scholarly journals Are physicians on the same page about do-not-resuscitate? To examine individual physicians’ influence on do-not-resuscitate decision-making: a retrospective and observational study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yen-Yuan Chen ◽  
Melany Su ◽  
Shu-Chien Huang ◽  
Tzong-Shinn Chu ◽  
Ming-Tsan Lin ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Outcome Variable ◽  
Surgical Intensive Care Unit ◽  
Do Not Resuscitate ◽  
Surgical Intensive Care ◽  
Individual Physician ◽  
Do Not Resuscitate Orders ◽  
Attending Physicians

Abstract Background Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate (DNR) orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order. Methods This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order. Results We found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so. Conclusion Our study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order.

FACTORS INFLUENCING DO-NOT-RESUSCITATE (DNR) DECISION MAKING IN A SURGICAL INTENSIVE CARE UNIT

1999 ◽  
Vol 27 (Supplement) ◽  
pp. 172A
Author(s):  
Matthew D. Bacchetta ◽  
Lynn J. Hydo ◽  
Diane P. Heller ◽  
Soumitra R. Eachempati ◽  
Philip S. Barie
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Do Not Resuscitate ◽  
Surgical Intensive Care ◽  
Factors Influencing

scholarly journals Disease-based Modeling to Predict Fluid Response in Intensive Care Units

2013 ◽  
Vol 52 (06) ◽  
pp. 494-502 ◽  
Author(s):  
L. A. Celi ◽  
F. Cismondi ◽  
S. M. Vieira ◽  
S. R. Reti ◽  
J. M. C. Sousa ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Fluid Resuscitation ◽  
White Blood Cells ◽  
Outcome Variable ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
General Group ◽  
Predictive Variables ◽  
Improved Performance

SummaryObjective: To compare general and disease-based modeling for fluid resuscitation and vasopressor use in intensive care units.Methods: Retrospective cohort study in -volving 2944 adult medical and surgical intensive care unit (ICU) patients receiving fluid resuscitation. Within this cohort there were two disease-based groups, 802 patients with a diagnosis of pneumonia, and 143 patients with a diagnosis of pancreatitis. Fluid resuscitation either progressing to subsequent vasopressor administration or not was used as the primary outcome variable to compare general and disease-based modeling.Results: Patients with pancreatitis, pneumonia and the general group all shared three common predictive features as core variables, arterial base excess, lactic acid and platelets. Patients with pneumonia also had non-invasive systolic blood pressure and white blood cells added to the core model, and pancreatitis patients additionally had temperature. Disease-based models had significantly higher values of AUC (p < 0.05) than the general group (0.82 f± 0.02 for pneumonia and 0.83 ± 0.03 for pancreatitis vs. 0.79 ± 0.02 for general patients).Conclusions: Disease-based predictive mod -eling reveals a different set of predictive variables compared to general modeling and improved performance. Our findings add support to the growing body of evidence advantaging disease specific predictive modeling.

Using a Decision Wheel to Reduce Use of Restraints in a Medical-Surgical Intensive Care Unit

2016 ◽  
Vol 25 (6) ◽  
pp. 479-486 ◽  
Author(s):  
Stacy Hevener ◽  
Barbara Rickabaugh ◽  
Toby Marsh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Intensive Care Units ◽  
Decision Support Tool ◽  
Educational Activity ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Support Tool ◽  
Unplanned Extubations

Background Little information is available on the use of tools in intensive care units to help nurses determine when to restrain a patient. Patients in medical-surgical intensive care units are often restrained for their safety to prevent them from removing therapeutic devices. Research indicates that restraints do not necessarily prevent injuries or removal of devices by patients. Objectives To decrease use of restraints in a medical-surgical intensive care unit and to determine if a decision support tool is useful in helping bedside nurses determine whether or not to restrain a patient. Methods A quasi-experimental study design was used for this pilot study. Data were collected for each patient each shift indicating if therapeutic devices were removed and if restraints were used. An online educational activity supplemented by 1-on-1 discussion about proper use of restraints, alternatives, and use of a restraint decision tool was provided. Frequency of restraint use was determined. Descriptive statistics and thematic analysis were used to examine nurses’ perceptions of the decision support tool. Results Use of restraints was reduced 32%. No unplanned extubations or disruption of life-threatening therapeutic devices by unrestrained patients occurred. Conclusions With implementation of the decision support tool, nurses decreased their use of restraints yet maintained patients’ safety. A decision support tool may help nurses who are undecided or who need reassurance on their decision to restrain or not restrain a patient.

Elderly patients' reports of physical restraint experiences in intensive care units

2001 ◽  
Vol 10 (3) ◽  
pp. 168-171 ◽  
Author(s):  
A Minnick ◽  
RM Leipzig ◽  
ME Johnson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Surgical Intensive Care Unit ◽  
Physical Restraints ◽  
Surgical Intensive Care ◽  
Staff Members ◽  
Well Elderly

BACKGROUND: Use of physical restraints has undesirable sequelae. As they weigh the risks and benefits of protocols for reducing the use of restraints, staff members in intensive care units, where restraints are most used in hospitals, need to know how well elderly patients remember being restrained and how patients perceive the use of restraints. OBJECTIVES: To estimate the proportion of patients who remember being restrained, describe the experience from the patients' perspectives, and describe any distress caused by use of restraints within the overall experience of being in the intensive care unit. METHODS: Transcripts of semistructured, audiotaped interviews of patients who had been in the medical or surgical intensive care unit in any of 3 eastern and midwestern medical centers were analyzed by question and for overall themes. RESULTS: Six patients (40%) remembered some aspect of being restrained but did not report great distress. Patients accepted restraints as needed because of the lack of alternatives. Patients reported remembering that they should not perform certain behaviors but being unable to stop themselves. Patients cited hallucinations and intubation as major stressors in the intensive care unit. Patients' continuing health problems after discharge from the intensive care unit severely limited recruitment of subjects. CONCLUSIONS: Patients do not remember great distress specifically related to the use of restraints, but the overall situation leading to use of restraints is disturbing if remembered. The discovery of methods to reduce the distress of intubation and hallucinations could decrease use of restraints.

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