EFFECTS OF A CLOSED INTENSIVE CARE UNIT MODEL ON PATIENT CARE OUTCOMES

Objectives: A high-intensity staffing model has been defined as either mandatory intensivist consultation or a closed intensive care unit in which intensivists manage all aspects of patient care. In the current climate of limited healthcare resources, transitioning to a closed intensive care unit model may lead to significant improvements in patient care and resource utilization. Methods: This is a single-center, retrospective cohort study of all mechanically ventilated intensive care unit admissions in the pre-intensive care unit closure period of 1 October 2014 to 30 September 2015 as compared with the post-intensive care unit closure period of 1 November 2015 to 31 October 2016. Patient demographics as well as outcome data (duration of mechanical ventilation, length of stay, direct costs, complications, and mortality) were abstracted from the electronic health record. All data were analyzed using descriptive and inferential statistics. Regression analyses were used to adjust outcomes for potential confounders. Results: A total of 549 mechanically ventilated patients were included in our analysis: 285 patients in the pre-closure cohort and 264 patients in the post-closure cohort. After adjusting for confounders, there was no significant difference in mortality rates between the pre-closure (40.7%) and post-closure (38.6%) groups (adjusted odds ratio = 0.82; 95% confidence interval = 0.56–1.18; p = 0.283). The post-closure cohort was found to have significant reductions in duration of mechanical ventilation (3.71–1.50 days; p < 0.01), intensive care unit length of stay (5.8–2.7 days; p < 0.01), hospital length of stay (10.9–7.3 days; p < 0.01), and direct hospital costs (US $16,197–US $12,731; p = 0.009). Patient complications were also significantly reduced post-intensive care unit closure. Conclusion: Although a closed intensive care unit model in our analysis did not lead to a statistical difference in mortality, it did demonstrate multiple beneficial outcomes including reduced ventilator duration, decreased intensive care unit and hospital length of stay, fewer patient complications, and reduced direct hospital costs.

Download Full-text

Internal medicine resident education in the medical intensive care unit: The impact on education and patient care of a scheduling change for didactic sessions

Yearbook of Pulmonary Disease ◽

10.1016/s8756-3452(08)70508-5 ◽

2007 ◽

Vol 2007 ◽

pp. 337-338

Author(s):

J.A. Barker

Keyword(s):

Internal Medicine ◽

Intensive Care Unit ◽

Intensive Care ◽

Patient Care ◽

Resident Education ◽

Medical Intensive Care Unit ◽

Internal Medicine Resident ◽

Medicine Resident ◽

Medical Intensive Care ◽

The Impact

Download Full-text

Contamination of Healthcare Worker Personal Protective Equipment with MRSA Outside the Intensive Care Unit Setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.505 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s27-s28

Author(s):

Gita Nadimpalli ◽

Lisa Pineles ◽

Karly Lebherz ◽

J. Kristie Johnson ◽

David Calfee ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Care ◽

Direct Patient Care ◽

Care Group ◽

Surveillance Culture ◽

Care Hospital ◽

Contact Precautions ◽

Patient Interactions ◽

The Right

Background: Estimates of contamination of healthcare personnel (HCP) gloves and gowns with methicillin-resistant Staphylococcus aureus (MRSA) following interactions with colonized or infected patients range from 17% to 20%. Most studies were conducted in the intensive care unit (ICU) setting where patients had a recent positive clinical culture. The aim of this study was to determine the rate of MRSA transmission to HCP gloves and gown in non-ICU acute-care hospital units and to identify associated risk factors. Methods: Patients on contact precautions with history of MRSA colonization or infection admitted to non-ICU settings were randomly selected from electronic health records. We observed patient care activities and cultured the gloves and gowns of 10 HCP interactions per patient prior to doffing. Cultures from patients’ anterior nares, chest, antecubital fossa and perianal area were collected to quantify bacterial bioburden. Bacterial counts were log transformed. Results: We observed 55 patients (Fig. 1), and 517 HCP–patient interactions. Of the HCP–patient interactions, 16 (3.1%) led to MRSA contamination of HCP gloves, 18 (3.5%) led to contamination of HCP gown, and 28 (5.4%) led to contamination of either gloves or gown. In addition, 5 (12.8%) patients had a positive clinical or surveillance culture for MRSA in the prior 7 days. Nurses, physicians and technicians were grouped in “direct patient care”, and rest of the HCPs were included in “no direct care group.” Of 404 interactions, 26 (6.4%) of providers in the “direct patient care” group showed transmission of MRSA to gloves or gown in comparison to 2 of 113 (1.8%) interactions involving providers in the “no direct patient care” group (P = .05) (Fig. 2). The median MRSA bioburden was 0 log 10CFU/mL in the nares (range, 0–3.6), perianal region (range, 0–3.5), the arm skin (range, 0-0.3), and the chest skin (range, 0–6.2). Detectable bioburden on patients was negatively correlated with the time since placed on contact precautions (rs= −0.06; P < .001). Of 97 observations with detectable bacterial bioburden at any site, 9 (9.3%) resulted in transmission of MRSA to HCP in comparison to 11 (3.6%) of 310 observations with no detectable bioburden at all sites (P = .03). Conclusions: Transmission of MRSA to gloves or gowns of HCP caring for patients on contact precautions for MRSA in non-ICU settings was lower than in the ICU setting. More evidence is needed to help guide the optimal use of contact precautions for the right patient, in the right setting, for the right type of encounter.Funding: NoneDisclosures: None

Download Full-text

Transition from an Open Bay to a Private Room Neonatal Intensive Care Unit Design — A Human Factors Evaluation

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120504901128 ◽

2005 ◽

Vol 49 (11) ◽

pp. 974-978 ◽

Cited By ~ 4

Author(s):

Thomas J. Smith ◽

Sandra Clayton ◽

Kathleen Schoenbeck

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Human Factors ◽

Neonatal Intensive Care Unit ◽

Patient Care ◽

Neonatal Intensive Care ◽

Patient Care Team ◽

Care Staff ◽

Care Technology

This report summarizes findings from a human factors evaluation of a change in the design of a neonatal intensive care unit (NICU) from an open bay (OBNICU) to a private room (PRNICU) patient care environment. The objective was to compare and contrast effects of this design change on the perceptions and performance of NICU patient care staff. Results indicate that, relative to work on the OBNICU, staff perceived that work on the PRNICU resulted in notable improvements in the quality of physical environmental conditions, their jobs, patient care and patient safety, interaction with parents of NICU patients, interaction with patient care technology and their life off-the-job. In contrast, staff perceived that the quality of interaction among different members of the NICU patient care team worsened substantially after the move to the PRNICU. The latter finding prompted the recommendation that a virtual open bay environment be implemented in the PRNICU.

Download Full-text

The Effect of Nocturnal Patient Care Interventions on Patient Sleep and Satisfaction With Nursing Care in Neurosurgery Intensive Care Unit

Journal of Neuroscience Nursing ◽

10.1097/jnn.0000000000000122 ◽

2015 ◽

Vol 47 (2) ◽

pp. 104-112 ◽

Cited By ~ 6

Author(s):

Gülay Altun Uğraş ◽

Sultan Babayigit ◽

Keziban Tosun ◽

Güler Aksoy ◽

Yüksel Turan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Care ◽

Nursing Care

Download Full-text

Physicians' Reactions to Training in a Pediatric Intensive Care Unit

PEDIATRICS ◽

10.1542/peds.53.3.375 ◽

1974 ◽

Vol 53 (3) ◽

pp. 375-383

Author(s):

I. David Todres ◽

Mary C. Howell ◽

Daniel C. Shannon

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Emotional Reactions ◽

Training Period ◽

Patient Death ◽

Training Experience ◽

Optimal Patient Care

Physician trainees working in a pediatric intensive care unit (ICU) were interviewed early in their training experience, at the end of their training, and 1 to 12 months after their training had ended. Pediatricians responded significantly differently from anesthesiologists: they commented more often about their own feelings, and less often about procedural-intellectual-technical matters as contrasted with feelings and relationships. Pediatricians were also more likely than anesthesiologists to mention their own emotional reactions to ill children, their sense that patient death meant physician failure, and their dismay early in the training period about the stressful intensity of the work. Physicians who were parents differed from those who were not parents by commenting more frequently about their work with the parents of patients, and about the necessity for teamwork. Physician trainees interviewed early in the training period were less reflective about the experience, and less likely to comment on feelings and relationships, compared to those interviewed later. Analysis of the sources of satisfaction and discontent with work in the ICU, as stated by the physician trainees, has been useful in efforts to improve the climate of work and learning in the unit, and to provide optimal patient care.

Download Full-text

Cardiothoracic Surgery and Postoperative Intensive Care

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0066 ◽

2019 ◽

pp. 417-423

Author(s):

Juan G. Ripoll Sanz ◽

Robert A. Ratzlaff

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Care ◽

Heart Surgery ◽

Open Heart Surgery ◽

Cardiothoracic Surgery ◽

Open Heart ◽

Postoperative Intensive Care ◽

Main Factor

Cardiothoracic surgical (CTS) critical care responsibilities have progressively shifted away from surgeons and toward intensivists in the past several decades. CTS patients present unique challenges, and optimal patient care in the intensive care unit is a main factor for the prevention of deaths after any type of open heart surgery.

Download Full-text

Timely Family Feedback to Guide Family Engagement in the Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2020644 ◽

2020 ◽

Vol 40 (6) ◽

pp. 42-51

Author(s):

Natalie S. McAndrew ◽

Laura Mark ◽

Mary Butler

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Improvement ◽

Patient Care ◽

Care Delivery ◽

Family Engagement ◽

Family Satisfaction ◽

Family Experience ◽

Improvement Project ◽

The Family

Background Organizations motivated to provide high-quality care in the intensive care unit are exploring strategies to engage families in patient care. Such initiatives are based on emerging evidence that family engagement improves quality and safety of care. Objective To gather family feedback to guide future nurse-led quality improvement efforts to engage families in the intensive care unit setting. Methods The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families during the intensive care unit stay from March through December 2017. Content analysis was used to identify themes regarding the family experience. Results Responses were collected from 178 family members. The mean (SD) score on the survey was 4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family interactions with the interdisciplinary team, information sharing and effective communication, family navigation of the intensive care unit environment, family engagement in the intensive care unit, and quality of patient care. Conclusions This quality improvement project provided foundational information to guide family engagement efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family experience and guiding family-centered care delivery in this practice environment.

Download Full-text