scholarly journals The Ventilator Management Team: Repurposing Anesthesia Workstations and Personnel to Combat COVID-19

2020 ◽  
Vol 35 (9) ◽  
pp. 927-932
Author(s):  
Robert Canelli ◽  
Nicole Spence ◽  
Nisha Kumar ◽  
Gerardo Rodriguez ◽  
Mauricio Gonzalez
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Health Care Systems ◽  
Ventilatory Support ◽  
Management Team ◽  
Mechanical Ventilators ◽  
Care Services ◽  
Number Of Patients ◽  
Ventilator Management ◽  
Care Systems

The coronavirus disease 2019 pandemic resulted in unprecedented numbers of patients with respiratory failure requiring ventilatory support. The number of patients who required critical care quickly outpaced the availability of intensive care unit (ICU) beds. Consequently, health care systems had to creatively expand critical care services into alternative hospital locations with repurposed staff and equipment. Deploying anesthesia workstations to the ICU to serve as mechanical ventilators requires equipment preparation, multidisciplinary planning, and targeted education. We aim to contextualize this process, highlighting major differences between anesthesia workstations and ICU ventilators, and to share the insights gained from our experiences creating an anesthesia provider-based ventilator management team.

scholarly journals AN INTERDISCIPLINARY APPROACH TO THE MANAGEMENT OF CRITICALLY ILL PATIENTS DURING COVID-19 PANDEMIC; AN EXPERIENCE OF A UNIVERSITY HOSPITAL IN ENGLAND

2020 ◽  
Vol 73 (7) ◽  
pp. 1576-1579
Author(s):  
Tomasz Torliński ◽  
Lucas Rakasz ◽  
Barbara Wysota ◽  
Marcin Czyż ◽  
Catherine Snelson
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Clinical Pathways ◽  
Health Care Systems ◽  
Interdisciplinary Approach ◽  
University Hospital ◽  
Care Staff ◽  
Queen Elizabeth Hospital ◽  
Number Of Patients ◽  
Care Systems

COVID-19 pandemic presents significant challenges in delivering safe and efficient patient care, especially during the surges. In all health care systems, provision of available critical care facilities is a scarce resource, even in normal times. Problematic is not just the limitation of physical spaces in intensive care units, but also the availability of trained personnel. The critical care model, developed in Queen Elizabeth Hospital Birmingham to cope with the surge of COVID-19 patients, is based on early implementation of an interdisciplinary approach and extensive cooperation between the branches of practice, allowing to address both challenges. The main pillars are early upskilling of non-critical care staff, creation of safe, streamlined clinical pathways, adjustment of the physical layout of critical care units and comprehensive cross-town cooperation allowing to accommodate an increased number of patients, requiring intensive care. The model was well tested in clinical practice, enabling the hospital to increase the critical care footprint by more than 200% during the pandemic’s surge between March and May 2020.

scholarly journals SARS-CoV-2 and Cytomegalovirus Co-Infections—A Case Series of Critically Ill Patients

2021 ◽  
Vol 10 (13) ◽  
pp. 2792
Author(s):  
Patrícia Moniz ◽  
Sérgio Brito ◽  
Pedro Póvoa
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Immune Suppression ◽  
Clinical Course ◽  
Health Care Systems ◽  
Case Series ◽  
Confounding Factors ◽  
Care Systems ◽  
The Impact ◽  
Cmv Reactivation

The SARS-CoV-2 pandemic has placed great strain on the most developed of health care systems, especially in the context of critical care. Although co-infections with cytomegalovirus (CMV) are frequent in the critically ill due to underlying immune suppression of multiple causes, the impact on COVID-19 patients remains unclear. Furthermore, severe COVID-19 has recently been associated with significant immune suppression, and this may in turn impact CMV reactivation, possibly contributing to clinical course. Nevertheless, multiple confounding factors in these patients will certainly challenge upcoming research. The authors present a case series of five patients admitted to the intensive care unit (ICU) in the context of respiratory failure due to severe COVID-19. All patients evolved with CMV reactivation during ICU stay.

scholarly journals Community system of social support

2017 ◽  
Vol 127 (1) ◽  
pp. 37-40
Author(s):  
Krzysztof Włoch ◽  
Janusz Jaroszyński ◽  
Ewa Warchoł-Sławińska ◽  
Anna Jurek ◽  
Bartłomiej Drop ◽  
...  
Keyword(s):  
Social Support ◽  
Health Care ◽  
Health Care Systems ◽  
Family Doctors ◽  
Community System ◽  
Modern Health Care ◽  
Number Of Patients ◽  
The World ◽  
Care Systems ◽  
Is Evaluation

Abstract Community System of Social Support is the basis of modern health care systems not only in Poland but all over the world in the prophylaxis-treatment-rehabilitation procedure. In Poland, family doctors, commune councils and territorial self-governments are involved in it. Family doctors perform a substantial function, whereas commune councils and territorial self-governments an administrative one. The principle of the system work is evaluation of its benefits. Its aim is the reduction of the number of patients who abuse alcohol and those who abuse alcohol despite treatment.

scholarly journals Future Perspectives of Health Care: Closing Remarks

2021 ◽  
pp. 375-380
Author(s):  
Gørill Haugan ◽  
Monica Eriksson
Keyword(s):  
Health Care ◽  
Health Promotion ◽  
Health Care Services ◽  
Health Care Systems ◽  
Health Sector ◽  
Care Services ◽  
Care Systems ◽  
Health Promoting ◽  
Professional Leadership ◽  
Salutogenic Model

AbstractThe Covid-19 pandemic has demonstrated the vulnerability of our health care systems as well as our societies. During the year of 2020, we have witnessed how whole societies globally have been in a turbulent state of transformation finding strategies to manage the difficulties caused by the pandemic. At first glance, the health promotion perspective might seem far away from handling the serious impacts caused by the Covid-19 pandemic. However, as health promotion is about enabling people to increase control over their health and its determinants, paradoxically health promotion seems to be ever more important in times of crisis and pandemics. Probably, in the future, pandemics will be a part of the global picture along with the non-communicable diseases. These facts strongly demand the health care services to reorient in a health promoting direction.The IUHPE Global Working Group on Salutogenesis suggests that health promotion competencies along with a reorientation of professional leadership towards salutogenesis, empowerment and participation are required. More specifically, the IUHPE Group recommends that the overall salutogenic model of health and the concept of SOC should be further advanced and applied beyond the health sector, followed by the design of salutogenic interventions and change processes in complex systems.

scholarly journals A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lorena Michele Brennan-Bourdon ◽  
Alan O. Vázquez-Alvarez ◽  
Jahaira Gallegos-Llamas ◽  
Manuel Koninckx-Cañada ◽  
José Luis Marco-Garbayo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medication Errors ◽  
Public Hospital ◽  
Care Practice ◽  
Tertiary Level ◽  
Skin Reactions ◽  
Pediatric Critical Care ◽  
Care Services

Abstract Background Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. Methods A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. Results In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. Conclusion Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

scholarly journals Older multimorbid patients’ experiences on integration of services: a systematic review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lilian Keene Boye ◽  
Christian Backer Mogensen ◽  
Tine Mechlenborg ◽  
Frans Boch Waldorff ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Health Care ◽  
Continuity Of Care ◽  
Health Care Services ◽  
Health Care Systems ◽  
Easy Access ◽  
Ageing Population ◽  
Health Providers ◽  
Care Coordinator ◽  
Care Services ◽  
Care Systems

Abstract Background Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. Methods A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. Inclusion criteria: studies exploring patients’ point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. Results Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. Conclusions Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.

The making and sustaining of leaders in health care

2019 ◽  
Vol 33 (2) ◽  
pp. 241-262 ◽  
Author(s):  
Terry J. Boyle ◽  
Kieran Mervyn
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Care Services ◽  
Health Care Systems ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Triple Aim ◽  
Content Type ◽  
Care Services ◽  
Care Systems

Purpose Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools. Design/methodology/approach This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development. Findings This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages. Research limitations/implications The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community. Practical implications The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles. Originality/value This paper demonstrates how health care leadership can be developed and sustained.

Regional critical care delivery systems

2016 ◽  
Author(s):  
Theodore J. Iwashyna ◽  
Colin R. Cooke
Keyword(s):  
Critical Care ◽  
Systems Of Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Cost Effective ◽  
Design Decisions ◽  
Regional Systems ◽  
Regional System ◽  
Care Systems ◽  
Regionalization Of Care

A regional system of critical care is one in which hospitals are acknowledged to vary in their care of critically-ill patients, and procedures exist to systematically refer patients to a subset of those hospitals. Given scarcity in health care systems, regional systems of care are an attempt to rationalize differentiation among hospitals. There are several examples that suggest regionalization of care can result in cost-effective improvements in patient outcomes. Yet there are also numerous examples of regional systems of care that offer few benefits to patients, or that fail to actually concentrate patients despite the grand plans of their designers. This chapter suggests several key design decisions that can be used to help improve the effectiveness of regional system of care. Addressing all these issues may offer dramatic benefits for patients.

scholarly journals The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

2020 ◽  
Vol 11 (01) ◽  
pp. 182-189
Author(s):  
Ellen T. Muniga ◽  
Todd A. Walroth ◽  
Natalie C. Washburn
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Prescribing Patterns ◽  
Number Of Patients ◽  
Order Sets ◽  
Critical Care Admission ◽  
The Impact ◽  
Order Set

Abstract Background Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited. Objective The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Methods A retrospective, observational before-and-after exploratory study was performed on adult patients admitted to the medical intensive care unit using the Inpatient Critical Care Admission Order Set. The primary outcome measure was the percentage change in the number of orders for scheduled acetaminophen, a histamine-2 receptor antagonist (H2RA), and lactated ringers at admission before implementation of the revised order set compared with after implementation. Secondary outcomes assessed clinical impact of changes made to the order set. Results The addition of a different dosing strategy for a medication already available on the order set (scheduled acetaminophen vs. as needed acetaminophen) had no impact on physician prescribing (0 vs. 0%, p = 1.000). The addition of a new medication class (an H2RA) to the order set significantly increased the number of patients prescribed an H2RA for stress ulcer prophylaxis (0 vs. 20%, p < 0.001). Rearranging the list of maintenance intravenous fluids to make lactated ringers the first fluid option in place of normal saline significantly decreased the number of orders for lactated ringers (17 vs. 4%, p = 0.005). The order set changes had no significant impact on clinical outcomes such as incidence of transaminitis, gastrointestinal bleed, and acute kidney injury. Conclusion Making changes to an admission order set can impact provider prescribing patterns. The type of change made to the order set, in addition to the specific medication changed, may have an effect on how influential the changes are on prescribing patterns.

scholarly journals Patient length of stay and mortality prediction: A survey

2017 ◽  
Vol 30 (2) ◽  
pp. 105-120 ◽  
Author(s):  
Aya Awad ◽  
Mohamed Bader–El–Den ◽  
James McNicholas
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Length Of Hospital Stay ◽  
Hospital Performance ◽  
Mortality Prediction ◽  
Cost Of Care ◽  
Resource Utilisation ◽  
Number Of Patients

Over the past few years, there has been increased interest in data mining and machine learning methods to improve hospital performance, in particular hospitals want to improve their intensive care unit statistics by reducing the number of patients dying inside the intensive care unit. Research has focused on prediction of measurable outcomes, including risk of complications, mortality and length of hospital stay. The length of stay is an important metric both for healthcare providers and patients, influenced by numerous factors. In particular, the length of stay in critical care is of great significance, both to patient experience and the cost of care, and is influenced by factors specific to the highly complex environment of the intensive care unit. The length of stay is often used as a surrogate for other outcomes, where those outcomes cannot be measured; for example as a surrogate for hospital or intensive care unit mortality. The length of stay is also a parameter, which has been used to identify the severity of illnesses and healthcare resource utilisation. This paper examines a range of length of stay and mortality prediction applications in acute medicine and the critical care unit. It also focuses on the methods of analysing length of stay and mortality prediction. Moreover, the paper provides a classification and evaluation for the analytical methods of the length of stay and mortality prediction associated with a grouping of relevant research papers published in the years 1984 to 2016 related to the domain of survival analysis. In addition, the paper highlights some of the gaps and challenges of the domain.

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