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ICU outreach

Stephen C Gale, JoAnn Peters, Jason S Murry, Jessica S Crystal, Viktor Y Dombrovskiy
Background: Late middle age (LMA), is a watershed between youth and old age, with unique physical and social changes and declines in vitality, but a desire to remain active despite increasing comorbidity. While post-injury outcomes in the elderly are well studied, little is known regarding LMA patients. We analyzed the injured LMA population admitted to a rural, regional Level 1 Trauma Center relative to outcomes for both younger and older patients. Materials and methods: Our registry was queried retrospectively for patients admitted 7/2008- 12/2015; they were divided into three cohorts: 18-54, 55-65, and >65 years...
March 2018: Annals of Medicine and Surgery
Wivica Kauppi, Matilda Proos, Sepideh Olausson
BACKGROUND: Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit. AIMS AND OBJECTIVES: The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU. DESIGN AND METHODS: Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden...
January 22, 2018: Nursing in Critical Care
Mags Guest
The transfer of patients from the intensive care unit (ICU) to a general ward can present several challenges for nurses. Such patients are at high risk of adverse outcomes, including readmission to the ICU, and increased nosocomial infections and mortality, with a resultant increase in hospital costs. This article explores the challenges of transferring patients from the ICU and uses evidence to examine ways to address them to ensure optimal care for a complex patient group. Transfer time, factors affecting general ward care, handover processes, recognition of deterioration and education, intensive care outreach, and the psychological factors affecting these patients are examined...
November 1, 2017: Nursing Standard
Portia Jordan, Ferestas Mpasa, Wilma Ten Ham-Baloyi, Candice Bowers
Purpose The purpose of this paper is to critically analyze empirical studies related to the implementation strategies for clinical practice guidelines (CPGs) in intensive care units (ICUs). Design/methodology/approach A systematic review with a narrative synthesis adapted from Popay et al.'s method for a narrative synthesis was conducted. A search using CINAHL, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials, MEDLINE via PUBMED and grey literature was conducted in 2014 and updated in 2016 (August)...
May 8, 2017: International Journal of Health Care Quality Assurance
James Malycha, Tim Bonnici, Katarina Sebekova, Tatjana Petrinic, Duncan Young, Peter Watkinson
BACKGROUND: Failure to promptly identify deterioration in hospitalised patients is associated with delayed admission to intensive care units (ICUs) and poor outcomes. Existing vital sign-based Early Warning Score (EWS) algorithms do not have a sufficiently high positive predictive value to be used for automated activation of an ICU outreach team. Incorporating additional patient data might improve the predictive power of EWS algorithms; however, it is currently not known which patient data (or variables) are most predictive of ICU admission...
March 28, 2017: Systematic Reviews
Hayley B Gershengorn, Yunchao Xu, Carri W Chan, Mor Armony, Michelle N Gong
RATIONALE: Hospitals are increasingly using critical care outreach teams (CCOTs) to respond to patients deteriorating outside intensive care units (ICUs). CCOT staffing is variable across hospitals and optimal team composition is unknown. OBJECTIVES: To assess whether adding a critical care medicine trained physician assistant (CCM-PA) to a critical care outreach team (CCOT) impacts clinical and process outcomes. METHODS: We performed a retrospective study of two cohorts-one with a CCM-PA added to the CCOT (intervention hospital) and one with no staffing change (control hospital)-at two facilities in the same system...
2016: PloS One
(no author information available yet)
BACKGROUND: Rapid response teams (RRTs) are a mandatory element of Australian national health care policy. However, the uptake, resourcing, case load and funding of RRTs in Australian and New Zealand hospitals remain unknown. AIM: To assess the clinical activity, funding, staffing and governance of RRTs in Australian and New Zealand hospitals. METHODS: Survey of Australian and New Zealand hospitals as part of a biannual audit of intensive care resources and capacity...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
K A Hollowed, T E Travis, M H Jordan, J W Shupp
Education of first responders and referring medical professionals is considered vital to high-quality burn care. Prior to 1999, the community education program at The Burn Center of MedStar Washington Hospital Center (MWHC) was staffed by ICU nurses who volunteered their time. As the program became more popular in the mid-1990s, the requests for lectures exceeded the capacity of a volunteer program. A request to hospital administration for a full-time education coordinator position was rejected in the climate of budget cut-backs and declining reimbursement...
December 31, 2015: Annals of Burns and Fire Disasters
Laura Alberto, Brigid M Gillespie, Anna Green, Maria Del Carmen Martínez, Angel Cañete, Haydee Zotarez, Carlos Alberto Díaz, Marcelino Enriquez, Mario Gerónimo, Wendy Chaboyer
BACKGROUND: The Intensive Care Unit Liaison Nurse (ICULN), also known as an outreach nurse, is an advanced practice nursing role that emerged in the late 1990s in Australia and the United Kingdom (UK). Little is known about this role in less developed economies. OBJECTIVE: To describe the activities undertaken by ICULNs in Argentina. METHODS: Prospective, descriptive, observational, single site study in an Argentinean metropolitan tertiary referral hospital...
March 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Joseph L Nates, Mark Nunnally, Ruth Kleinpell, Sandralee Blosser, Jonathan Goldner, Barbara Birriel, Clara S Fowler, Diane Byrum, William Scherer Miles, Heatherlee Bailey, Charles L Sprung
OBJECTIVES: To update the Society of Critical Care Medicine's guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research. DESIGN: An appointed Task Force followed a standard, systematic, and evidence-based approach in reviewing the literature to develop these guidelines. MEASUREMENTS AND MAIN RESULTS: The assessment of the evidence and recommendations was based on the principles of the Grading of Recommendations Assessment, Development and Evaluation system...
August 2016: Critical Care Medicine
Kristen V Dicks, Eric Lofgren, Sarah S Lewis, Rebekah W Moehring, Daniel J Sexton, Deverick J Anderson
OBJECTIVE To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN Interrupted time series analysis. SETTING The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013. PARTICIPANTS All ICU patients at study hospitals during the study period...
July 2016: Infection Control and Hospital Epidemiology
Frida Kareliusson, Lina De Geer, Anna Oscarsson Tibblin
BACKGROUND: Readmission to intensive care units (ICU) is accompanied with longer ICU stay as well as higher ICU, in-hospital and 30-day mortality. Different scoring systems have been used in order to predict and reduce readmission rates. METHODS: The purpose of this study was to evaluate the Stability and Workload Index for Transfer (SWIFT) score as a predictor of readmission. Further, we wanted to study steps and measures taken at the ward prior to readmission...
2015: Journal of Intensive Care
Maartje L G de Vos, Sabine N van der Veer, Bram Wouterse, Wilco C Graafmans, Niels Peek, Nicolette F de Keizer, Kitty J Jager, Gert P Westert, Peter H J van der Voort
BACKGROUND: Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards. METHODS: In a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team...
July 8, 2015: Implementation Science: IS
Lisa Hinton, Louise Locock, Marian Knight
OBJECTIVE: For every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care in the context of pregnancy poses distinct issues for staff and patients, for example, with breastfeeding support and separation from the newborn. This study aimed to understand the experiences of women who experience a maternal near miss and require critical care after childbirth. SETTING: Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity...
April 27, 2015: BMJ Open
Marie A Bakitas, Tor D Tosteson, Zhigang Li, Kathleen D Lyons, Jay G Hull, Zhongze Li, J Nicholas Dionne-Odom, Jennifer Frost, Konstantin H Dragnev, Mark T Hegel, Andres Azuero, Tim A Ahles
PURPOSE: Randomized controlled trials have supported integrated oncology and palliative care (PC); however, optimal timing has not been evaluated. We investigated the effect of early versus delayed PC on quality of life (QOL), symptom impact, mood, 1-year survival, and resource use. PATIENTS AND METHODS: Between October 2010 and March 2013, 207 patients with advanced cancer at a National Cancer Institute cancer center, a Veterans Affairs Medical Center, and community outreach clinics were randomly assigned to receive an in-person PC consultation, structured PC telehealth nurse coaching sessions (once per week for six sessions), and monthly follow-up either early after enrollment or 3 months later...
May 1, 2015: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Leanne M Aitken, Wendy Chaboyer, Amanda Vaux, Shannon Crouch, Elizabeth Burmeister, Michael Daly, Chris Joyce
BACKGROUND: Rapid response systems (RRS) have been recommended as a strategy to prevent and treat deterioration in acute care patients. Questions regarding the most effective characteristics of RRS and strategies for implementing these systems remain. AIMS: The aims of this study were to (i) describe the structures and processes used to implement a 2-tier RRS, (ii) determine the comparative prevalence of deteriorating patients and incidence of unplanned intensive care unit (ICU) admission and cardiac arrest prior to and after implementation of the RRS, and (iii) determine clinician satisfaction with the RRS...
August 2015: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Nidhi Srivastava, Mohan Deep Kaur, Sandeep Sharma
BACKGROUND: Critical care outreach services (CCOS) is a relatively a new concept in India and is not as developed as in Western countries. Efficient utilization of limited intensive care service requires comprehensive CCOS. Appropriate activation of such services will limit excess burden on already scarce human resources. AIM: To evaluate the functioning of CCOS in a tertiary care hospital and also to identify factors leading to its overactivation. MATERIALS AND METHODS: Data of 400 calls received in resuscitation room (RR) of the Trauma Center during January 2011-June 2011 was analyzed...
January 2014: International Journal of Critical Illness and Injury Science
N Alam, E L Hobbelink, A J van Tienhoven, P M van de Ven, E P Jansma, P W B Nanayakkara
BACKGROUND: Acute deterioration in critical ill patients is often preceded by changes in physiological parameters, such as pulse, blood pressure, temperature and respiratory rate. If these changes in the patient's vital parameters are recognized early, excess mortality and serious adverse events (SAEs) such as cardiac arrest may be prevented. The Early Warning Score (EWS) is a scoring system which assists with the detection of physiological changes and may help identify patients at risk of further deterioration...
May 2014: Resuscitation
Sabine N van der Veer, Maartje L G de Vos, Peter H J van der Voort, Niels Peek, Ameen Abu-Hanna, Gert P Westert, Wilco C Graafmans, Kitty J Jager, Nicolette F de Keizer
OBJECTIVE: To assess the impact of applying a multifaceted activating performance feedback strategy on intensive care patient outcomes compared with passively receiving benchmark reports. DESIGN: The Information Feedback on Quality Indicators study was a cluster randomized trial, running from February 2009 to May 2011. SETTING: Thirty Dutch closed-format ICUs that participated in the national registry. Study duration per ICU was sixteen months...
August 2013: Critical Care Medicine
Tanja Jantzen, Matthias Fischer, Michael P Müller, Stephan Seewald, Jan Wnent, Jan-Thorsten Gräsner
5-10% of in-hospital patients are affected by adverse events, 10% of these requiring CPR. Standardized in-hospital emergency management may improve results, including reduction of mortality, hospital stay and cost. Early warning scores and clinical care outreach teams may help to identify patients at risk and should be combined with standard operation procedure and consented alarm criteria. These teams of doctors and nurses should be called for all in hospital emergencies, providing high-end care and initiate ICU measures at bedside...
June 2013: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
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