scholarly journals Geographical access to critical care services in Scotland

2017 ◽  
Vol 19 (1) ◽  
pp. 6-14 ◽  
Author(s):  
Philip Emerson ◽  
Naomi Dodds ◽  
David R Green ◽  
Jan O Jansen
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Rural Areas ◽  
Care Facility ◽  
Population Data ◽  
Small Towns ◽  
Health Board ◽  
Care Services ◽  
Geographical Access ◽  
Scottish Population

Background Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. Methods This was a descriptive, geographical analysis of population access to ‘intermediate’ and ‘definitive’ critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter. Access was analysed by health board, rurality and as a country using freely available geographically referenced population data. Results Ninety-six percent of the population reside within a 45-min drive of the nearest intermediate critical care facility, and 94% of the population live within a 45-min ambulance drive time to the nearest intensive care unit. By helicopter, these figures were 95% and 91%, respectively. Some health boards had no access to definitive critical care services within 45 min via helicopter or road. Very remote small towns and very remote rural areas had poorer access than less remote and rural regions.

scholarly journals Challenges in the delivery of critical care in India during the COVID-19 pandemic

2020 ◽  
pp. 175114372095259
Author(s):  
Bharath Kumar Tirupakuzhi Vijayaraghavan ◽  
Sheila Nainan Myatra ◽  
Meghena Mathew ◽  
Nirmalyo Lodh ◽  
Jigeeshu Vasishtha Divatia ◽  
...  
Keyword(s):  
Critical Care ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Tract ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Upper Respiratory Tract ◽  
Care Services ◽  
Life Threatening ◽  
Upper Respiratory

Coronavirus disease 2019 cases in India continue to increase and are expected to peak over the next few weeks. Based on some projection models, India is expected to have more than 10 million cases by September 2020. The spectrum of disease can vary from mild upper respiratory tract symptoms to life-threatening acute respiratory distress syndrome and multi-organ failure requiring intensive care. Even if less than 5% of patients require critical care services, this will still rapidly overwhelm the healthcare system in a country, where intensive care services and resources are scarce and unevenly distributed. In this perspective article, we highlight the critical care preparedness of India for the pandemic and the associated challenges.

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 The Ethics of Rationing of Critical Care Services: Should Technology Assessment Play a Role?

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Eric L. Bloomfield
Keyword(s):  
United States ◽  
Health Care ◽  
Decision Making ◽  
Critical Care ◽  
Intensive Care ◽  
Risk Analysis ◽  
Technology Assessment ◽  
The United States ◽  
Electronic Records ◽  
Care Services

The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future.

scholarly journals A California Hospital’s Response to COVID-19: From a Ripple to a Tsunami Warning

2020 ◽  
Vol 40 (6) ◽  
pp. e1-e16
Author(s):  
Mary Kay Bader ◽  
Annabelle Braun ◽  
Cherie Fox ◽  
Lauren Dwinell ◽  
Jennifer Cord ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Task Force ◽  
The United States ◽  
Tsunami Warning ◽  
Care Services ◽  
Evidence Review ◽  
Excellent Care

Background The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a “tsunami” warning requiring instantaneous implementation and escalation of disaster plans. Evidence Review An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. Implementation The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S’s became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. Evaluation Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. Sustainability The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19.

scholarly journals Lessons for intensive care units in COVID-19 pandemic-moving towards sustainability

2020 ◽  
Vol 7 (3) ◽  
pp. 1
Author(s):  
Prashant Nasa ◽  
Ruchi Nasa ◽  
Aanchal Singh
Keyword(s):  
Critical Care ◽  
Supply Chain ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Standard Of Care ◽  
Infrastructure Development ◽  
Care Providers ◽  
Care Services ◽  
Second Wave ◽  
And Training

The Coronavirus disease-2019 (COVID-19) pandemic has inundated critical care services globally. The intensive care units (ICUs) and critical care providers have been forefront of this pandemic, evolving continuously from experiences and emerging evidence. In this review, we discuss the key lessons from the ongoing wave of COVID-19 pandemic and preparations for a future surge or second wave. The model of sustainable critical care services should be based on 1) infrastructure development, 2) preparation and training of manpower, 3) implementing standard of care and infection control, 4) sustained supply-chain and finally, and 5) surge planning. 

scholarly journals The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Michael Beil ◽  
Hans Flaatten ◽  
Bertrand Guidet ◽  
Sigal Sviri ◽  
Christian Jung ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Chronic Conditions ◽  
Fine Tuning ◽  
Demographic Ageing ◽  
Care Services ◽  
Research And Innovation ◽  
The World ◽  
Support Decision Making

AbstractThere is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of multi-morbidity now requires fine-tuning to support decision-making for patients along their whole trajectory in healthcare, including in the intensive care unit (ICU). This article will discuss current challenges and present approaches to adapt critical care services to the needs of these patients.

Barriers to Addressing the Spiritual and Religious Needs of Patients and Families in the Intensive Care Unit: A Qualitative Study of Critical Care Physicians

2020 ◽  
pp. 104990912097090
Author(s):  
Christian K. Alch ◽  
Christina L. Wright ◽  
Kristin M. Collier ◽  
Philip J. Choi
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Spiritual Care ◽  
Spiritual Needs ◽  
Care Providers ◽  
Structured Interviews ◽  
Care Services ◽  
Qualitative Research Design ◽  
Data Saturation

Objectives: Though critical care physicians feel responsible to address spiritual and religious needs with patients and families, and feel comfortable in doing so, they rarely address these needs in practice. We seek to explore this discrepancy through a qualitative interview process among physicians in the intensive care unit (ICU). Methods: A qualitative research design was constructed using semi-structured interviews among 11 volunteer critical care physicians at a single institution in the Midwest. The physicians discussed barriers to addressing spiritual and religious needs in the ICU. A code book of themes was created and developed through a regular and iterative process involving 4 investigators. Data saturation was reached as no new themes emerged. Results: Physicians reported feeling uncomfortable in addressing the spiritual needs of patients with different religious views. Physicians reported time limitations, and prioritized biomedical needs over spiritual needs. Many physicians delegate these conversations to more experienced spiritual care providers. Physicians cited uncertainty into how to access spiritual care services when they were desired. Additionally, physicians reported a lack of reminders to meet these needs, mentioning frequently the ICU bundle as one example. Conclusions: Barriers were identified among critical care physicians as to why spiritual and religious needs are rarely addressed. This may help inform institutions on how to better meet these needs in practice.

scholarly journals HIV/AIDS and admission to intensive care units: A comparison of India, Brazil and South Africa

2013 ◽  
Vol 14 (1) ◽  
pp. 15-16 ◽  
Author(s):  
Kantharuben Naidoo ◽  
Jerome Amir Singh ◽  
Umesh Gangaram Lalloo
Keyword(s):  
South Africa ◽  
Critical Care ◽  
Intensive Care ◽  
Regulatory Mechanisms ◽  
Level Of Care ◽  
Admission Criteria ◽  
Hiv Status ◽  
Care Services ◽  
Policy Frameworks ◽  
Made In

In resource-constrained settings and in the context of HIV-infected patients requiring intensive care, value-laden decisions by critical care specialists are often made in the absence of explicit policies and guidelines. These are often based on individual practitioners’ knowledge and experience, which may be subject to bias. We reviewed published information on legislation and practices related to intensive care unit (ICU) admission in India, Brazil and South Africa, to assess access to critical care services in the context of HIV. Each of these countries has legal instruments in place to provide their citizens with health services, but they differ in their provision of ICU care for HIV-infected persons. In Brazil, some ICUs have no admission criteria, and this decision vests solely on the ‘availability, and the knowledge and the experience’ of the most experienced ICU specialist at the institution. India has few regulatory mechanisms to ensure ICU care for critically ill patients including HIV-infected persons. SA has made concerted efforts towards non-discriminatory criteria for ICU admissions and, despite the shortage of ICU beds, HIV-infected patients have relatively greater access to this level of care than in other developing countries in Africa, such as Botswana. Policymakers and clinicians should devise explicit policy frameworks to govern ICU admissions in the context of HIV status. S Afr J HIV Med 2013;14(1):15-16. DOI:10.7196/SAJHIVMED.887

Patients With Advanced Cancer Requiring Intensive Care: Reasons for ICU Admission, Mortality Outcomes, and the Role of Palliative Care

2021 ◽  
Vol 32 (3) ◽  
pp. 324-331
Author(s):  
Varsha N. Patel ◽  
Stephanie D. Stone
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Nurses ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Past ◽  
Care Services ◽  
Palliative Care Services

Medical advancements in oncology and critical care during the past 2 decades have led to more patients with cancer being admitted to intensive care units. This article discusses the most common reasons for intensive care unit admission and factors associated with mortality among patients with cancer. It also reviews the multiple benefits of palliative care services in caring for critically ill patients with cancer and opportunities for critical care nurses working with these patients.

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