Healthcare Provider Limitation of Life-Sustaining Treatment without Patient or Surrogate Consent

2017 ◽  
Vol 45 (3) ◽  
pp. 442-451
Author(s):  
Andrew Courtwright ◽  
Emily Rubin
Keyword(s):  
Critical Care ◽  
Empirical Evidence ◽  
Healthcare Provider ◽  
North American ◽  
Intractable Conflict ◽  
Life Sustaining Treatment ◽  
New Guidelines ◽  
Surrogate Consent

In June 2015, the major North American and European critical care societies released new joint guidelines that delineate a process-based approach to resolving intractable conflicts over the appropriateness of providing or continuing LST.2 This article frames the new guidelines within the history, ethical arguments, legal landscape, and empirical evidence regarding limitation of LST without surrogate consent in cases of intractable conflict.

Advances in critical care for the older patient

2013 ◽  
Vol 23 (2) ◽  
pp. 118-130 ◽  
Author(s):  
Diane Monkhouse
Keyword(s):  
Quality Of Life ◽  
Critical Care ◽  
Critical Illness ◽  
General Population ◽  
Acute Illness ◽  
Limited Resources ◽  
Care Practice ◽  
Older Patient ◽  
Life Sustaining Treatment

SummaryAs the proportion of elderly people in the general population increases, so does the number admitted to critical care. In caring for an older patient, the intensivist has to balance the complexities of an acute illness, pre-existing co-morbidities and patient preference for life-sustaining treatment with the chances of survival, quality of life after critical illness and rationing of expensive, limited resources. This remains one of the most challenging areas of critical care practice.

Airway Management in Critical Care - New Guidelines, Old Problems

2012 ◽  
Vol 13 (2) ◽  
pp. 100-101 ◽  
Author(s):  
B. McGrath ◽  
E. O'Donohoe ◽  
C. Waldmann
Keyword(s):  
Critical Care ◽  
Airway Management ◽  
New Guidelines

Practice Patterns and Opinions on Current Clinical Practice Guidelines Regarding the Management of Delirium in the Intensive Care Unit

2016 ◽  
Vol 30 (2) ◽  
pp. 162-171 ◽  
Author(s):  
Yoonsun Mo ◽  
Anthony E. Zimmermann ◽  
Michael C. Thomas
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Large Scale ◽  
Online Survey ◽  
Early Mobilization ◽  
Screening Tools ◽  
Delirium Management ◽  
New Guidelines ◽  
Pharmacologic Agents

Objective: The aim of this study was to determine current delirium practices in the intensive care unit (ICU) setting and evaluate awareness and adoption of the 2013 Pain, Agitation, and Delirium (PAD) guidelines with emphasis on delirium management. Design, Setting, and Participants: A large-scale, multidisciplinary, online survey was administered to physician, pharmacist, nurse, and mid-level practitioner members of the Society of Critical Care Medicine (SCCM) between September 2014 and October 2014. A total of 635 respondents completed the survey. Measurements and Main Results: Nonpharmacologic interventions such as early mobilization were used in most ICUs (83%) for prevention of delirium. A majority of respondents (97%) reported using pharmacologic agents to treat hyperactive delirium. Ninety percent of the respondents answered that they were aware of the 2013 PAD guidelines, and 75% of respondents felt that their delirium practices have been changed as a result of the new guidelines. In addition, logistic regression analysis of this study showed that respondents who use delirium screening tools were twice more likely to be fully aware of key components of the updated guidelines (odds ratio [OR] = 2.07, 95% confidence interval [CI] = 1.20-3.60). Conclusions: Most critical care practitioners are fully aware and knowledgeable of key recommendations in the new guidelines and have changed their delirium practices accordingly.

scholarly journals Psychometric properties of the North American version of the Flodén ATODAI (Attitudes Toward Organ Donor Advocacy Instrument): a validation study

2020 ◽  
Author(s):  
Anne Flodén ◽  
Maria Stadtler ◽  
Stephanie E Jones Collazo ◽  
Tom Mone ◽  
Rick Ash ◽  
...  
Keyword(s):  
Critical Care ◽  
Psychometric Properties ◽  
North American ◽  
Delphi Technique ◽  
Expert Panel ◽  
Intraclass Correlation ◽  
Organ Donor ◽  
Sign Test ◽  
Delphi Panel ◽  
The North

Abstract Background: Intensive and critical-care nurses are the key to successful donor management in the critical-care setting. No studies measuring attitudes toward organ donor advocacy existed before 2011, when the 51-item Swedish “Attitudes Toward Organ Donor Advocacy Scale” was developed. The aim of this study was to translate, adapt and establish the psychometric properties of the North American version of the Flodén ATODAI (Attitudes Toward Organ Donor Advocacy Instrument) in terms of validity and reliability. Methods: A multi-step approach was used: Initial translation; Back-translation; Review and synthesis of these translations; Expert panel (N=7) rated the prefinal version of the instrument for content validity index (CVI); International panel made adjustments guided by the expert panel . Reliability testing with test and retest of the adjusted 46-item version was conducted using intraclass correlation coefficient (ICC), weighted kappa ( ҡ Weight ), sign test, and Cronbach’s alpha coefficient (α), (N=50); and finally Delphi technique procedure with a preselected Delphi panel (N=15). Results: The CVI was determined to be greater than the 0.05 significance level. Item level (I-CVI) ranged 0.82-1.0, with a mean of 0.97. Scale level (S-CVI) on the entire instrument was 0.97. Test-retest procedure was performed to estimate stability. In total, 34 of the items had good-to-high ICC. Accepting an ICC of > 0.70 resulted in a total of 24 items. Homogeneity reliability was estimated by α and was calculated for these items where α=0.90. In total, 20 of the items had a substantial or almost perfect ҡ Weight and 23 showed a moderate ҡ Weight . None of the items showed systematical differences. The Delphi technique procedure was used on the 22 items with ICC <0.70 resulted in adjustments establishing that consensus was achieved. Conclusions: Undertaking this multi-step, cross-cultural adaptation procedure has effectively ensured that the 46-item Flodén ATODAI [North America version] produces valid and reliable measurements.

Impact of Critical Care Transesophageal Echocardiography in Medical–Surgical ICU Patients: Characteristics and Results From 274 Consecutive Examinations

2018 ◽  
Vol 35 (9) ◽  
pp. 896-902 ◽  
Author(s):  
Robert Arntfield ◽  
Vincent Lau ◽  
Yves Landry ◽  
Fran Priestap ◽  
Ian Ball
Keyword(s):  
Critical Care ◽  
Transesophageal Echocardiography ◽  
North American ◽  
Tertiary Care ◽  
Care Program ◽  
Hemodynamic Instability ◽  
Diagnostic Reliability ◽  
Icu Patients ◽  
Critical Care Echocardiography ◽  
Doppler Techniques

Objective: Critical care echocardiography has become an integral tool in the assessment and management of critically ill patients. Critical care transesophageal echocardiography (TEE) offers diagnostic reliability, superior image quality, and an expanded diagnostic scope to transthoracic echocardiography. Despite its favorable attributes, TEE use in North American intensive care units (ICUs) remains relatively undescribed. In this article, we seek to characterize the feasibility, indications, and clinical impact of a critical care TEE program. Design: Retrospective, observational study. Setting: Tertiary care, academic critical care program consisting of 2 hospitals in Ontario, Canada. Participants: Consecutive critical care TEE examinations on ICU patients performed between December 2012 and December 2016 Interventions: None. Measurements and Main Results: Consecutive critical care TEE studies on ICU patients from December 1, 2012, to December 31, 2016, were reviewed. The TEEs performed on cardiac surgery patients and those without reports were excluded. Examination details, including indications, complications, examination complexity (number of views, Doppler techniques), and clinical recommendations were aggregated and analyzed. Two hundred seventy-four TEE studies were performed by 38 operators. Common indications for TEE studies were hemodynamic instability (45.2%), assessment for infective endocarditis (22.2%), and cardiac arrest (20.1%). A change in patient management was proposed following 79.5% of TEE studies. Thirty-eight percent of TEE studies were performed during evening hours or on weekends. There were no mechanical complications. Conclusions: Our observational data support intensivist-performed TEE as being safe and therapeutically influential across a broad range of indications. Our program’s demonstrated feasibility and impact may act as a model for TEE adoption in other North American ICUs.

scholarly journals 12-Hour nursing shifts in critical care: A service evaluation

2018 ◽  
Vol 19 (3) ◽  
pp. 214-218 ◽  
Author(s):  
Ceri Battle ◽  
Paul Temblett
Keyword(s):  
Critical Care ◽  
Healthcare Provider ◽  
Service Evaluation ◽  
Critical Care Nursing ◽  
Single Centre ◽  
Burn Out ◽  
Single Centre Study ◽  
Care Outcomes ◽  
Provider Outcomes ◽  
The Impact

The aim of this single-centre study was to investigate the impact of the introduction of 12-h critical care nursing shifts on healthcare provider and patient care outcomes. A single-centre, prospective service evaluation was completed over a two-year period, comparing the 8-h and 12-h shifts. Outcomes included number of clinical incidents, levels of burn-out, sick rates, personal injuries and training. There were no significant differences between the clinical incidents, sickness rates, personal injuries and staff training between the two data collection periods. The results of the burn-out analysis demonstrate that emotional exhaustion and depersonalisation improved, from the 8-h to 12-h shifts (both p < 0.05). In conclusion, the results of this service evaluation have demonstrated that 12-h nursing shifts can be introduced safely into the critical care environment, without any detriment to patient or healthcare provider outcomes.

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