000000000003847] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance. Pediatr Crit Care Med 2019; 20:847-887. [PMID: 31483379 DOI: 10.1097/pcc.0000000000001963] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To update the American Academy of Pediatrics and Society of Critical Care Medicine's 2004 Guidelines and levels of care for PICU. DESIGN A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016. Only 21 pediatric studies evaluating outcomes related to pediatric level of care, specialized PICU, patient volume, or personnel. Of these, 13 studies were large retrospective registry data analyses, six small single-center studies, and two multicenter survey analyses. Limited high-quality evidence was found, and therefore, a modified Delphi process was used. Liaisons from the American Academy of Pediatrics were included in the panel representing critical care, surgical, and hospital medicine expertise for the development of this practice guidance. The title was amended to "practice statement" and "guidance" because Grading of Recommendations, Assessment, Development, and Evaluation methodology was not possible in this administrative work and to align with requirements put forth by the American Academy of Pediatrics. METHODS The panel consisted of two groups: a voting group and a writing group. The panel used an iterative collaborative approach to formulate statements on the basis of the literature review and common practice of the pediatric critical care bedside experts and administrators on the task force. Statements were then formulated and presented via an online anonymous voting tool to a voting group using a three-cycle interactive forecasting Delphi method. With each cycle of voting, statements were refined on the basis of votes received and on comments. Voting was conducted between the months of January 2017 and March 2017. The consensus was deemed achieved once 80% or higher scores from the voting group were recorded on any given statement or where there was consensus upon review of comments provided by voters. The Voting Panel was required to vote in all three forecasting events for the final evaluation of the data and inclusion in this work. The writing panel developed admission recommendations by level of care on the basis of voting results. RESULTS The panel voted on 30 statements, five of which were multicomponent statements addressing characteristics specific to PICU level of care including team structure, technology, education and training, academic pursuits, and indications for transfer to tertiary or quaternary PICU. Of the remaining 25 statements, 17 reached consensus cutoff score. Following a review of the Delphi results and consensus, the recommendations were written. CONCLUSIONS This practice statement and level of care guidance manuscript addresses important specifications for each PICU level of care, including the team structure and resources, technology and equipment, education and training, quality metrics, admission and discharge criteria, and indications for transfer to a higher level of care. The sparse high-quality evidence led the panel to use a modified Delphi process to seek expert opinion to develop consensus-based recommendations where gaps in the evidence exist. Despite this limitation, the members of the Task Force believe that these recommendations will provide guidance to practitioners in making informed decisions regarding pediatric admission or transfer to the appropriate level of care to achieve best outcomes.
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Len EK, Akkisetty R, Royal S, Brooks M, Coyle S, Gupta R, Lissauer M. Increased Healthcare-Associated Infections in a Surgical Intensive Care Unit Related to Boarding Non-Surgical Patients. Surg Infect (Larchmt) 2019; 20:332-337. [PMID: 30767723 DOI: 10.1089/sur.2018.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background: Hospital over-capacity often forces boarding patients outside of their designated intensive care unit (ICU). Anecdotal evidence suggested medical intensive care unit (MICU) patients boarding in the surgical intensive care unit (SICU) were responsible for increases in healthcare-associated infection (HAI) rates. We studied the effect of ICU boarding on rates of SICU HAIs. Methods: This single-center, retrospective two-year database study compared primary SICU patients (Home) to MICU patients boarding in the SICU (Boarders). Variables studied included age, gender, Acute Physiology and Chronic Health Evaluation III (APACHE III) scores, and comorbidities. Healthcare-associated infections included Clostridium difficile infection, catheter-associated urinary tract infections, central line-associated blood stream infection, and ventilator-associated pneumonia. Student t-test, Fisher exact testing, and a multivariable regression model were used to determine the significance of associations. Results: A total of 2,562 patients were included in the study; 328 (12.8%) were Boarders and 2,234 (87.2%) were Home. Univariable analysis demonstrated that Boarders were older (64.0 ± 16.9 vs. 60.2 ± 17.4), more severely ill (APACHE III score 70.5 ± 31.1 vs. 53.4 ± 21.9), more likely to have cirrhosis, coronary artery disease, and asthma/chronic obstructive pulmonary disease, but less likely to have hypertension. On univariable analysis boarding was associated with an increase HAI rate (19 HAI/1,000 patient days vs. 6.2, p < 0.001). Multivariable regression modeling demonstrated boarding status remained independently associated with HAI (odds ratio [OR] 1.83 95% confidence interval [CI] 1.02-3.27). Cost estimates demonstrated an additional cost of $83,303 per 1,000 patient days. Conclusion: The practice of hospital boarding is associated with development of HAI and increased hospital costs. Efforts at determining the cause of this increase and then reducing HAIs will improve patient care and help hospital budgets.
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Affiliation(s)
- Edward K Len
- 1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Division of Acute Care Surgery Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ritesh Akkisetty
- 1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Division of Acute Care Surgery Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sandia Royal
- 2 Robert Wood Johnson University Hospital, Barnabas Health, New Brunswick, New Jersey
| | - Maryanne Brooks
- 2 Robert Wood Johnson University Hospital, Barnabas Health, New Brunswick, New Jersey
| | - Susette Coyle
- 3 Department of Surgery, Division of Acute Care Surgery Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rajan Gupta
- 3 Department of Surgery, Division of Acute Care Surgery Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Matthew Lissauer
- 3 Department of Surgery, Division of Acute Care Surgery Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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de la Oliva P, Cambra-Lasaosa FJ, Quintana-Díaz M, Rey-Galán C, Sánchez-Díaz JI, Martín-Delgado MC, de Carlos-Vicente JC, Hernández-Rastrollo R, Holanda-Peña MS, Pilar-Orive FJ, Ocete-Hita E, Rodríguez-Núñez A, Serrano-González A, Blanch L. [Admission, discharge and triage guidelines for paediatric intensive care units in Spain]. An Pediatr (Barc) 2019; 88:287.e1-287.e11. [PMID: 29728212 DOI: 10.1016/j.anpedi.2017.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 10/17/2022] Open
Abstract
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.
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Affiliation(s)
- Pedro de la Oliva
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil La Paz, Madrid, España; Universidad Autónoma, Madrid, España.
| | - Francisco José Cambra-Lasaosa
- Servicio Área de Críticos Pediátricos, Hospital Sant Joan de Déu, Barcelona, España; Universidad de Barcelona, Barcelona, España
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, Madrid, España; Universidad Autónoma, Madrid, España
| | - Corsino Rey-Galán
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Oviedo, Asturias, España
| | - Juan Ignacio Sánchez-Díaz
- Sección de Cuidados Intensivos Pediátricos y Urgencias Infantiles, Hospital Universitario 12 de Octubre, Madrid, España; Universidad Complutense, Madrid, España
| | - María Cruz Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - Juan Carlos de Carlos-Vicente
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Ramón Hernández-Rastrollo
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil, Badajoz, España; Universidad de Extremadura, Badajoz, España
| | - María Soledad Holanda-Peña
- Unidad de Cuidados Intensivos Materno-Infantil, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | | | - Esther Ocete-Hita
- Unidad de Cuidados Intensivos Pediátricos, Hospital Virgen de Las Nieves, Universidad de Granada, Granada, España
| | - Antonio Rodríguez-Núñez
- Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Ana Serrano-González
- Servicio de Cuidados Intensivos Pediátricos, Hospital Niño Jesús, Madrid, España; Universidad Autónoma, Madrid, España
| | - Luis Blanch
- Centro de Críticos, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación e Innovación Parc Taulí, Sabadell, Barcelona, España
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Carter BG, Kiraly N, Hochmann M, Stephens R, Osborne A. ICU Staffing: Identification and Survey of Staff Involved in Providing Technical Support Services to Australian and New Zealand Intensive Care Units. Anaesth Intensive Care 2019; 35:259-65. [PMID: 17444317 DOI: 10.1177/0310057x0703500216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted a survey of all (200) Australian and New Zealand intensive care units to determine the presence and nature of staff employed in a technical support role. Specifically, we attempted to identify staff who are formally employed in a role where they are directly responsible for the equipment used in intensive care. Of 130 returned surveys, 80 units (62%) reported not having any personnel in this role. In these units technical tasks were most commonly performed by registered nurses (79%) but were also performed by a variety of other personnel. Fifty units (38%), consisting of approximately 105 individuals providing a total of 84.3 EFTs and most commonly in public (84%) or metropolitan (70%) hospitals or level 3 (64%) intensive care units, did have one or more staff acting in a formal technical support role. The most common groups filling the technical support role were nurses (42%), technicians (24%), biomedical engineers (10%) and technologists (6%). The most common duties performed were equipment troubleshooting (92%), training (80%), equipment evaluation (80%), ordering supplies (77%), consumable evaluation (75%), equipment cleaning (73%), delivery of supplies (70%), handling product recalls (65%), equipment maintenance (65%) and sitting on hospital committees (52%). This is the first attempt to identify and understand the technical support role in Australian and New Zealand intensive care units. Numerous issues remain and future work will hopefully add to our findings, with the possibility of formal recognition of the role, training and/or accreditation and its extension into other hospital departments.
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Affiliation(s)
- B G Carter
- Paediatric and Neonatal Intensive Care Units, Royal Children's Hospital, Melbourne, Victoria, Australia
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49
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de la Oliva P, Cambra-Lasaosa FJ, Quintana-Díaz M, Rey-Galán C, Sánchez-Díaz JI, Martín-Delgado MC, de Carlos-Vicente JC, Hernández-Rastrollo R, Holanda-Peña MS, Pilar-Orive FJ, Ocete-Hita E, Rodríguez-Núñez A, Serrano-González A, Blanch L. Admission, discharge and triage guidelines for paediatric intensive care units in Spain. Med Intensiva 2019; 42:235-246. [PMID: 29699643 DOI: 10.1016/j.medin.2017.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/24/2017] [Indexed: 12/16/2022]
Abstract
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.
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Affiliation(s)
- Pedro de la Oliva
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil La Paz, Madrid, España; Universidad Autónoma, Madrid, España.
| | - Francisco José Cambra-Lasaosa
- Servicio Área de Críticos Pediátricos, Hospital Sant Joan de Déu, Barcelona, España; Universidad de Barcelona, Barcelona, España
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, Madrid, España; Universidad Autónoma, Madrid, España
| | - Corsino Rey-Galán
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Oviedo, Asturias, España
| | - Juan Ignacio Sánchez-Díaz
- Sección de Cuidados Intensivos Pediátricos y Urgencias Infantiles, Hospital Universitario 12 de Octubre, Madrid, España; Universidad Complutense, Madrid, España
| | - María Cruz Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - Juan Carlos de Carlos-Vicente
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Ramón Hernández-Rastrollo
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil, Badajoz, España; Universidad de Extremadura, Badajoz, España
| | - María Soledad Holanda-Peña
- Unidad de Cuidados Intensivos Materno-Infantil, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | | | - Esther Ocete-Hita
- Unidad de Cuidados Intensivos Pediátricos, Hospital Virgen de Las Nieves, Universidad de Granada, Granada, España
| | - Antonio Rodríguez-Núñez
- Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Ana Serrano-González
- Servicio de Cuidados Intensivos Pediátricos, Hospital Niño Jesús, Madrid, España; Universidad Autónoma, Madrid, España
| | - Luis Blanch
- Centro de Críticos, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación e Innovación Parc Taulí, Sabadell, Barcelona, España
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DiDomenico RJ. Cardiology clinical pharmacy practice: Keep spreading the news! JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robert J. DiDomenico
- Center for Pharmacoepidemiology and Pharmacoeconomic Research and Department of Pharmacy Practice University of Illinois at Chicago Chicago Illinois
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