379 The Critical Care Experience of Irish Surgical Non-Consultant Hospital Doctors, Are We Equipped to Assist During the Covid-19 Outbreak and Beyond?

Abstract Introduction The ongoing COVID-19 pandemic has presented unforeseen threats and stresses to healthcare systems around the world, most notably in the ability to provide critical care. Aim To assess surgical NCHD experience in providing critical care and working in an intensive care environment. Method An electronic survey was distributed amongst surgical trainees and then amongst individual surgical departments. Ten questions were included in the survey assessing the NCHD’s experience with aspects of critical care. Results 39 respondents including 16 specialist registrars, 3 senior registrars, 11 registrars and 9 senior house officers. 18% of respondents had previous experience in anaesthetics or intensive care. 23% self-reported being competent in performing endotracheal intubation. 15% self-reported being competent in the use of CPAP and BiPaP, 5% did not know what these were. 20% self-reported being competent in the use of AIRVO. 15% self-reported being competent in placing central and arterial lines. 15% self-reported being competent in starting and adjusting inotropes/vasopressors. 49% reported completing a CCRISP or BASIC course. 85% felt that a rotation in anaesthesia should be a routine part of surgical training. Conclusions Whilst there is critical care experience amongst the surgical NCHD cohort there remains room for further development.

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Applied Pervasive Patient Timeline in Intensive Care Units

Hospital Management and Emergency Medicine ◽

10.4018/978-1-7998-2451-0.ch028 ◽

2020 ◽

pp. 567-579

Author(s):

André Braga ◽

Filipe Portela ◽

Manuel Filipe Santos ◽

António da Silva Abelha ◽

José Machado ◽

...

Keyword(s):

Data Mining ◽

Decision Making ◽

Critical Care ◽

Intensive Care ◽

Intensive Care Units ◽

Daily Activity ◽

Vital Signs ◽

Care Environment ◽

Future Condition

This study has the objective of introducing an innovative way of presenting and representing information concerning patients in Intensive Care Units. Therefore, the Pervasive Patient Timeline, which has the purpose of offering support to intensivists' decision-making process, by providing access to a real-time environment, was developed. The solution is patient-centred as it can be accessed from anywhere, at any time and it contains patients' clinical data since they are admitted to the ICU until their discharge. The environment holds data concerning vital signs, laboratory results, therapeutics, and data mining predictions, which can be analysed to have a better understanding of patients' present and future condition. Due to the nature of the critical care environment, the pervasive aspect is crucial because it allows intensivists make decisions when they have to be made. The Pervasive Patient Timeline is focused on improving the quality of care by helping the intensivists perform better in their daily activity.

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Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

American Journal of Critical Care ◽

10.4037/ajcc2009131 ◽

2010 ◽

Vol 19 (3) ◽

pp. 272-276 ◽

Cited By ~ 21

Author(s):

Mohamad F. El-Khatib ◽

Salah Zeineldine ◽

Chakib Ayoub ◽

Ahmad Husari ◽

Pierre K. Bou-Khalil

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Care Providers ◽

Care Experience ◽

Respiratory Therapists ◽

Evidence Based Guidelines

Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

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Development of a Tele-ICU Postorientation Support Program for Bedside Nurses

Critical Care Nurse ◽

10.4037/ccn2015368 ◽

2015 ◽

Vol 35 (4) ◽

pp. e8-e16 ◽

Cited By ~ 3

Author(s):

Theresa Brindise ◽

Manisa Phophairat Baker ◽

Pat Juarez

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Support Program ◽

Intensive Care Unit Nurse ◽

Orientation Program ◽

Care Experience ◽

Formal Unit ◽

Consistent Support

The end of the formal unit orientation program is a stressful time of adjustment for nurses hired into critical care without previous critical care experience. Although most units offer reassurance that experienced colleagues will provide the needed guidance, consistent support may not be available for many reasons. Development of a structured postorientation program designed to provide support and ongoing feedback to bedside nurses who have completed orientation is one strategy to assist nurses through this period of adjustment. The experience and expertise of the tele–intensive care unit nurse are excellent resources that can be called on to provide the needed support.

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SP2.2.4National multi centre cohort study of transferable skills acquired among redeployed core surgical trainees to intensive care units during the COVID-19 pandemic

British Journal of Surgery ◽

10.1093/bjs/znab361.041 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Yiannis Vyrides ◽

Antonio Leyte Golpe ◽

Shahram Shirazi ◽

Anna Bogdanova ◽

Peter Daum ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Average Length ◽

Care Experience ◽

Transferable Skills ◽

Surgical Trainees ◽

Operative Care ◽

Before And After ◽

National Cohort ◽

Key Aspects

Abstract Aim Due to the COVID-19 pandemic a large number of core surgical trainees have been redeployed to intensive care units across the country. This study analyses the procurement of transferable skills by trainees mapped to the ISCP curriculum among a large national cohort. Methods An anonymous questionnaire mapped to common areas in the ISCP syllabus, including basic sciences, post-operative care, critical care and management of the dying patient, was administered to a nationwide group of core surgical trainees redeployed to ITU. The results were compared with responses from a cohort of trainees that were not redeployed. Subgroup analysis was also performed on the redeployed cohort to compare skills before and after redeployment. Result A total of 72 complete responses from among 3 deaneries nationwide were received, 39 who were redeployed, and 33 who were not. Mean age (24.5 vs 24.9 years) and time post-graduation (37.5 vs 38.2 months) were similar in each group. The average length of redeployment was 12 ±0.157 weeks. The mean score in those not redeployed was 1.85 ±0.167, compared to 4.02±0.175 in the redeployed cohort (p < 0.05). Among those redeployed, scores prior to redeployment were significantly lower 1.89 ±0.122 (p < 0.05). Conclusion This study demonstrates that even a brief period of intensive care experience significantly increases knowledge of key aspects of the ISCP curriculum. It is the authors’ opinion that a module of intensive care experience during core surgical training should be considered. Our cohort will be followed to assess performance in postgraduate examinations.

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Trainee Doctors’ Perception of the Adequacy of Support During Their Intensive Care Attachment- A Phenomenological Study

10.21203/rs.3.rs-34474/v1 ◽

2020 ◽

Author(s):

dale ventour ◽

Rebecca O'Rouke

Keyword(s):

Critical Care ◽

Intensive Care ◽

Phenomenological Study ◽

Phenomenological Approach ◽

Daily Basis ◽

Care Environment ◽

Educational Support ◽

The Status ◽

Care Culture ◽

Care Support

Abstract BACKGROUNDThe perception of junior non-anaesthetic trainees’ educational support during their Intensive Care attachment was evaluated by this study using a phenomenological approach. The author in his role as College Tutor for Intensive Care was evaluating the factors within the Intensive Care environment which led to supporting the junior trainees in this tense environment and whether it can help trainees to adapt to changing doctor’s roles in the future. The aim was to evaluate the factors which influenced junior trainees learning and ability to effectively perform on a daily basis within the stressful intensive care environment.RESULTSThemes affecting learning included: Authority, Hierarchy, Safety, Intimidating environment, Disorientation, Friendliness, limited member of the team, Dreading on-call duties, communication and consultant input.CONCLUSIONThe author suggested a ‘tripod of critical care support’ with the junior doctor at the apex and three arms of support comprising; the nurses, consultants and the intensive care environment. These three components combine to form the ‘critical care culture’ which trains, nurtures and support critical care doctors. It is evident from the trainees’ interview that the presence of a critical care culture is a palpable entity with the nurses at the center reinforcing the status quo and the trainees need to be on the nurses ‘good side’ in order to maximize and enjoy their critical care rotation.

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Pain management in the critically ill

10.1093/med/9780199600830.003.0357 ◽

2016 ◽

Author(s):

Ross D. MacPherson

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Pain Management ◽

Pain Relief ◽

Critically Ill ◽

Controlled Trials ◽

Care Environment ◽

Significant Pain ◽

High Level

Despite the fact that patients in the critical care environment are more likely than others to have significant pain, there have been few controlled trials and even fewer examples of high level evidence that can be used to guide pain management. This chapter surveys the main modalities for pain management in the intensive care unit. Parenteral strategies remain the most commonly used form of administration and opioids are still the basis of good pain management. However, in recent times there have been a number of new opioids made available and some of these have a clear application in the critical care environment.In addition to opioids there are a range of adjunct agents that can be usedto give better quality pain relief, while at the same time reducing opioid requirements. Numerous studies have confirmed that pain managementin the critical care environment could be better managed. Strategies to improve pain management are suggested.

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Effectiveness of participant recruitment strategies for critical care trials: A systematic review and narrative synthesis

Clinical Trials ◽

10.1177/1740774520988678 ◽

2021 ◽

pp. 174077452098867

Author(s):

Timia Raven-Gregg ◽

Fiona Wood ◽

Victoria Shepherd

Keyword(s):

Critical Care ◽

Intensive Care ◽

English Language ◽

Future Research ◽

Trial Participation ◽

Recruitment Strategies ◽

Narrative Synthesis ◽

Research Practice ◽

Care Environment ◽

Participant Recruitment

Background: Critical care trials are limited by problems with participant recruitment, and little is known about the most effective ways to enhance trial participation. Despite clinical research improving in the past decades within intensive care, participant recruitment remains a challenge. Not all eligible patients are identified, and opportunities for enrolment into clinical trials are often missed. Interventions to facilitate recruitment need to be identified to improve trial conduct in the critical care environment. Therefore, we aimed to establish the effectiveness of recruitment strategies in critical care trials in order to inform future research practice. Methods: Databases including MEDLINE, Embase, CINAHL and PsycINFO were searched for English language papers from inception to February 2020. The objectives were to: (1) establish the effectiveness of recruitment strategies and (2) recommend how effective recruitment strategies can inform research practice. Two reviewers independently assessed papers for inclusion and critically appraised the quality of the studies. Discrepancies were discussed within the research team. Relevant data were extracted and thematically coded into five overarching themes using a narrative synthesis approach. The review was prospectively registered on PROSPERO (CRD42019160519). Results: The search resulted in 2509 initially identified articles, with 15 that met the inclusion criteria. Articles reported a combination of quantitative, mixed methods and qualitative studies and a range of low-, moderate- and high-quality studies. Although, in-keeping with narrative synthesis approaches, none were excluded based on methodological quality. Five themes were identified relating to: patient eligibility identification, who provides information and seeks consent, resource limitations, research culture or environment and the consent model used. The relative success of recruitment strategies was dependent upon the experience and availability of the staff involved in the approach, trial design, the application of the strategy to the specific intensive care environment, the acceptability of the recruitment and consent models used, and the efficiency of the recruitment procedures. Opportunities for consent were missed in a proportion of eligible patients in most studies, suggesting that clinicians may avoid recruiting more complex patients or in more complex situations and that further development of strategies is needed. Conclusion: More effective recruitment strategies are required to enhance recruitment and the representativeness of the patient sample obtained in critical care trials, in order to expand the evidence base for treatments in this field. Greater focus is needed on assessing the performance of different recruitment strategies within different types of studies and critical care research environments. Future research should explore key stakeholders’ experiences of, and attitudes towards, recruitment and establish the most important and feasible modifiable barriers to recruitment.

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