Critical Care for the Surgical Patient

Dr Chris Aps has been involved, since the early 1980s, with the impact of the surgical patient on critical care provision. At that time, he established clinical techniques to lower patient dependency after cardiac surgery. This allowed for the postoperative management of such patients in a general recovery facility rather than in the formal Intensive Care Unit (ICU). This became known as cardiac fast-tracking and led to the development of the Overnight Intensive Recovery (OIR) concept.

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The Impact of Implementing Critical Care Team on Open General Intensive Care Unit

Tuberculosis and Respiratory Diseases ◽

10.4046/trd.2012.73.2.100 ◽

2012 ◽

Vol 73 (2) ◽

pp. 100 ◽

Cited By ~ 1

Author(s):

Ick Hee Kim ◽

Seung Bae Park ◽

Seonguk Kim ◽

Sang-Don Han ◽

Seung Seok Ki ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Care Team ◽

General Intensive Care Unit ◽

The Impact ◽

Critical Care Team

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Survey of Physiotherapy Practice in Ontario Cardiac Surgery Intensive Care Units

Physiotherapy Canada ◽

10.3138/ptc-2020-0069 ◽

2021 ◽

pp. e20200069

Author(s):

Anastasia N.L. Newman ◽

Michelle E. Kho ◽

Jocelyn E. Harris ◽

Alison Fox-Robichaud ◽

Patricia Solomon

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Cardiac Surgery ◽

Intensive Care ◽

Critically Ill ◽

Outcome Measures ◽

Median Number ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Physiotherapy Practice

Purpose: This article describes current physiotherapy practice for critically ill adult patients requiring prolonged stays in critical care (> 3 d) after complicated cardiac surgery in Ontario. Method: We distributed an electronic, self-administered 52-item survey to 35 critical care physiotherapists who treat adult cardiac surgery patients at 11 cardiac surgical sites. Pilot testing and clinical sensibility testing were conducted beforehand. Participants were sent four email reminders. Results: The response rate was 80% (28/35). The median (inter-quartile range) reported number of cardiac surgeries performed per week was 30 (10), with a median number of 14.5 (4) cardiac surgery beds per site. Typical reported caseloads ranged from 6 to 10 patients per day pe therapist, and 93% reported that they had initiated physiotherapy with patients once they were clinically stable in the intensive care unit. Of 28 treatments, range of motion exercises (27; 96.4%), airway clearance techniques (26; 92.9%), and sitting at the edge of the bed (25; 89.3%) were the most common. Intra-aortic balloon pump and extracorporeal membrane oxygenation appeared to limit physiotherapy practice. Use of outcome measures was limited. Conclusions: Physiotherapists provide a variety of interventions with critically ill cardiac surgery patients. Further evaluation of the limited use of outcome measures in the cardiac surgical intensive care unit is warranted.

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In Situ Simulation-based Team Training for Post-cardiac Surgical Emergency Chest Reopen in the Intensive Care Unit

Anaesthesia and Intensive Care ◽

10.1177/0310057x0903700109 ◽

2009 ◽

Vol 37 (1) ◽

pp. 74-78 ◽

Cited By ~ 22

Author(s):

L. Nunnink ◽

A.-M. Welsh ◽

M. Abbey ◽

C. Buschel

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multiple Choice ◽

Surgical Patient ◽

Multiple Choice Questions ◽

In Situ Simulation ◽

Video Training ◽

Surgical Emergency ◽

Simulation Based ◽

The Impact

Emergency chest reopen of the post cardiac surgical patient in the intensive care unit is a high-stakes but infrequent procedure which requires a high-level team response and a unique skill set. We evaluated the impact on knowledge and confidence of team-based chest reopen training using a patient simulator compared with standard video-based training. We evaluated 49 medical and nursing participants before and after training using a multiple choice questions test and a questionnaire of self-reported confidence in performing or assisting with emergency reopen. Both video- and simulation-based training significantly improved results in objective and subjective domains. Although the post-test scores did not differ between the groups for either the objective (P=0.28) or the subjective measures (P=0.92), the simulation-based training produced a numerically larger improvement in both domains. In a multiple choice question out of 10, participants improved by a mean of 1.9 marks with manikin-based training compared to 0.9 with video training (P=0.03). On a questionnaire out of 20 assessing subjective levels of confidence, scores improved by 3.9 with manikin training compared to 1.2 with video training (P=0.002). Simulation-based training appeared to be at least as effective as video-based training in improving both knowledge and confidence in post cardiac surgical emergency resternotomy.

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

Applied Clinical Informatics ◽

10.1055/s-0040-1702215 ◽

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.

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

BMJ Open ◽

10.1136/bmjopen-2017-019165 ◽

2018 ◽

Vol 8 (1) ◽

pp. e019165 ◽

Cited By ~ 5

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.

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Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study (Preprint)

10.2196/preprints.20143 ◽

2020 ◽

Author(s):

Atiya Dhala ◽

Farzan Sasangohar ◽

Bita Kash ◽

Nima Ahmadi ◽

Faisal Masud

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Care Delivery ◽

Care Physician ◽

Rapid Expansion ◽

Code Blue ◽

Scope Of Application ◽

Spread Of Infection ◽

The Impact

BACKGROUND The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. OBJECTIVE The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. METHODS The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. RESULTS Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. CONCLUSIONS Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.

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Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study

Journal of Medical Internet Research ◽

10.2196/20143 ◽

2020 ◽

Vol 22 (9) ◽

pp. e20143

Author(s):

Atiya Dhala ◽

Farzan Sasangohar ◽

Bita Kash ◽

Nima Ahmadi ◽

Faisal Masud

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Care Delivery ◽

Care Physician ◽

Rapid Expansion ◽

Code Blue ◽

Scope Of Application ◽

Spread Of Infection ◽

The Impact

Background The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. Methods The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.

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The impact of critical care transition programs on outcomes after intensive care unit (ICU) discharge: can we get there from here?

Journal of Thoracic Disease ◽

10.21037/jtd.2016.05.30 ◽

2016 ◽

Vol 8 (7) ◽

pp. 1374-1376 ◽

Cited By ~ 3

Author(s):

Regis Goulart Rosa ◽

Juçara Gasparetto Maccari ◽

Ricardo Viegas Cremonese ◽

Tulio Frederico Tonietto ◽

Rafael Viegas Cremonese ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Transition Programs ◽

Care Transition ◽

Icu Discharge ◽

The Impact

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Telenursing in the Intensive Care Unit: Transforming Nursing Practice

Critical Care Nurse ◽

10.4037/ccn2012525 ◽

2012 ◽

Vol 32 (6) ◽

pp. 62-69 ◽

Cited By ~ 18

Author(s):

Lisa-Mae Williams ◽

Kenneth E. Hubbard ◽

Olive Daye ◽

Connie Barden

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Nursing Practice ◽

Care Patient ◽

Critical Care Nursing ◽

Telecommunication Technology ◽

Use Of Technology ◽

The Impact ◽

Care Nursing

In tele–intensive care units, informatics, telecommunication technology, telenursing, and telemedicine are merged to provide expert, evidence-based, and cutting-edge services to critically ill patients. Telenursing is an emerging subspecialty in critical care that is neither well documented in the extant literature nor well understood within the profession. Documentation and quantification of telenursing interventions help to clarify the impact of the telenurse’s role on nursing practice, enhancement of patient care, patient safety, and outcomes. Tele–intensive care unit nursing will continue to transform how critical care nursing is practiced by enhancing/leveraging available resources through the use of technology.

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