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Bedside rounds

Luc Morin, Samiran Ray, Clare Wilson, Solenn Remy, Mohamed Rida Benissa, Nicolaas J G Jansen, Etienne Javouhey, Mark J Peters, Martin Kneyber, Daniele De Luca, Simon Nadel, Luregn Jan Schlapbach, Graeme Maclaren, Pierre Tissieres
PURPOSE: Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal intensive care (ESPNIC) experts' definition of paediatric RSS. METHODS: We conducted a two-round Delphi study followed by an observational multicentre retrospective study...
October 5, 2016: Intensive Care Medicine
Lioudmila V Karnatovskaia, Margaret M Johnson, Travis J Dockter, Ognjen Gajic
PURPOSE: Survivors of critical illness are frequently unable to return to their premorbid level of psychocognitive functioning following discharge. Therefore, we aimed to evaluate the burden of psychological trauma experienced by patients in the intensive care unit (ICU) as perceived by clinicians to assess factors that can impede its recognition and treatment in the ICU. MATERIALS AND METHODS: Two distinct role-specific Web-based surveys were administered to critical care physicians and nurses in medical and surgical ICUs of 2 academic medical centers...
September 14, 2016: Journal of Critical Care
Shawn P Griffin, Joelle E Nelson
CONTEXT: Tacrolimus requires close therapeutic drug monitoring (TDM) to ensure efficacy and minimize adverse effects. Pharmacists are uniquely positioned on transplant teams to interpret levels and recommend therapy modifications. Their impact in the immediate postoperative setting has not been described previously. OBJECTIVE: To evaluate the impact of a clinical solid organ transplant pharmacist on nephrotoxicity, TDM, and revenue generation in adult kidney transplant recipients on tacrolimus...
September 14, 2016: Progress in Transplantation
Eric Young, Jaime Paulk, James Beck, Mel Anderson, McKenna Burck, Luke Jobman, Chad Stickrath
Interdisciplinary rounds provide a valuable venue for delivering patient-centered care but are difficult to implement due to time constraints and coordination challenges. In this article, we describe a unique model for fostering a culture of bedside interdisciplinary rounds through adjustment of the morning medication administration time, auditing physician communication with nurses, and displaying physician performance in public areas. Implementation of this model led to measurable improvements in physician-to-nurse communication on rounds, teamwork climate, and provider job satisfaction...
September 8, 2016: Journal of Nursing Care Quality
Jed D Gonzalo, Judy Himes, Brian McGillen, Vicki Shifflet, Erik Lehman
BACKGROUND: Interprofessional collaboration improves the quality of medical care, but integration into inpatient workflow has been limited. Identification of systems-based factors promoting or diminishing bedside interprofessional rounds (BIR), one method of interprofessional collaboration, is critical for potential improvements in collaboration in hospital settings. The objective of this study was to determine whether the percentage of bedside interprofessional rounds in 18 hospital-based clinical units is attributable to spatial, staffing, patient, or nursing perception characteristics...
2016: BMC Health Services Research
John W Peabody, David R Paculdo, Diana Tamondong-Lachica, Jhiedon Florentino, Othman Ouenes, Riti Shimkhada, Lisa DeMaria, Trever B Burgon
BACKGROUND: Poor clinical outcomes are caused by multiple factors such as disease progression, patient behavior, and structural elements of care. One other important factor that affects outcome is the quality of care delivered by a provider at the bedside. Guidelines and pathways have been developed with the promise of advancing evidence-based practice. Yet, these alone have shown mixed results or fallen short in increasing adherence to quality of care. Thus, effective, novel tools are required for sustainable practice change and raising the quality of care...
September 2016: Journal of Clinical Medicine Research
Melissa B Jones, Dawn Tucker
OBJECTIVE: The objectives of this review are to describe the education and critical thinking skills that characterize pediatric critical care nursing and how these skills impact patient care and outcomes in pediatric cardiac critical care. DATA SOURCE: MEDLINE and PubMed. CONCLUSIONS: Pediatric cardiac critical care nurses manage complex and vulnerable patients requiring various levels of support. Effective care of these patients requires knowledge about the complex anatomy and physiology associated with congenital and acquired heart disease, as well as the effects of mechanical ventilation, mechanical circulatory support, and vasoactive medications...
August 2016: Pediatric Critical Care Medicine
Hina J Talib, Ellen J Silver, Elizabeth M Alderman
OBJECTIVES: Protecting confidentiality for hospitalized adolescents can be challenging and may interfere with optimal adolescent-friendly care. The goal of this study was to explore physician trainees' experience with adolescent confidentiality at an academic children's hospital. METHODS: A total of 175 trainees were invited to complete an online survey about knowledge, attitudes, and experiences with confidential adolescent concerns in the inpatient setting. A total of 133 (76%) responded: 78% female; 65% pediatric or family medicine residents; and 35% medical students...
August 2016: Hospital Pediatrics
Stephanie E Hastings, Esther Suter, Judy Bloom, Krishna Sharma
BACKGROUND: Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban acute care hospital Evidence-based care processes were introduced, including an initial patient assessment and orientation, comfort rounds, bedside shift reports, patient whiteboards, Name Occupation Duty, rapid rounds, and team huddles...
2016: BMC Health Services Research
Susan E Merel, Christy M McKinney, Patrick Ufkes, Alan C Kwan, Andrew A White
Sitting at a patient's bedside in the inpatient setting is recommended as a best practice but has not been widely adopted. Previous studies suggest that a physician's seated posture may increase the patient's perception of time spent in the room but have not included hospitalists. We performed a cluster-randomized trial of seated versus standing physician posture during inpatient rounds on a hospitalist service at an academic medical center. Patients whose physician sat were significantly more likely to rate their physician highly on measures of listening carefully and explaining things in a way that was easy to understand...
July 5, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Eizen Kimura, Miho Nakai, Ken Ishihara
We introduced medical devices with RFID tags and the terminal with RFID reader in our hospital. Time study was conducted in two phases. In phase I, nurses round as usual, and in phase II, the nurse round the ward with a terminal installed on a cart. This study concluded that RFID system shortens the time for vital sign documentation. However, deploying the terminals at every bedside did not contribute the more time reduction.
2016: Studies in Health Technology and Informatics
Veronica Perry, Mollie Christiansen, Angela Simmons
Interprofessional bedside rounds are essential for patient-centered care. However, it may be difficult for nurses to round with physicians on medical-surgical units. Using a daily goals tool for indirect rounds improved nurse-physician communication and interprofessional care for patients.
March 2016: Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses
Mohamed A Hendaus, Shabina Khan, Samar Osman, Yasser Alsamman, Tushar Khanna, Ahmed H Alhammadi
BACKGROUND: The average number of clerkship weeks required for the pediatric core rotation by the US medical schools is significantly lower than those required for internal medicine or general surgery. OBJECTIVE: The objective behind conducting this survey study was to explore the perceptions and expectations of medical students and pediatric physicians about the third-year pediatric clerkship. METHODS: An anonymous survey questionnaire was distributed to all general pediatric physicians at Hamad Medical Corporation and to students from Weill Cornell Medical College-Qatar...
2016: Advances in Medical Education and Practice
Brian T Wessman, Carrie Sona, Marilyn Schallom
BACKGROUND: Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. METHODS: This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month...
June 6, 2016: Journal of Intensive Care Medicine
Rita N Bakhru, David J McWilliams, Douglas J Wiebe, Vicki J Spuhler, William D Schweickert
RATIONALE: Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices. OBJECTIVES: We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. METHODS: We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone...
September 2016: Annals of the American Thoracic Society
Stanislav Henkin, Tony Y Chon, Marie L Christopherson, Andrew J Halvorsen, Lindsey M Worden, John T Ratelle
BACKGROUND: Teamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician-nurse teamwork are often suboptimal. OBJECTIVE: To improve nurse-physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds. INTERVENTION: From July 2013 through October 2013, physicians (attendings and residents) and nurses from four general medicine teams in a single nursing unit participated in bedside rounding, which involved the inclusion of nurses in morning rounds with the medicine teams at the patients' bedside...
2016: Journal of Multidisciplinary Healthcare
Lindsey B Justice, David S Cooper, Carla Henderson, James Brown, Katherine Simon, Lindsey Clark, Elizabeth Fleckenstein, Alexis Benscoter, David P Nelson
OBJECTIVES: To improve communication during daily cardiac ICU multidisciplinary rounds. DESIGN: Quality improvement methodology. SETTING: Twenty-five-bed cardiac ICUs in an academic free-standing pediatric hospital. PATIENTS: All patients admitted to the cardiac ICU. INTERVENTIONS: Implementation of visual display of patient daily goals through a write-down and read-back process. MEASUREMENTS AND MAIN RESULTS: The Rounds Effectiveness Assessment and Communication Tool was developed based on the previously validated Patient Knowledge Assessment Tool to evaluate comprehension of patient daily goals...
July 2016: Pediatric Critical Care Medicine
F J Harries, P A Begg
OBJECTIVE: The use of non-rinse skin cleansers in the care of patients who are at risk of tissue breakdown is not new within the National Health Service (NHS). Back to the Floor Continence Care Rounds (introduced in 2012 to facilitate bedside continence care education) at University Hospitals Birmingham had identified that in the current climate of austerity and efficiency savings, the use of non-rinse cleanser was being randomly rationed. Our objective was to determine whether the introduction of a smaller tube of non-rinse cleanser with targeted education would improve usage and ultimately improve the skin of incontinent patients...
May 2016: Journal of Wound Care
Sara Garfield, Seetal Jheeta, Fran Husson, Jill Lloyd, Alex Taylor, Charles Boucher, Ann Jacklin, Anna Bischler, Christine Norton, Rob Hayles, Bryony Dean Franklin
BACKGROUND: Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing. METHODS: We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study...
2016: PloS One
Brianna L Mckelvie, James Dayre Mcnally, Kusum Menon, Maelle G R Marchand, Deepti N Reddy, W David Creery
OBJECTIVE: In healthcare, checklists help to ensure patients receive evidence-based, safe care. Since 2007, we have used a bedside checklist in our PICU to facilitate daily discussion of care-related questions at each bedside. The primary objective of this study was to assess compliance with checklist use and to assess how often individual checklist elements affected patient management. A secondary objective was to determine whether patient and unit factors (severity of illness, unit census, weekday vs...
June 2016: International Journal for Quality in Health Care
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