The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration

2020 ◽  
Vol 163 (2) ◽  
pp. 232-243 ◽  
Author(s):  
Rebecca L. Cherney ◽  
Vinciya Pandian ◽  
Ashly Ninan ◽  
Debra Eastman ◽  
Brian Barnes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Care Pathway ◽  
Interdisciplinary Collaboration ◽  
Unit Length ◽  
Control Group ◽  
Staff Nurse ◽  
Prospective Comparison

Objective To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. Methods The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). Results Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 ( P < .05). The incidence of adverse events was unchanged. Discussion Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Implications for Practice Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

Ketamine as an Analgesic Adjuvant in Adult Trauma Intensive Care Unit Patients With Rib Fracture

2018 ◽  
Vol 52 (9) ◽  
pp. 849-854 ◽  
Author(s):  
Mary K. Walters ◽  
Joseph Farhat ◽  
James Bischoff ◽  
Mary Foss ◽  
Cory Evans
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Group Versus ◽  
Standard Of Care ◽  
Pain Scale ◽  
Rib Fracture ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Opioid Use

Background: Rib fracture associated pain is difficult to control. There are no published studies that use ketamine as a therapeutic modality to reduce the amount of opioid to control rib fracture pain. Objective: To examine the analgesic effects of adjuvant ketamine on pain scale scores in trauma intensive care unit (ICU) rib fracture. Methods: This retrospective, case-control cohort chart review evaluated ICU adult patients with a diagnosis of ≥1 rib fracture and an Injury Severity Score >15 during 2016. Patients received standard-of-care pain management with the physician’s choice analgesics with or without ketamine as a continuous, fixed, intravenous infusion at 0.1 mg/kg/h. Results: A total of 15 ketamine treatment patients were matched with 15 control standard-of-care patients. Efficacy was measured via Numeric Pain Scale (NPS)/Behavioral Pain Scale (BPS) scores, opioid use, and ICU and hospital length of stay. Safety of ketamine was measured by changes in vital signs, adverse effects, and mortality. Average NPS/BPS, severest NPS/BPS, and opioid use were lower in the ketamine group than in controls (NPS: 4.1 vs 5.8, P < 0.001; severest NPS: 7.0 vs 8.9, P = 0.004; opioid use: 2.5 vs 3.5 mg morphine equivalents/h/d, P = 0.015). No difference was found between the cohort’s length of stay or mortality. Average diastolic blood pressure was higher in the treatment group versus the control group (75.3 vs 64.6 mm Hg, P = 0.014). Conclusion: Low-dose ketamine appears to be a safe and effective adjuvant option to reduce pain and decrease opioid use in rib fracture.

Association of Length of Stay at Emergency Services in the Outcome of Admitted Patients

2019 ◽  
Author(s):  
RP Neupane ◽  
S Raut ◽  
TM Shrestha ◽  
R Aacharya
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Emergency Services ◽  
Unit Length ◽  
University Teaching ◽  
Cross Sectional ◽  
Prolonged Stay ◽  
Icu Outcome ◽  
Ultimate Outcome

Abstract Background: Access block and overcrowding leading to prolonged stay in emergency room is a common problem of Emergency services of Tribhuvan University Teaching Hospital (TUTH) Kathmandu. Those patients who stayed longer in emergency department might affect continuing care and the ultimate outcome of patients. Study aims to evaluate the association of emergency services length of stay and outcome of admitted patients in wards or Intensive Care Unit at the predefined cut-off value of 6 hour. Methods: It was a prospective cross sectional comparative study done in TUTH, Kathmandu. Data were collected from records from emergency services, wards, ICU and hospital record section from October, 2018 to April, 2019. Adult patients were grouped in to two groups; Emergency services to wards (ES to Wards) and Emergency services to ICU (ES to ICU). Outcome was compared between those admitted within 6hr and those admitted after 6hr of stay in emergency services. Results: A total of 2,059 patients were enrolled over 6 months. Out of them, Male were 55.5% and 42.6% patients were at the age of equal to or above 60 years. Total admitted patients who stayed equal to or less than 6 hr in emergency services was 26.7%. It was found that there was no significant association between Emergency services length of stay (ESLOS) and outcome of admitted total patients (p= 0.160) as well as in ICU (p= 0.559) or Ward admitted patients (p= 0.361). Age was found independent predictor for outcome (p= <0.01). Association of ESLOS and age was also found statistically significant (p= 0.02). Conclusions: Emergency service length of stay is not predictor for outcome of admitted patients. Key words: Emergency services, intensive care unit, length of stay, mortality.

Improving Family Communications at the End of Life: Implications for Length of Stay in the Intensive Care Unit and Resource Use

2003 ◽  
Vol 12 (4) ◽  
pp. 317-324 ◽  
Author(s):  
Tom Ahrens ◽  
Valerie Yancey ◽  
Marin Kollef
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Resource Utilization ◽  
Intervention Group ◽  
Clinical Nurse Specialist ◽  
Control Group ◽  
Nurse Specialist ◽  
Clinical Nurse

• Background Inadequate communication persists between healthcare professionals and patients and patients’ families in intensive care units. Unwanted or ineffective treatments can occur when patients’ goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients’ outcomes and resource utilization.• Objectives To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit.• Methods During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician.• Results Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15 559 vs $24 080) and variable ($5087 vs $8035) costs.• Conclusions Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients’ families reduced lengths of stay and resource utilization.

375: ADMISSION PLATELET COUNT AND INTENSIVE CARE UNIT LENGTH OF STAY

2020 ◽  
Vol 48 (1) ◽  
pp. 169-169
Author(s):  
Tanya Marvi ◽  
Ryan Brown ◽  
Li Wang ◽  
Matthew Semler ◽  
Todd Rice
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Length Of Stay ◽  
Unit Length ◽  
Intensive Care Unit Length

‘Normal’ Vital Signs Belie Occult Hypoperfusion in Geriatric Trauma Patients

2010 ◽  
Vol 76 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Jeremiah T. Martin ◽  
Fuad Alkhoury ◽  
Judith A. O'Connor ◽  
Tassos C. Kyriakides ◽  
John A. Bonadies
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Unit Length ◽  
Vital Signs ◽  
Intensive Care Unit Length ◽  
Hospital Length Of Stay ◽  
Common Finding ◽  
Trauma Patients ◽  
Severity Scores

Base deficit (BD) and lactic acid (LA) are accepted markers of hypoperfusion and predictors of outcome in the trauma patient and we aim to assess the value of these markers in the triage of the elderly with “normal” vital signs. Patients older than age 65 who presented between 1997 and 2004 but who did not have isolated head injuries were included. Three patient groups were established: normal, occult hypoperfusion (OH), and shock. Outcome measures included mortality, hospital length of stay, intensive care unit length of stay, and discharge disposition. One hundred six patients were included in the analysis and had similar Injury Severity Scores. Mean systolic blood pressure was similar in the normal and OH groups. Forty-two per cent of patients had abnormal BD or LA in the emergency room indicating OH. These patients were more likely to have a longer intensive care unit length of stay (8.6 days vs 3 days; P = 0.01) and were also more likely to be discharged to a nursing facility ( P = 0.03). The trend was toward increased mortality in the OH group. OH is a common finding in elderly trauma patients. Outcomes in these patients are different and more like those presenting in shock.

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