The “Flipped Classroom” Model for Teaching in the Intensive Care Unit

2016 ◽  
Vol 32 (3) ◽  
pp. 187-196 ◽  
Author(s):  
Christopher R. Tainter ◽  
Nelson L. Wong ◽  
Gaston A. Cudemus-Deseda ◽  
Edward A. Bittner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Learning Environment ◽  
Flipped Classroom ◽  
Point Of Care ◽  
Perceived Usefulness ◽  
Successful Implementation ◽  
Education Curriculum ◽  
Patient Acuity ◽  
Wide Range

Introduction: The intensive care unit (ICU) is a dynamic and complex learning environment. The wide range in trainee’s experience, specialty training, fluctuations in patient acuity and volume, limitations in trainee duty hours, and additional responsibilities of the faculty contribute to the challenge in providing a consistent experience with traditional educational strategies. The “flipped classroom” is an educational model with the potential to improve the learning environment. In this paradigm, students gain exposure to new material outside class and then use class time to assimilate the knowledge through problem-solving exercises or discussion. The rationale and pedagogical foundations for the flipped classroom are reviewed, practical considerations are discussed, and an example of successful implementation is provided. Methods: An education curriculum was devised and evaluated prospectively for teaching point-of-care echocardiography to residents rotating in the surgical ICU. Results: Preintervention and postintervention scores of knowledge, confidence, perceived usefulness, and likelihood of use the skills improved for each module. The quality of the experience was rated highly for each of the sessions. Conclusion: The flipped classroom education curriculum has many advantages. This pilot study was well received, and learners showed improvement in all areas evaluated, across several demographic subgroups and self-identified learning styles.

scholarly journals Adult intensive care in an environment of resource restriction: How should the unit director respond?

1997 ◽  
Vol 20 (2) ◽  
pp. 68 ◽  
Author(s):  
Alan Henderson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Intensive Care Units ◽  
Low Risk ◽  
Patient Acuity ◽  
Wide Range ◽  
Intensive Care Unit Director ◽  
Evidenced Based

Adult intensive care touches the lives of very few while consuming a disproportionatelyhigh level of resources. To survive in the future environment of resource restrictionand accountability, the unit director must rapidly acquire a wide range of professionalmanagement skills. The intensive care unit director must be able to demonstrate tocolleagues, health managers and the community that the large amount of resourcesprovided to intensive care, and the remarkable freedom given to intensivists to usethose resources, are justified in terms of compassionate evidenced-based care, efficiency,efficacy and appropriateness. While many outcomes may be subjected to audit,intensive care units must publish minimal performance data indexed to severity ofillness and including their mortality, hospital mortality and length of stay and anoverall indicator of patient acuity to identify patients at low risk who need not beadmitted to an expensive intensive care bed.

scholarly journals Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie-Susanne Stecher ◽  
Sofia Anton ◽  
Alessia Fraccaroli ◽  
Jeremias Götschke ◽  
Hans Joachim Stemmler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Course ◽  
Point Of Care ◽  
Clinical Deterioration ◽  
Normal Lung ◽  
Icu Patients ◽  
Standardized Protocol ◽  
Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

scholarly journals Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

2018 ◽  
Vol 19 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Prashant Parulekar ◽  
Ed Neil-Gallacher ◽  
Alex Harrison
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Diagnostic Quality ◽  
The Core ◽  
Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

scholarly journals Enablers and challenges of caring in the Intensive Care Unit--Part 2: In relation to nurses

2021 ◽  
Vol 12 (2) ◽  
pp. 18
Author(s):  
Hanan Subhi Al-Shamaly
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Care ◽  
Optimal Level ◽  
Ethnographic Study ◽  
Personal Factors ◽  
Team Members ◽  
Educational Backgrounds ◽  
Wide Range ◽  
Different Sources

The concept of caring is vague and complex, especially in critical environments such as the intensive care unit (ICU), where technological dehumanisation is a challenge for nurses. ICU nursing care includes not only patients but also extends to patients’ families, nurses, other health team members and the unit’s environment. Caring in critical care settings is affected by enabling and impeding factors. To explore these enablers and challenges factors, a focused ethnographic study was conducted in an Australian ICU. The data was collected from 35 registered nurses through various resources: participants' observations, documents reviews, interviews, and additional participants’ notes. Data were analysed inductively and thematically. The study outlines comprehensively and widely a wide range of enablers and challenges affecting caring in the ICU - which originate from different sources such as patients, families, nurses, and the ICU environment. This paper is the second in a two-part series which explores the ICU nurses’ experiences and perspectives of the enablers and challenges of caring in the ICU. Part 1 was concerned with the enablers and challenges to caring that are related to ICU patients, families, and environment. While Part 2 introduces readers to the enablers and challenges factors that are concerned with the nurses in ICU. These factors include nurses’ educational backgrounds and professional experience, employment working factors, leadership styles, relationships, and personal factors. Nurses and other stakeholders such as clinicians, educators, researchers, managers, and policymakers need to recognize these factors and their implications for providing quality care, in order to enhance and maintain the optimal level of caring in the ICU.

scholarly journals Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit

2020 ◽  
Author(s):  
Lukasz Krzych ◽  
Olga Wojnarowicz ◽  
Paweł Ignacy ◽  
Julia Dorniak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Point Of Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Impact

Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.

Point-of-Care Ultrasound in the Intensive Care Unit

2018 ◽  
Vol 39 (1) ◽  
pp. 79-97 ◽  
Author(s):  
Steven J. Campbell ◽  
Rabih Bechara ◽  
Shaheen Islam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound

Mitigating emotional responses to stressors: coping strategies, modifiers and support

2021 ◽  
pp. 103985622110472
Author(s):  
D. Dennis ◽  
P.V van Heerden ◽  
C. Knott ◽  
R. Khanna
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Coping Strategies ◽  
Emotional Responses ◽  
Well Being ◽  
Environmental Stressors ◽  
Professional Help ◽  
Wide Range ◽  
Audio Recordings ◽  
Emerging Themes

Objective: The stressful nature of the intensive care unit (ICU) environment is increasingly well characterised. The aim of this paper was to explore modifiers, coping strategies and support pathways identified by experienced Intensivists, in response to these stressors. Method: Prospective qualitative study employing interviews with Intensivists in two countries. Participants were asked how they mitigated their emotional responses to the stressors of the ICU. Audio-recordings were transcribed and analysed by all researchers who agreed upon emerging themes and subthemes. Results: A wide range of strategies were reported. Although several participants had sought professional help and all supported its utility, few disclosed accessing such help to others indicating stigma. Many felt a sense of responsibility for the well-being of other staff but identified barriers that suggest alternate support pathways are required. Further implications of these findings to training considerations are described. Conclusions: Several approaches were described as regularly employed by Intensivists to mitigate ICU environmental stressors. Intensivists perceive themselves to have limited training to provide support to others; they also perceive stigma in seeking professional help.

Governance in point-of-care ultrasound

2019 ◽  
pp. 273-278
Author(s):  
Peter Macnaughton ◽  
Marcus Peck
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Ultrasound Examination ◽  
Point Of Care ◽  
Good Practice ◽  
Point Of Care Ultrasound ◽  
Equipment Management ◽  
Image Storage ◽  
Ensure Patient Safety

The performance and interpretation of ultrasound examination are very user-dependent that require significant training and experience. This chapter details the processes that should be adopted within an intensive care unit using point-of-care ultrasound to ensure that practitioners are appropriately trained and are able to maintain and develop their skills. The chapter also outlines recommendations regarding good practice in reporting and image storage, together with guidance regarding equipment management, to ensure patient safety.

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