Surrogate Measures of Patient-centered Outcomes in Critical Care

2003 ◽  
pp. 169-180 ◽  
Author(s):  
G.D. Rubenfeld
Keyword(s):  
Critical Care ◽  
Patient Centered ◽  
Surrogate Measures

scholarly journals Adaptation of the AACN Synergy Model for Patient Care to Critical Care Transport

2014 ◽  
Vol 34 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Scott Swickard ◽  
Wendy Swickard ◽  
Andrew Reimer ◽  
Deborah Lindell ◽  
Chris Winkelman
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Level Of Care ◽  
Patient Centered ◽  
Levels Of Care ◽  
Interhospital Transfer ◽  
Mode Of Transport ◽  
Interfacility Transport

Today’s health care delivery system relies heavily on interhospital transfer of patients who require higher levels of care. Although numerous tools and algorithms have been used for the prehospital determination of mode of transport, no tool for the transfer of patients between hospitals has been widely accepted. Typically, the interfacility transport decision is left to the discretion of the referring provider, who may or may not be aware of the level of care provided or the means of transport available. A need exists to determine the appropriate level of care required to meet the needs of patients during transport. The American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care is a patient-centered model that focuses on optimizing patient care by matching the characteristics of the patient with the competencies of the nurse. This model shows significant promise in providing the theoretical backing to guide the decision on the level of care necessary to complete interfacility transfers safely and effectively. This article describes a new tool inspired by the AACN Synergy Model for Patient Care to determine the appropriate level of care required for interfacility transport.

scholarly journals Nursing Handovers in Critical Care: A Retrospective Analysis of Information Content and Function

2019 ◽  
Vol 8 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Emily S. Patterson ◽  
Anne McIntire ◽  
Nicholas Beecroft ◽  
Mary Beth Happ ◽  
Susan D. Moffatt-Bruce
Keyword(s):  
Critical Care ◽  
Information Content ◽  
Medication Administration ◽  
Clinical Judgments ◽  
Verbal Reports ◽  
Patient Centered ◽  
Policies And Procedures ◽  
Progress Notes ◽  
Centered Care ◽  
And Function

Translating validated handover protocols from physicians in non-critical care settings to nursing report in critical care is challenging. Our objectives are to identify information content in verbal reports, where information is documented, and the function of non-documented communication. This is a descriptive study of 20 reports describing 27 patients from two medical intensive care units. Analysis involved unique coding of phrases and emergent themes analysis. Information categories included: Identify patient (51.9%); Narrative history (96.3%); Unusual symptoms (88.9%); Response to care (37%); Status of tasks (100%); Expectations of patients and families (55.6%). Information is documented in progress notes, the medication administration record, nursing flowsheets, lab results, orders, and past medical history. Information not typically documented supports providing patient-centered care, sharing clinical judgments, coordinating work, and mentorship. These objectives may guide nursing administrators in tailoring policies and procedures for nursing report to the needs of registered nurses in a critical care setting.

The LOTUS: A Journey to Value-Based, Patient-Centered Care

2019 ◽  
Vol 25 (1) ◽  
pp. 17-24
Author(s):  
Liza Barbarello Andrews ◽  
Nina Roberts ◽  
Carol Ash ◽  
Natalie Jones ◽  
Meghan Rolston ◽  
...  
Keyword(s):  
Critical Care ◽  
Community Hospital ◽  
Scope Of Practice ◽  
Care Planning ◽  
Patient Centered ◽  
High Functioning ◽  
Icu Length Of Stay ◽  
System A ◽  
Centered Care ◽  
Ownership Transformation

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.

Patient-centered critical care reconsidered

2012 ◽  
Vol 40 (8) ◽  
pp. 2486-2487
Author(s):  
Constantine A. Manthous
Keyword(s):  
Critical Care ◽  
Patient Centered

Use of PADIS Assessment Tools by Critical Care Nurses: An Integrative Review

2020 ◽  
pp. 019394592097302
Author(s):  
Denise Waterfield ◽  
Susan Barnason
Keyword(s):  
Critical Care ◽  
Assessment Tool ◽  
Reasoned Action ◽  
Final Analysis ◽  
Critical Care Nurses ◽  
Assessment Tools ◽  
Integrative Review ◽  
Control Beliefs ◽  
Reasoned Action Approach ◽  
Patient Centered

The purpose of this integrative review was to evaluate the literature from January 2013 to April 2020 and to explore critical care nurses’ perspectives of and intent to use recommended Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) patient assessment tools in adult critical care units. A literature search was performed with a total of 47 studies included in the final analysis for this review. The studies’ data were organized and further reduced based on The Reasoned Action Approach behavioral theory to reflect the extent to which a nurse plans to use a PADIS assessment tool. Extracted themes were related to behavioral beliefs in patient-centered care and critical thinking; normative beliefs about communication and prioritization; and control beliefs concerning autonomy and confidence. Contextualizing the international phenomenon of variation in PADIS assessment tool use by critical care nurses provides a deeper understanding of its complexity for use in the clinical setting.

Research in the Critical Care Environment

2021 ◽  
pp. 345-372
Author(s):  
Dorothy Wade ◽  
Deborah Smyth ◽  
David C. J. Howell
Keyword(s):  
Critical Care ◽  
Recovery Period ◽  
Psychological Impact ◽  
Psychological Research ◽  
Psychology Research ◽  
Patient Centered ◽  
Care Environment ◽  
The Past ◽  
Research Areas ◽  
Hospital Rehabilitation

Research into the psychological impact of critical care has burgeoned over the past 20 years. This chapter outlines the major areas of psychological and rehabilitation research being conducted in critical care, as well as the gaps that remain to be filled. The authors review research areas corresponding to the early acute critical care phase, the in-hospital rehabilitation phase, and the post-hospital recovery period. The focus is on patient-centered research. The authors also review how clinicians can set themselves up to conduct psychological research, what kind of teams they need to assemble, and the challenges they could face working in critical care environments. The authors draw on their own experiences conducting linked, critical care psychology research studies, and compare this to methods used by other researchers.

scholarly journals GERIATRICS MICU CO-MANAGEMENT: INTEGRATING GERIATRIC ASSESSMENTS FOR CRITICALLY ILL PATIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S448-S448
Author(s):  
Gowrishankar Gnanasekaran ◽  
Eduardo Mireles-Cabodevila
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Task Force ◽  
Clinical Care ◽  
Elderly Care ◽  
Management Program ◽  
Quality Improvement Initiative ◽  
Discharge Process ◽  
Patient Centered

Abstract Programs like orthogeriatrics, geriatric cardiology have shown to improve outcomes in hospitalized geriatric patients. Our Geriatrics MICU Co-management program is a quality improvement initiative that instigates a partnership approach with critical care medicine in integrating geriatric assessments and build foundation for interdisciplinary care of critically ill patients. MICU (Medical Intensive Care Unit) protocols do not have standard geriatrics assessments integrated in clinical care. An electronic dash-board identifies high risk elderly (HRE) patients admitted at a MICU in a large teaching hospital in Northeast Ohio based on nursing specific screening triggers. A geriatrics co-management team engages in a comprehensive geriatric assessments and care transition. 386 patient were identified using HRE screening triggers in a period of 100 days. 33 % (n=131) were generated as consults for co-management. A pilot review on 131 HRE patients was conducted. 70% (n=93) patients had incident frailty. 93% (n=87) of patients with frailty were diagnosed with incident delirium. 56% (n=74) of patients were newly diagnosed with cognitive impairment. 56 % (N=74) of patients had a medication reduction. An average of 1.23 medication was changed. 85% (n =112) of patients had a warm hand off to the next level of provider on discharge. 90% (n=119) of patients notified improved self-management skills and better understanding of discharge process. The Geri-MICU program demonstrates a patient -centered approach in integrating geriatric assessments for critically ill patients and build foundation of a geriatrics-critical care task force. The program would be a mile stone in optimizing elderly care in critical care units.

scholarly journals Fluid Therapy: Double-Edged Sword during Critical Care?

2015 ◽  
Vol 2015 ◽  
pp. 1-14 ◽  
Author(s):  
Jan Benes ◽  
Mikhail Kirov ◽  
Vsevolod Kuzkov ◽  
Mitja Lainscak ◽  
Zsolt Molnar ◽  
...  
Keyword(s):  
Critical Care ◽  
Side Effects ◽  
Hemodynamic Monitoring ◽  
Fluid Therapy ◽  
Patient Management ◽  
Patient Centered ◽  
Monitoring Tools ◽  
Invasive Hemodynamic Monitoring ◽  
Postural Changes ◽  
Dynamic Perspective

Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.

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