scholarly journals A phenomenological study on the experiences of patient transfer from the intensive care unit to general wards

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254316
Author(s):  
Eun-Young Lee ◽  
Jin-Hee Park
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Data Analysis ◽  
Phenomenological Study ◽  
General Ward ◽  
University Hospital ◽  
Nursing Interventions ◽  
Icu Patients ◽  
Holistic Understanding ◽  
General Wards

Objectives This study aimed to derive an in-depth understanding of the transfer experience of intensive care unit (ICU) patients in South Korea through a phenomenological analysis. Methods Participants were 15 adult patients who were admitted to a medical or surgical ICU at a university hospital for more than 48 hours before being transferred to a general ward. Data were collected three to five days after their transfer to the general ward from January to December 2017 through individual in-depth interviews and were analyzed using Colaizzi’s phenomenological data analysis method, phenomenological reduction, intersubjective reduction, and hermeneutic circle. Data analysis yielded eight themes and four theme clusters related to the unique experiences of domestic ICU patients in the process of transfer to the general ward. Results The four main themes of the patients’ transfer experiences were “hope amid despair,” “gratitude for being alive,” “recovery from suffering,” and “seeking a return to normality.” Conclusion Our findings expand the realistic and holistic understanding from the patient’s perspective. This study’s findings can contribute to the development of appropriate nursing interventions that can support preparation and adaptation to the transfer of ICU patients.

scholarly journals Use of a Combination Biomarker Algorithm To Identify Medical Intensive Care Unit Patients with Suspected Sepsis at Very Low Likelihood of Bacterial Infection

2015 ◽  
Vol 59 (10) ◽  
pp. 6494-6500 ◽  
Author(s):  
Jennifer H. Han ◽  
Irving Nachamkin ◽  
Susan E. Coffin ◽  
Jeffrey S. Gerber ◽  
Barry Fuchs ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Amyloid ◽  
University Hospital ◽  
Bacterial Sepsis ◽  
Suspected Sepsis ◽  
Icu Patients ◽  
Predictive Values ◽  
Time Points ◽  
Amyloid A

ABSTRACTSepsis remains a diagnostic challenge in the intensive care unit (ICU), and the use of biomarkers may help in differentiating bacterial sepsis from other causes of systemic inflammatory syndrome (SIRS). The goal of this study was to assess test characteristics of a number of biomarkers for identifying ICU patients with a very low likelihood of bacterial sepsis. A prospective cohort study was conducted in a medical ICU of a university hospital. Immunocompetent patients with presumed bacterial sepsis were consecutively enrolled from January 2012 to May 2013. Concentrations of nine biomarkers (α-2 macroglobulin, C-reactive protein [CRP], ferritin, fibrinogen, haptoglobin, procalcitonin [PCT], serum amyloid A, serum amyloid P, and tissue plasminogen activator) were determined at baseline and at 24 h, 48 h, and 72 h after enrollment. Performance characteristics were calculated for various combinations of biomarkers for discrimination of bacterial sepsis from other causes of SIRS. Seventy patients were included during the study period; 31 (44%) had bacterial sepsis, and 39 (56%) had other causes of SIRS. PCT and CRP values were significantly higher at all measured time points in patients with bacterial sepsis. A number of combinations of PCT and CRP, using various cutoff values and measurement time points, demonstrated high negative predictive values (81.1% to 85.7%) and specificities (63.2% to 79.5%) for diagnosing bacterial sepsis. Combinations of PCT and CRP demonstrated a high ability to discriminate bacterial sepsis from other causes of SIRS in medical ICU patients. Future studies should focus on the use of these algorithms to improve antibiotic use in the ICU setting.

scholarly journals Nursing Interventions in the Clinical Practice of an Intensive Care Unit

2010 ◽  
Vol 18 (5) ◽  
pp. 873-880 ◽  
Author(s):  
Amália de Fátima Lucena ◽  
Maria Gaby Rivero de Gutiérrez ◽  
Isabel Cristina Echer ◽  
Alba Lucia Bottura Leite de Barros
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Nursing Care ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Nursing Interventions ◽  
Sectional Study ◽  
Cross Sectional ◽  
Respiratory Management

This cross-sectional study was carried out at a university hospital to describe the nursing interventions most frequently performed in the clinical practice of an intensive care unit, based on nursing care prescriptions, and to investigate their similarity to the Nursing Interventions Classification (NIC). The sample consisted of 991 hospitalizations of patients. Data were retrospectively collected from the computer database and analyzed through descriptive statistics and cross-mapping. A total of 57 different NIC interventions frequently used in the unit were identified; most of them in the complex (42%) and basic physiological (37%) domains, in the classes ‘respiratory management’ and ‘self-care facilitation’. Similarity between the nursing care prescribed and nursing interventions/NIC was found in 97.2% of the cases. The conclusion is that the interventions/NIC used in the clinical practice of this intensive care unit reflects the level of complexity of nursing care, which is mainly directed at the regulation of the body’s physical and homeostatic functioning.

scholarly journals Incidence of pressure injury and nursing care time in intensive care

2020 ◽  
Author(s):  
Yasmin Cardoso Metwaly Mohamed Ali ◽  
Taís Milena Milena Pantaleão Souza ◽  
Paulo Carlos Garcia ◽  
Paula Cristina Nogueira
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Data Analysis ◽  
Nursing Care ◽  
University Hospital ◽  
Central Tendency ◽  
Hospital Data ◽  
Nursing Team ◽  
Pressure Injury

Objectives: To correlate the incidence of pressure injury (PI) with the average time of nursing care in an intensive care unit (ICU). Method: Epidemiological, observational, retrospective study, carried out in the ICU of a university hospital. Data were collected by consulting the PI incidence and the average nursing care time from ICU databases between 2010 and 2014. Measures of central tendency and variability, and Pearson’s correlation coefficient were used for data analysis. Results: The average incidence of PI between 2010 and 2014 was 10.83% (SD = 2.87) and the average time spent in nursing care for patients admitted to the ICU was 15 hours (SD = 0.94). There was no statistically significant correlation between the incidence of PI and the nursing care time (r = -0.17; p = 0.199), however, the results suggested an overload on the nursing team. Conclusion: This study confirms the importance of implementing and reassessing the effectiveness of preventive care protocols for PI, in addition to warning about the work overload of nursing in assisting critically ill patients.

Nosocomial Infection After Septic Shock Among Intensive Care Unit Patients

2008 ◽  
Vol 29 (11) ◽  
pp. 1054-1065 ◽  
Author(s):  
Caroline Landelle ◽  
Alain Lepape ◽  
Adrien Français ◽  
Eve Tognet ◽  
Hélène Thizy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Initial Phase ◽  
Pulmonary Infection ◽  
University Hospital ◽  
Icu Patients ◽  
Significant Difference ◽  
The Impact

Objectives.To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.Design.Prospective cohort study.Setting.TWO intensive care units (ICUs) of a French university hospital.Patients and Methods.The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.Results.Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).Conclusions.The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.

scholarly journals Trigger alerts associated with laboratory abnormalities on identifying potentially preventable adverse drug events in the intensive care unit and general ward

2018 ◽  
Vol 9 (4) ◽  
pp. 207-217 ◽  
Author(s):  
Mitchell S. Buckley ◽  
Jeffrey R. Rasmussen ◽  
Dale S. Bikin ◽  
Emily C. Richards ◽  
Andrew J. Berry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Adverse Drug Events ◽  
Continuous Process ◽  
General Ward ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Continuous Process Improvement ◽  
Drug Induced

Background Medication safety strategies involving trigger alerts have demonstrated potential in identifying drug-related hazardous conditions (DRHCs) and preventing adverse drug events in hospitalized patients. However, trigger alert effectiveness between intensive care unit (ICU) and general ward patients remains unknown. The objective was to investigate trigger alert performance in accurately identifying DRHCs associated with laboratory abnormalities in ICU and non-ICU settings. Methods This retrospective, observational study was conducted at a university hospital over a 1-year period involving 20 unique trigger alerts aimed at identifying possible drug-induced laboratory abnormalities. The primary outcome was to determine the positive predictive value (PPV) in distinguishing drug-induced abnormal laboratory values using trigger alerts in critically ill and general ward patients. Aberrant lab values attributed to medications without resulting in an actual adverse event ensuing were categorized as a DRHC. Results A total of 634 patients involving 870 trigger alerts were included. The distribution of trigger alerts generated occurred more commonly in general ward patients (59.8%) than those in the ICU (40.2%). The overall PPV in detecting a DRHC in all hospitalized patients was 0.29, while the PPV in non-ICU patients (0.31) was significantly higher than the critically ill (0.25) ( p = 0.03). However, the rate of DRHCs was significantly higher in the ICU than the general ward (7.49 versus 0.87 events per 1000 patient days, respectively, p < 0.0001). Although most DRHCs were considered mild or moderate in severity, more serious and life-threatening DRHCs occurred in the ICU compared with the general ward (39.8% versus 12.4%, respectively, p < 0.001). Conclusions Overall, most trigger alerts performed poorly in detecting DRHCs irrespective of patient care setting. Continuous process improvement practices should be applied to trigger alert performance to improve clinician time efficiency and minimize alert fatigue.

scholarly journals Cost Analysis of Open Surgical Bedside Tracheostomy in Intensive Care Unit Patients

2021 ◽  
pp. 014556132110185
Author(s):  
Mats Døving ◽  
Steven Anandan ◽  
Kjetil Gudmundson Rogne ◽  
Tor Paaske Utheim ◽  
Cathrine Brunborg ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Analysis ◽  
Operating Room ◽  
University Hospital ◽  
Annual Reports ◽  
Complication Rates ◽  
Icu Patients ◽  
Surgical Tracheostomy ◽  
Open Surgical Tracheostomy

Objectives: Open surgical tracheostomy (OST) is a common procedure performed on intensive care unit (ICU) patients. The procedure can be performed bedside in the ICU (bedside open surgical tracheostomy, BeOST) or in the operating room (operating room open surgical tracheostomy, OROST), with comparable safety and long-term complication rates. We aimed to perform a cost analysis and evaluate the use of human resources and the total time used for both BeOSTs and OROSTs. Methods: All OSTs performed in 2017 at 5 different ICUs at Oslo University Hospital Ullevål were retrospectively evaluated. The salaries of the personnel involved in the 2 procedures were obtained from the hospital’s finance department. The time taken and the number of procedures performed were extracted from annual reports and from the electronic patient record system, and the annual expenditures were calculated. Results: Altogether, 142 OSTs were performed, of which 122 (86%) and 20 (14%) were BeOSTs and OROSTs, respectively. A BeOST cost 343 EUR (95% CI: 241.4-444.6) less than an OROST. Bedside open surgical tracheostomies resulted in an annual cost efficiency of 41.818 EUR. In addition, BeOSTs freed 279 hours of operating room occupancy during the study year. Choosing BeOST instead of OROST made 1 nurse, 2 surgical nurses, and 1 anesthetic nurse redundant. Conclusion: Bedside open surgical tracheostomy appears to be cost-, time-, and resource-effective than OROST. In the absence of contraindications, BeOSTs should be performed in ICU patients whenever possible.

scholarly journals In hospital cardiac arrest in Intensive Care Unit versus non Intensive Care Unit patients with COVID 19. A systematic review and meta analysis

2021 ◽  
Author(s):  
Georgios Mavrovounis ◽  
Maria Mermiri ◽  
Athanasios Chalkias ◽  
Vishad Sheth ◽  
Vasiliki Tsolaki ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Meta Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Icu Patients ◽  
Pooled Prevalence ◽  
General Wards ◽  
Hospital Cardiac Arrest

Aim: To estimate the incidence of in hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID 19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non ICU patients with COVID 19. Methods: We systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies. Results: Eleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID 19 patients was 7% [95% CI: 4, 11%; P < 0.0001] and 44% [95% CI: 30, 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42, 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow up was 59% [95% CI: 37, 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards. Conclusion: The incidence of IHCA amongst hospitalized COVID 19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ.

scholarly journals Emerging aspergillosis by azole-resistant Aspergillus fumigatus at an intensive care unit in the Netherlands, 2010 to 2013

2016 ◽  
Vol 21 (30) ◽  
Author(s):  
Judith van Paassen ◽  
Anne Russcher ◽  
Astrid WM in 't Veld - van Wingerden ◽  
Paul E Verweij ◽  
Eduard J Kuijper
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
The Netherlands ◽  
Aspergillus Fumigatus ◽  
Resistance Mechanisms ◽  
Antifungal Treatment ◽  
University Hospital ◽  
Resistant Isolate ◽  
Azole Resistance ◽  
Icu Patients

The prevalence of invasive aspergillosis (IA) at the intensive care unit (ICU) is unknown and difficult to assess since IA also develops in patients lacking specific host factors. In the Netherlands, increasing azole-resistance in Aspergillus fumigatus complicates treatment of patients with IA. The aim of this study was to determine the prevalence of IA by azole-resistant A. fumigatus at the ICU among patients receiving antifungal treatment and to follow their clinical outcome and prognosis. A retrospective cohort study was conducted in a university hospital ICU from January 2010 to December 2013. From all patients who received antifungal treatment for suspected IA, relevant clinical and microbiological data were collected using a standardised questionnaire. Of 9,121 admitted ICU-patients, 136 had received antifungal treatment for suspected IA, of which 38 had a positive A. fumigatus culture. Ten of the 38 patients harboured at least one azole-resistant isolate. Resistance mechanisms consisted of alterations in the cyp51A gene, more specific TR34/L98H and TR46/T289A/Y121F. Microsatellite typing did not show clonal relatedness, though isolates from two patients were genetically related. The overall 90-day mortality of patients with IA by azole-resistant A. fumigatus and patients with suspicion of IA by azole-susceptible isolates in the ICU was 100% (10/10) vs 82% (23/28) respectively. We conclude that the changing pattern of IA in ICU patients requires appropriate criteria for recognition, diagnosis and rapid resistance tests. The increase in azole resistance rates also challenges a reconsideration of empirical antifungal therapy.

Comparison of antimicrobial resistance pattern among clinical isolates of Gram negative bacilli from Intensive care units and General wards in a tertiary care hospital

2016 ◽  
Vol 5 (08) ◽  
pp. 4770
Author(s):  
Gomathi Maniyan* ◽  
Vijayalakshmi Arumugam ◽  
Nithya Gomatheswari ◽  
Malathi Murugesan
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Ward ◽  
Clinical Samples ◽  
Care Hospital ◽  
Icu Patients ◽  
Gram Negative ◽  
General Wards

Increasing antimicrobial resistance is a worldwide concern. The prevalence of resistance among hospitalized patients varies in different location. The right choice of antibiotic is utmost importance to initiate empirical therapy especially in critical care areas. To compare and assess the differences in the pattern of antimicrobial resistance shown by Gram Negative Bacilli (GNB) isolates from general wards and Intensive Care Unit (ICU) patients. This is a retrospective study conducted in a tertiary care hospital on 100 (50 + 50) isolates of GNB from clinical samples collected from General ward and ICU patients respectively. GNB isolates were identified by standard biochemical tests and their antimicrobial susceptibility pattern was determined as per CLSI guidelines and analyzed for both the groups. The resistant strains were identified for Extended Spectrum Beta Lactamases (ESBL) and Metallo Beta Lactamase (MBL) production. In general ward isolates, Enterobacteriaceae was the commonest (78%) and nonfermenters accounts to 22%. In ICU, Enterobacteriaceae 64% and nonfermenters 36%. In ICU maximum resistance to third generation cephalosporins and fluoroquinolones was noted among nonfermenters. In contrary, in general ward, Escherichia coli showed highest resistance to almost all the drugs except aminoglycosides. Majority of the isolates in both the groups were sensitive to aminoglycosides (80%). ESBL producer in ICU was 80% and in general ward 72%. MBL production among nonfermenters in ICU was 25%. This study provides information on antibiotic resistance in different areas of the hospital. Need of the day is that, each hospital should have a comprehensively drafted and strictly implemented antibiotic policy.

scholarly journals Humanization in intensive care from the perspective of the health team/A humanização em terapia intensiva na perspectiva da equipe de saúde/La humanización en terapia intensiva en la perspectiva del equipo de salud

2015 ◽  
Vol 4 (1) ◽  
pp. 4
Author(s):  
Fabiana Bolela ◽  
Adriana Katia Correa
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Working Conditions ◽  
Phenomenological Study ◽  
Patient Care Team ◽  
Care Team ◽  
University Hospital ◽  
Health Team ◽  
Terapia Intensiva

Objective: To grasp the meaning of humanized care for the health team of professionals engaged in intensive care. Methodology: Phenomenological study conducted with 26 professionals from the intensive care unit of a university hospital in Ribeirão Preto. Open interviews were conducted between September 2007 and January 2008. Results: The analysis of the interviews, the themes have emerged: Humanization means recognizing the patient in their uniqueness and completeness; make technical X humanization in daily intensive care; working conditions and their implications for the humanization of care in intensive care; and the preparation of the team to build a humanized care. Conclusion: The situations that consider the patient in its entirety and uniqueness in the intensive care unit are not always considered, even if doing this dichotomy make technical and humanization. The team's working conditions point to difficulties in the construction of humanized care. The preparation of the team shows up limited, with training, meaningful strategy for reflection and recreation of everyday care. Keywords: Patient care team. Intensive care. Humanization of assistance. 

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