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Sprung CL, Devereaux AV, Ghazipura M, Burry LD, Hossain T, Hamele MT, Gist RE, Dempsey TM, Dichter JR, Henry KN, Niven AS, Alptunaer T, Huffines M, Bowden KR, Martland AMO, Felzer JR, Mitchell SH, Tosh PK, Persoff J, Mukherjee V, Downar J, Báez AA, Maves RC. Critical Care Staffing in Pandemics and Disasters: A Consensus Report from a Sub-committee of the Task Force for Mass Critical Care- Systems Strategies to Sustain the Healthcare Workforce. Chest 2023:S0012-3692(23)00331-8. [PMID: 36907373 PMCID: PMC10007715 DOI: 10.1016/j.chest.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) pandemic has led to unprecedented mental health disturbances, burnout, and moral distress among healthcare workers, impacting their ability to care for themselves and their patients. METHODS The Workforce Sustainment subcommittee of the Task Force for Mass Critical Care (TFMCC) utilized a consensus development process, incorporating evidence from literature review with expert opinion through a modified Delphi approach to determine factors impacting mental health, burnout, and moral distress in healthcare workers, in order to propose necessary actions to help prevent these issues and enhance workforce resilience, sustainment, and retention. RESULTS Consolidation of evidence gathered from literature review and expert opinion resulted in 197 total statements that were synthesized into 14 major suggestions. These suggestions were organized into three categories: (1) mental health and wellbeing for staff in medical settings, (2) system-level support and leadership, and (3) research priorities and gaps. Suggestions include both general and specific occupational interventions to support healthcare worker basic physical needs, psychological distress, reduce moral distress and burnout, and foster mental health and resilience. CONCLUSIONS The Workforce Sustainment subcommittee of the TFMCC offers evidence-informed operational strategies to assist healthcare workers and hospitals plan, prevent, and treat the factors impacting healthcare worker mental health, burnout, and moral distress to improve resilience and retention following the COVID-19 pandemic.
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Affiliation(s)
- Charles L Sprung
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | | | - Tanzib Hossain
- New York University, Grossman School of Medicine, New York, New York, USA
| | - Mitchell T Hamele
- Tripler Army Medical Center, Honolulu, Hawaii, USA; Uniformed Services University, Bethesda, Maryland, USA
| | - Ramon E Gist
- SUNY Downstate Health Science University, Brooklyn, New York, USA
| | - Timothy M Dempsey
- David Grant Medical Center, US Air Force, Travis AFB, California, USA
| | | | | | | | - Timur Alptunaer
- Uniformed Services University, Bethesda, Maryland, USA; Leonard J. Chabert Medical Center Houma, Louisiana, USA
| | | | - Kasey R Bowden
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | | | - Jason Persoff
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | - Amado A Báez
- Medical College of Georgia, Augusta, Georgia, USA
| | - Ryan C Maves
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Dichter JR, Devereaux AV, Sprung CL, Mukherjee V, Persoff J, Baum KD, Ornoff D, Uppal A, Hossain T, Henry KN, Ghazipura M, Bowden KR, Feldman HJ, Hamele MT, Burry LD, Martland AMO, Huffines M, Tosh PK, Downar J, Hick JL, Christian MD, Maves RC. Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies - A Preliminary Report of Findings From the Task Force for Mass Critical Care. Chest 2021; 161:429-447. [PMID: 34499878 PMCID: PMC8420082 DOI: 10.1016/j.chest.2021.08.072] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 01/25/2023] Open
Abstract
Background After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world. Research Question A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality. Study Design and Methods TFMCC adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, the TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence. Results Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. ICU surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and to avoid crisis triage, with early transfer strategies to further load-balance care. We suggest that intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in ICUs. Interpretation A subcommittee from the TFMCC offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands resulting from COVID-19.
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Affiliation(s)
| | | | | | | | | | | | | | - Amit Uppal
- Grossman School of Medicine, New York University, New York, NY
| | - Tanzib Hossain
- Grossman School of Medicine, New York University, New York, NY
| | | | - Marya Ghazipura
- Grossman School of Medicine, New York University, New York, NY
| | | | - Henry J Feldman
- Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Cambridge, MA
| | - Mitchell T Hamele
- Uniformed Services University, Bethesda, MD; Tripler Army Medical Center, Honolulu, HI
| | | | | | | | | | | | - John L Hick
- University of Minnesota, Minneapolis, MN; Hennepin Health Care, Minneapolis, MN
| | - Michael D Christian
- Research & Clinical Effectiveness Lead/HEMS Doctor, London's Air Ambulance, Bart's NHS Health Trust, London, England
| | - Ryan C Maves
- Uniformed Services University, Bethesda, MD; Wake Forest School of Medicine, Winston-Salem, NC
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Branson R, Dichter JR, Feldman H, Devereaux A, Dries D, Benditt J, Hossain T, Ghazipura M, King M, Baldisseri M, Christian MD, Domingiuez-Cherit G, Henry K, Martland AMO, Huffines M, Ornoff D, Persoff J, Rodriquez D, Maves RC, Kissoon NT, Rubinson L. The US Strategic National Stockpile Ventilators in Coronavirus Disease 2019: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices. Chest 2020; 159:634-652. [PMID: 32971074 PMCID: PMC7503115 DOI: 10.1016/j.chest.2020.09.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Early in the coronavirus disease 2019 (COVID-19) pandemic, there was serious concern that the United States would encounter a shortfall of mechanical ventilators. In response, the US government, using the Defense Production Act, ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities, and whether all are able to support COVID-19 patients is not evident. RESEARCH QUESTION Evaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current US Strategic National Stockpile (SNS) ventilators employed during the pandemic, and finally, compare ordered ventilators' functionality based on COVID-19 patient needs. STUDY DESIGN AND METHODS Current published literature, publicly available documents, and lay press articles were reviewed by a diverse team of disaster experts. Data were assembled into tabular format, which formed the basis for analysis and future recommendations. RESULTS COVID-19 patients often develop severe hypoxemic acute respiratory failure and adult respiratory defense syndrome (ARDS), requiring high levels of ventilator support. Current SNS ventilators were unable to fully support all COVID-19 patients, and only approximately half of newly ordered ventilators have the capacity to support the most severely affected patients; ventilators with less capacity for providing high-level support are still of significant value in caring for many patients. INTERPRETATION Current SNS ventilators and those on order are capable of supporting most but not all COVID-19 patients. Technologic, logistic, and educational challenges encountered from current SNS ventilators are summarized, with potential next-generation SNS ventilator updates offered.
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Affiliation(s)
- Rich Branson
- Department of Surgery, Division of Trauma & Critical Care, University of Cincinnati, Cincinnati, OH
| | - Jeffrey R Dichter
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN.
| | | | - Asha Devereaux
- Department of Pulmonary Medicine, Sharp Coronado Hospital, Coronado, CA
| | - David Dries
- Department of Surgery, HealthPartners Medical Group, Regions Hospital, and University of Minnesota, St. Paul, MN
| | - Joshua Benditt
- Respiratory Care Services and General Pulmonary Clinic, University of Washington, Seattle, WA
| | - Tanzib Hossain
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, NY
| | - Marya Ghazipura
- The Department of Epidemiology and Biostatistics, New York University Langone Health, New York, NY
| | - Mary King
- Pediatric Critical Care Medicine and PICU, Harborview Medical Center, University of Washington, Seattle, WA
| | - Marie Baldisseri
- Critical Care Medicine and Neurocritical Care, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Guillermo Domingiuez-Cherit
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, and Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran," Mexico
| | | | | | | | - Doug Ornoff
- Internal Medicine Residency Training Program, University of Colorado School of Medicine, Aurora, CO
| | - Jason Persoff
- Division of Hospital Medicine, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Dario Rodriquez
- Airman Biosciences Division, Airman Systems Directorate, the Department of Surgery, University of Cincinnati, OH
| | - Ryan C Maves
- Department of Critical Care Medicine, Naval Medical Center, San Diego, CA; Uniformed Services University, Bethesda, MD
| | - Niranjan Tex Kissoon
- Department of Pediatrics and Emergency Medicine and the Child and Family Research Institute, UBC & BC Children's Hospital, Vancouver, BC, Canada
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Talley DA, Dunlap E, Silverman D, Katzer S, Huffines M, Dove C, Anders M, Galvagno SM, Tisherman SA. Improving Postoperative Handoff in a Surgical Intensive Care Unit. Crit Care Nurse 2020; 39:e13-e21. [PMID: 31575601 DOI: 10.4037/ccn2019523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Evidence-based research demonstrates that postoperative formalized handoff improves communication and satisfaction among hospital staff members, leading to improved patient outcomes. OBJECTIVE To improve postoperative patient safety in the surgical intensive care unit of a tertiary academic medical center. METHODS A verbal and written formal reporting method was designed, implemented, and evaluated. The intervention created an admission "time-out," allowing the handoff from surgical and anesthesia teams to the intensive care unit team and bedside nurses to occur in a more structured manner. Before and 1 year after implementation of the intervention, nurses completed surveys on the quality of postoperative handoff. RESULTS After the intervention, the proportion of nurses who reported receiving handoff from the surgical team increased from 20% to 60% (P < .001). More nurses felt satisfied with the surgical handoff (46% before vs 74% after the intervention; P < .001), and more nurses frequently felt included in the handoff process (42% vs 74%; P < .001). Nurses perceived improved communication with surgical teams (93%), anesthesia teams (89%), and the intensive care unit team (94%), resulting in a perception of better patient care (88%). CONCLUSION After implementation of a systematic multidisciplinary handoff process, surgical intensive care nurses reported improved frequency and completeness of the postoperative handoff process, resulting in a perception of better patient care.
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Affiliation(s)
- Deborah A Talley
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Eleanor Dunlap
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Dawn Silverman
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Stephanie Katzer
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Meredith Huffines
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Cindy Dove
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Megan Anders
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Samuel M Galvagno
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
| | - Samuel A Tisherman
- Deborah A. Talley, Eleanor Dunlap, Dawn Silverman, and Stephanie Katzer are acute care nurse practitioners in the surgical intensive care unit, University of Maryland Medical Center, Baltimore, Maryland. Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit, University of Maryland Medical Center. Cindy Dove is Director of Nursing for Surgery and Cardiac Surgical Services, University of Maryland Medical Center. Megan Anders is an anesthesiologist and Associate Chair for Safety and Quality, Department of Anesthesiology, University of Maryland Medical Center. Samuel M. Galvagno is an associate professor and Associate Medical Director, surgical intensive care unit, University of Maryland Medical Center, and Associate Chief Medical Officer, Maryland Critical Care Network, Baltimore. He is a colonel in the US Air Force and Director of Critical Care Air Transport Team operations, 943rd Aerospace Medicine Squadron, Davis-Monthan Air Force Base, Arizona. Samuel A. Tisherman is Medical Director, surgical intensive care unit, surgical intermediate care unit, and the Center for Critical Care and Trauma Education, University of Maryland Medical Center
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Huffines M, Johnson KL, Smitz Naranjo LL, Lissauer ME, Fishel MAM, D’Angelo Howes SM, Pannullo D, Ralls M, Smith R. Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit. Crit Care Nurse 2013; 33:56-69. [DOI: 10.4037/ccn2013354] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background
Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together.
Objectives
To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients’ families.
Methods
A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families’ satisfaction scores before and after implementation of the algorithm.
Results
Satisfaction scores for participation in decision making (45% vs 68%; z = −2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = −2.10, P = .04) improved significantly after implementation.
Conclusions
Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit’s team works together.
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Affiliation(s)
- Meredith Huffines
- Meredith Huffines is a senior clinical nurse II in the surgical intensive care unit at University of Maryland Medical Center in Baltimore
| | - Karen L. Johnson
- Karen L. Johnson is director of nursing research, Banner Healthcare System, Phoenix, Arizona. At the time of this project, she was director of nursing research and evidence-based practice at University of Maryland Medical Center
| | - Linda L. Smitz Naranjo
- Linda L. Smitz Naranjo was the clinical practice coordinator in the surgical intensive care unit at the University of Maryland Medical Center at the time of this project
| | - Matthew E. Lissauer
- Matthew E. Lissauer is the medical director of the surgical intensive care unit and an assistant professor of surgery in the trauma program at University of Maryland School of Medicine in Baltimore
| | - Marmie Ann-Michelle Fishel
- Marmie Ann-Michelle Fishel was a patient advocate at the University of Maryland Medical Center at the time of this project
| | - Susan M. D’Angelo Howes
- Susan M. D’Angelo Howes is a senior clinical nurse I in the surgical intensive care unit at University of Maryland Medical Center
| | - Diane Pannullo
- Diane Pannullo was a member of the palliative care team at the University of Maryland Medical Center at the time of this project. She is now a staff nurse in the surgical intensive care unit
| | - Mindy Ralls
- Mindy Ralls is a senior clinical nurse I in the surgical intensive care unit at the University of Maryland Medical Center
| | - Ruth Smith
- Ruth Smith is lead chaplain in the surgical intensive care unit at the University of Maryland Medical Center
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