scholarly journals An Assessment of Flight Surgeon Confidence to Perform En Route Care

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 306-309
Author(s):  
Chad T Andicochea ◽  
James Wilson ◽  
Emily Raetz ◽  
Benjamin Walrath
Keyword(s):  
Critically Ill ◽  
Process Improvement ◽  
Ad Hoc ◽  
Search And Rescue ◽  
Critically Ill Patient ◽  
Convenience Sample ◽  
Improvement Project ◽  
Patient Transport ◽  
The Past ◽  
Survey Results

Abstract Introduction En Route Care (ERC) is often an ad hoc mission for the USN. In a review of 428 Navy patient transports, a Flight Surgeon (FS) was the sole provider or a member of crew in 118 of the transports. Naval FSs receive approximately 4 hours of didactic ERC training during their 24-week Naval FS course. Regardless, an FS may be caring for a critically ill patient in a helicopter. We conducted a survey to evaluate FS confidence in their ability to perform ERC and to establish their understanding of the training of Search and Rescue Medical Technicians (SMT). Materials and Methods A convenience sample of FSs completed a needs analysis survey as part of a process improvement project. Flight Surgeons surveyed were actively assigned or had been assigned within the past year to a squadron with Search and Rescue/MEDEVAC capabilities. Results A total of 25 surveys were completed. An average of 13 (range 0–100) patient transport missions were performed by the respondents. Twenty-five percent reported feeling confident in their ability to provide ERC without senior level direction, while 41% stated they would require direction. Nearly 70% of the FSs surveyed expressed “minimal” or less understanding of the training of the SMT. Conclusions Our survey results reveal most FSs are confident in neither their ability to perform ERC nor the ability of their hospital corpsman to provide care during patient movement.

Transport of the critically ill patient

2017 ◽  
Author(s):  
Laura Flutter ◽  
Christoph Melzer-Gartzke ◽  
Claudia Spies ◽  
Julian Bion
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Best Practice ◽  
Ad Hoc ◽  
Critically Ill Patient ◽  
National Guidelines ◽  
Specialist Services ◽  
Hospital Transfer ◽  
Safe Transport

The safe transport of critically ill patients is recognized internationally as a key competency for clinicians working in anaesthesia, critical care, and emergency medicine. This includes inter- and intra-hospital, land, and air transport. The centralization of specialist services and growing demand for critical care beds have increased pressure on hospitals to provide transfer support for critically ill patients. A variety of systems have emerged to facilitate the increasing need for both inter- and intra-hospital transfer of patients, ranging from a national coordinated retrieval service to the ad hoc utilization of on-call teams. The potential for complications during all types of transfer has been well documented. In order to improve safety, a number of national guidelines and courses have been developed to provide a standardized approach to transfer medicine. This chapter reviews the current literature on the subject and provides a summary of best practice for the transfer of the critically ill patient.

scholarly journals Chloride in intensive care units: a key electrolyte

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1930 ◽  
Author(s):  
Ghassan Bandak ◽  
Kianoush B. Kashani
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Chloride Content ◽  
Patient Admission ◽  
Critically Ill Patient ◽  
The Past ◽  
Arterial Blood ◽  
Clinical Investigations

Over the past few years, chloride has joined the league of essential electrolytes for critically ill patients. Dyschloremia can occur secondary to various etiologic factors before and during patient admission in the intensive care unit. Some cases are disease-related; others, treatment-related. Chloride abnormalities were shown in animal models to have adverse effects on arterial blood pressure, renal blood flow, and inflammatory markers, which have led to several clinical investigations. Hyperchloremia was studied in several settings and correlated to different outcomes, including death and acute kidney injury. Baseline hypochloremia, to a much lesser extent, has been studied and associated with similar outcomes. The chloride content of resuscitation fluids was also a subject of clinical research. In this review, we describe the effect of dyschloremia on outcomes in critically ill patients. We review the major studies assessing the chloride content of resuscitation fluids in the critically ill patient.

Abstract P857: Rapid Cycle Process Improvement During a Pandemic: Changing How Patients at Low Risk for Complications Are Monitored Post Intravenous Thrombolysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michelle Whaley ◽  
Rebecca van Vliet ◽  
Leah Farrell ◽  
David Welcom
Keyword(s):  
Patient Safety ◽  
Critically Ill ◽  
Process Improvement ◽  
Nursing Staff ◽  
Intravenous Thrombolysis ◽  
Low Risk ◽  
Nursing Time ◽  
Improvement Project ◽  
Practice Nurses ◽  
Low Intensity

Background: During the initial emergence of the 2019 novel coronavirus (COVID-19) and the subsequent surge of patients requiring critical care, our Joint Commission certified thrombectomy-capable stroke center sought to utilize a low-intensity monitoring protocol in stable, post intravenous (IV) thrombolysis patients in our intensive care unit (ICU). The acuity level in our ICU jumped to an all-time high, with many critically ill COVID-19 patients. Our goal was simple, provide safe patient care, free up precious nursing time, and preserve the personal protective equipment supply. Purpose: The purpose of this study was to use a rapid cycle process improvement project to implement a low-intensity monitoring (LIM) protocol in stable, suspected stroke patients, who are deemed at low risk for complications, in the first twenty-four hours following IV thrombolysis. Methods: We utilized the Plan-Do-Study-Act (PDSA) model to implement this project. Collaboration between physician, nursing, and stroke program leaders occurred during the month of April 2020. Our new process utilized the O ptimal P ost T -pa I v M onitoring in I schemic ST roke (OPTIMIST) protocol. We continued to admit our post IV alteplase patients to the ICU, rather than a step-down unit, in order to accommodate the 3:1 patient to nurse ratio, ensure protocol adherence, and maximize patient safety with this high-risk medication. We used change of shift huddles to educate the ICU nursing staff over a two-week period. Stroke program advanced practice nurses were on-site to ensure compliance. Results: Since implementation of the new protocol, two IV alteplase patients have met protocol criteria; both remained stable throughout the twenty-four-hour LIM period. The protocol’s nursing ratio changes allowed the other, critically ill patients, to be staffed with traditional ICU ratios. Conclusion: Rapid cycle PI projects can be accomplished during times of extreme challenge, as evidenced during the COVID-19 pandemic. Nursing staff was able to adapt and even welcomed the change, while maintaining patient safety. Further study is needed to document the ongoing effect of this protocol.

scholarly journals Mortality among Critically Ill Acute Kidney Injury Patients Stratified with RIFLE Classification

2021 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Jais Kumar ◽  
Hassan Mumtaz ◽  
Arsh Zahoor ◽  
Naveed Sarwar ◽  
Kishore Kumar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Excess Mortality ◽  
Kidney Injury ◽  
Normal Function ◽  
Critically Ill Patient ◽  
The Past ◽  
End Stage

Acute kidney injury, also referred to as AKI, is a common complication seen in critically ill patients . There has been a significant increase in the number of AKI cases over the past few decades. In order to standardize the classification of AKI, the RIFLE (Risk, Injury, Failure, Loss, End-Stage) and AKIN (AKI Network) criteria were developed.This is a prospective, observational, and longitudinal cohort study where data from all patients admitted to the hospital intensive care unit (ICU) were collected. The study duration ranged from March 2019 to September 2020. During the study period, 198 patients were admitted to the ICU. Of these, 69 were excluded while the remaining 104 patients were included in the study.About 66–67% of the total critically ill patient population admitted in the ICU suffer from some etiology related to AKI. Our study highlights the aspect in which the cases of AKI are underreported. RIFLE class R or class I is still associated with excess mortality compared with patients who maintained normal function. RIFLE is a reliable system of classification, which is well classified and indicates the immediate necessity of renal replacement therapy (RRT); the prognosis of early RRT is fairly good in critically ill patients with AKI.

The timing of tracheostomy in critically ill patient

ORL ro ◽  
2017 ◽  
Vol 2 (35) ◽  
pp. 20
Author(s):  
Liliana Mirea ◽  
Raluca Ungureanu ◽  
Daniel Mirea ◽  
Mirela Țigliș ◽  
Ioana Cristina Grințescu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient

Ergonomic Process Improvement for Mapping Risk and Identifying Key Interventions for Eliminating Injuries from Needles and Sharps in the OR

2020 ◽  
Vol 64 (1) ◽  
pp. 716-720
Author(s):  
Pramila Kalaga ◽  
Barbara Wolford ◽  
Matthew Mormino ◽  
Timothy Kingston ◽  
Julie Fedderson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Process Improvement ◽  
Injury Risk ◽  
Best Practice ◽  
Physical Workload ◽  
Physical Factors ◽  
Improvement Project ◽  
Targeted Interventions ◽  
Effective Interventions ◽  
Sharps Injury

The risk of a needle stick or sharps injury in the operating room (OR) is high due to conditions such as minimal physical protective measures, frequent transfer of sharps, and reliance on human attention and skill for injury avoidance. An ergonomic process improvement project was initiated at a large metro teaching hospital to identify ergonomic risk factors for these OR injuries. To maximize the engagement of the front- end users, an ergonomic process improvement (EPI) team was developed, consisting of representatives from participating OR teams, an employee health nurse and two ergonomists. Surveys, observations, and interviews were conducted to quantify injury risk for the OR teams, evaluate barriers to best practice adherence, and identify opportunities for targeted interventions. Risk mapping was completed for the surgeons, surgical techs and OR nurses identifying double gloving and safe passing zone as areas in need of improvement. Through observation and interviews, researchers identified physical factors relating to musculoskeletal pain and cognitive factors leading to distractions as safety risk concerns. The overall success of the EPI was the engagement of the OR teams and surgeons in the process of identifying risk factors and potential opportunities for ergonomic solutions related to cognitive workload, physical workload, teamwork, and work design for injury prevention. The risk factors identified will provide the basis for developing targeted, effective interventions for eliminating injuries from needles and sharps within the OR.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

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