scholarly journals Protocol for a mixed methods exploratory study of success factors to escalation of care: the SUFFICE study

2021 ◽  
Author(s):  
Jody Ede ◽  
Peter Watkinson ◽  
Ruth Endacott
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Mixed Methods ◽  
Success Factors ◽  
Early Warning Systems ◽  
Failure To Rescue ◽  
Study Results ◽  
Hospital Patients ◽  
Ward Patient

Background: In the United Kingdom, hospital patients suffer preventable deaths (failure to rescue) and delayed admission to the Intensive Care Unit because of poor illness recognition. This problem has consistently been identified in care reviews. Strategies to improve deteriorating ward patient care, such as early warning systems and specialist care teams (critical care outreach or rapid response), have not reliably demonstrated reductions to patient deaths. Current research focuses on failure to rescue, but further reductions to patient deaths are possible, by examining care of unwell hospital patients who are rescued (successfully treated). Our primary objective is to develop a framework of care escalation success factors that can be developed into a complex intervention to reduce patient mortality and unnecessary admissions to the Intensive Care Unit (ICU). Methods and Analysis: SUFFICE is a multicentre mixed-methods, exploratory sequential study examining rescue events in the acutely unwell ward patient in two National Health Service Trusts with Teaching Hospital status. The study will constitute four key phases. Firstly, we will observe ward care escalation events to generate a theoretical understanding of the process of rescue. Secondly, we review care records from unwell ward patients in whom an ICU admission was avoided to identify care success factors. Thirdly we will conduct staff interviews with expert doctors, nurses, and Allied Health Professionals to identify how rescue is achieved and further explore care escalation success factors identified in the first two study phases. The final phase involves integrating the study data to generate the theoretical basis for the framework of care escalation success factors. Ethics and Dissemination: Ethical approval has been obtained through the Queen Square London Research and Ethics committee (REC Ref 20/HRA/3828; CAG-20CAG0106). Study results will be of interest to critical care, nursing and medical professions and results will be disseminated at national and international conferences.

scholarly journals Intensive Care Unit Services Preparedness for the Pandemic: An Efficiency Analysis

2021 ◽  
Vol 14 ◽  
pp. 117863292110375
Author(s):  
Songul Cinaroglu
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Health Resources ◽  
Public Hospitals ◽  
Teaching Hospitals ◽  
Efficient Management ◽  
Study Results ◽  
Before And After ◽  
The Difference

Intensive care unit (ICU) services efficiency and the shortage of critical care professionals has been a challenge during pandemic. Thus, preparing ICUs is a prominent part of any pandemic response. The objective of this study is to examine the efficiencies of ICU services in Turkey right before the pandemic. Data were gathered from the Public Hospital Statistical Year Book for the year 2017. Analysis are presented at hospital level by comparing teaching and non-teaching hospitals. Bootstrapped data envelopment analysis procedure was used to gather more precise efficiency scores. Three analysis levels are incorporated into the study such as, all public hospitals (N = 100), teaching (N = 53), non-teaching hospitals (N = 47), and provinces that are providing high density of ICU services through the country (N = 54). Study results reveal that average efficiency scores of ICU services obtained from teaching hospitals (eff = 0.65) is higher than non-teaching (eff = 0.54) hospitals. After applying the bootstrapping techniques, efficiency scores are significantly improved and the difference between before and after bootstrapping results are statistically significant ( P < .05). Province based analysis indicates that, ICU services efficiencies are high for provinces located in southeast part of the country and highly populated places, such as İstanbul. Evidence-based operational design that considers the spatial distribution of health resources and effective planning of critical care professionals are critical for efficient management of intensive care. Study results will be helpful for health policy makers to deeply understand dynamics of critical care.

scholarly journals Monitoring intensive care unit performance—impact of a novel individualised performance scorecard in critical care medicine: a mixed-methods study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019165 ◽  
Author(s):  
Shannon M Fernando ◽  
David Neilipovitz ◽  
Aimee J Sarti ◽  
Erin Rosenberg ◽  
Rabia Ishaq ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Mixed Methods ◽  
Performance Metrics ◽  
Quality Standard ◽  
Care Patient ◽  
Critical Care Medicine ◽  
Resource Utilisation ◽  
The Impact

IntroductionPatients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement. There is no widely accepted or standardised scorecard that has been used for overall CCM performance. We aim to improve quality of care, patient safety and patient/family experience in CCM practice through the utilisation of a standardised, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics.Methods and analysisThis will be a mixed-methods, controlled before and after study to assess the impact of a CCM-specific quality scorecard. Scorecard metrics were developed through expert consensus and existing literature. The study will include 19 attending CCM physicians and approximately 300 CCM nurses. Patient data for scorecard compilation are collected daily from bedside flow sheets. Preintervention baseline data will be collected for 6 months for each participant. After this, each participant will receive their scorecard measures. Following a 3-month washout period, postintervention data will be collected for 6 months. The primary outcome will be change in performance metrics following the provision of scorecard feedback to subjects. A cost analysis will also be performed, with the purpose of comparing total ICU costs prior to implementation of the scorecard with total ICU costs following implementation of the scorecard. The qualitative portion will include interviews with participants following the intervention phase. Interviews will be analysed in order to identify recurrent themes and subthemes, for the purposes of driving scorecard improvement.Ethics and disseminationThis protocol has been approved by the local research ethics board. Publication of results is anticipated in 2019. If this intervention is found to improve patient- and unit-directed outcomes, with evidence of cost-effectiveness, it would support the utilisation of such a scorecard as a quality standard in CCM.

scholarly journals Handoffs and transitions in critical care (HATRICC): protocol for a mixed methods study of operating room to intensive care unit handoffs

BMC Surgery ◽  
2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Meghan B Lane-Fall ◽  
Rinad S Beidas ◽  
Jose L Pascual ◽  
Meredith L Collard ◽  
Hannah G Peifer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Mixed Methods ◽  
Operating Room ◽  
Mixed Methods Study

scholarly journals Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis

2017 ◽  
Vol 12 ◽  
pp. 117863371771645 ◽  
Author(s):  
Nancy Ames ◽  
Rebecca Shuford ◽  
Li Yang ◽  
Brad Moriyama ◽  
Meredith Frey ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Mixed Methods ◽  
Self Report ◽  
Control Group ◽  
Music Listening ◽  
Post Intervention ◽  
Significant Difference ◽  
Numeric Rating

Background: Music listening may reduce the physiological, emotional, and mental effects of distress and anxiety. It is unclear whether music listening may reduce the amount of opioids used for pain management in critical care, postoperative patients or whether music may improve patient experience in the intensive care unit (ICU). Methods: A total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours) during the 48 hours of patients’ ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention. Results: There was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS) for pain between the music and the control groups ( P = .037). The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group’s interviews were analyzed for themes. Conclusions: Despite the limited sample size, this study identified music listening as an appropriate intervention that improved patients’ post-intervention experience, according to patients’ self-report. Future mixed methods studies are needed to examine both qualitative patient perspectives and methodology to improve music listening in critical care units.

scholarly journals A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care

2021 ◽  
Vol 36 (1) ◽  
pp. 55-70
Author(s):  
Jeffrey Haspel ◽  
Minjee Kim ◽  
Phyllis Zee ◽  
Tanja Schwarzmeier ◽  
Sara Montagnese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Human Physiology ◽  
Critical Care ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Circadian Clock ◽  
Clinical Course ◽  
Disease Expression ◽  
Severe Manifestation ◽  
Novel Coronavirus

We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

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