scholarly journals Non-readmission decisions in the intensive care unit: A qualitative study of physicians’ experience in a multicentre French study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244919
Author(s):  
Marine Jacquier ◽  
Nicolas Meunier-Beillard ◽  
Fiona Ecarnot ◽  
Audrey Large ◽  
François Aptel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Average Length ◽  
Care Pathway ◽  
Healthcare Providers ◽  
Full Time ◽  
Goals Of Care ◽  
Team Meetings ◽  
Icu Physicians

Purpose Deciding not to re-admit a patient to the intensive care unit (ICU) poses an ethical dilemma for ICU physicians. We aimed to describe and understand the attitudes and perceptions of ICU physicians regarding non-readmission of patients to the ICU. Materials and methods Multicenter, qualitative study using semi-directed interviews between January and May 2019. All medical staff working full-time in the ICU of five participating centres (two academic and three general, non-academic hospitals) were invited to participate. Participants were asked to describe how they experienced non-readmission decisions in the ICU, and to expand on the manner in which the decision was made, but also on the traceability and timing of the decision. Interviews were recorded, transcribed and analyzed using textual content analysis. Results In total, 22 physicians participated. Interviews lasted on average 26±7 minutes. There were 14 men and 8 women, average age was 35±9 years, and average length of ICU experience was 7±5 years. The majority of respondents said that they regretted that the question of non-readmission was not addressed before the initial ICU admission. They acknowledged that the ICU stay did lead to more thorough contemplation of the overall goals of care. Multidisciplinary team meetings could help to anticipate the question of readmission within the patient’s care pathway. Participants reported that there is a culture of collegial decision-making in the ICU, although the involvement of patients, families and other healthcare professionals in this process is not systematic. The timing and traceability of non-readmission decisions are heterogeneous. Conclusions Non-readmission decisions are a major issue that raises ethical questions surrounding the fact that there is no discussion of the patient’s goals of care in advance. Better anticipation, and better communication with the patients, families and other healthcare providers are suggested as areas that could be targeted for improvement.

scholarly journals The Costs of Caring for Patients in a Tertiary Referral Australian Intensive Care Unit

2005 ◽  
Vol 33 (4) ◽  
pp. 477-482 ◽  
Author(s):  
I. J. Rechner ◽  
J. Lipman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Average Length ◽  
Cost Driver ◽  
Full Time ◽  
Tertiary Referral ◽  
Agency Staff ◽  
Average Length Of Stay ◽  
Percentage Difference ◽  
Full Time Employment

We determined the direct cost of an Intensive Care Unit (ICU) bed in a tertiary referral Australian ICU and the cost drivers thereof, by retrospectively analysing a number of prospectively designed Hospital- and Unit-specific electronic databases. The study period was a financial year, from 1 July 2002 to 30 June 2003. There were 1615 patients occupying 5692 fractional occupied bed days at a total cost of A$15,915,964, with an average length of stay of 3.69 days (range 0.5–77, median 1.06, interquartile range 2.33). The main cost driver not incorporated into this analysis was blood products (paid for centrally). The average costs of an ICU day and total stay per patient were A$2670 and A$9852 respectively. Staff-related charges were 68.76%, with consumables related expenditure making up 19.65%, clinical support services 9.55% and capital equipment 2.04%. Overtime charges and nursing agency staff were 19.4% of staff-related charges (2.9% for agency staff), 3.9% lower than expenditure associated with full-time employment charges, such as pension and leave. The emergency nature of ICU means it is difficult to accurately set a nursing establishment to cater for all admissions and therefore it is hard to decide what is an acceptable percentage difference between agency/overtime costs compared with the costs associated with full-time staff appointments. Consumable expenditure is likely to increase the most with new innovation and therapies. Using protocol driven practices may tighten and control costs incurred in ICU.

Vicarious spiritual distress in intensive care unit healthcare providers: A qualitative study

2021 ◽  
pp. 102982
Author(s):  
Jennifer Smiechowski ◽  
Henry Stelfox ◽  
Shane Sinclair ◽  
Tasnim Sinuff ◽  
Kathleen Grindrod-Millar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Healthcare Providers ◽  
Spiritual Distress

scholarly journals WITHDRAWN: Vicarious spiritual distress in intensive care unit healthcare providers: A qualitative study

2020 ◽  
pp. 102913
Author(s):  
Jennifer Smiechowski ◽  
Henry Stelfox ◽  
Shane Sinclair ◽  
Tasnim Sinuff ◽  
Kathleen Grindrod-Millar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Healthcare Providers ◽  
Spiritual Distress

scholarly journals Evaluating Sleep Characteristics in Intensive Care Unit and Non-Intensive Care Unit Physicians

2011 ◽  
Vol 39 (6) ◽  
pp. 1071-1075 ◽  
Author(s):  
G. Ok ◽  
H. Yilmaz ◽  
D. Tok ◽  
K. Erbüyün ◽  
S. Çoban ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Shift Work ◽  
Pittsburgh Sleep Quality Index ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Total Activity ◽  
Sleep Time ◽  
Sleep Parameters ◽  
Icu Physicians

Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.

Healing experience for family caregivers after an intensive care unit death

2019 ◽  
pp. bmjspcare-2018-001561 ◽  
Author(s):  
Susan DeSanto-Madeya ◽  
Dan Willis ◽  
Julie McLaughlin ◽  
Aristotle Boslet
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Family Caregivers ◽  
Phenomenological Study ◽  
Healthcare Providers ◽  
Loved One ◽  
Hermeneutic Phenomenological ◽  
Telephone Interviews ◽  
Hermeneutic Phenomenological Study ◽  
Purposive Sample

ObjectivesFamily caregivers suffer a high burden of emotional and psychological distress following the death of a loved one in the intensive care unit and often struggle to heal in the weeks following their loss. The purpose of this hermeneutic phenomenological study was to describe and interpret the experience of healing for family caregivers six weeks following the death of a loved one in the ICU.MethodsSemi-structured telephone interviews were conducted with a purposive sample of twenty-four family caregivers six weeks following the death of their loved ones in the ICU. Qualitative analysis techniques were used to identify common themes central to the experience of healing across all interviews.ResultsSeven themes were interpreted from the data: searching for clarity from a time of uncertainty; riding an emotional rollercoaster; seeking peace in one’s decisions; moving forward with each new day; taking comfort in the memories; valuing layers of support; and discovering life on one’s own.ConclusionBy identifying and gaining an understanding of healing following the death of a loved one in the ICU, nursing and other healthcare providers have an opportunity to promote healing and positively impact family caregiver’s bereavement.

scholarly journals More skilled clinical management of COVID-19 patients modified mortality in an intermediate respiratory intensive care unit in Italy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Giovanna E. Carpagnano ◽  
Giovanni Migliore ◽  
Salvatore Grasso ◽  
Vito Procacci ◽  
Emanuela Resta ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Management ◽  
Average Length ◽  
Limited Attention ◽  
Average Length Of Stay ◽  
Before And After ◽  
Respiratory Intensive Care Unit ◽  
Transferred Patients

Abstract Background Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management. Methods In the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020). Results With improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 days vs. who survived 6.4 ± 3.3 days). T Conclusions The present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.

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