Variation in Intensive Care Unit Intubation Practices in Pulmonary Critical Care Medicine Fellowship

IntroductionPatients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement. There is no widely accepted or standardised scorecard that has been used for overall CCM performance. We aim to improve quality of care, patient safety and patient/family experience in CCM practice through the utilisation of a standardised, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics.Methods and analysisThis will be a mixed-methods, controlled before and after study to assess the impact of a CCM-specific quality scorecard. Scorecard metrics were developed through expert consensus and existing literature. The study will include 19 attending CCM physicians and approximately 300 CCM nurses. Patient data for scorecard compilation are collected daily from bedside flow sheets. Preintervention baseline data will be collected for 6 months for each participant. After this, each participant will receive their scorecard measures. Following a 3-month washout period, postintervention data will be collected for 6 months. The primary outcome will be change in performance metrics following the provision of scorecard feedback to subjects. A cost analysis will also be performed, with the purpose of comparing total ICU costs prior to implementation of the scorecard with total ICU costs following implementation of the scorecard. The qualitative portion will include interviews with participants following the intervention phase. Interviews will be analysed in order to identify recurrent themes and subthemes, for the purposes of driving scorecard improvement.Ethics and disseminationThis protocol has been approved by the local research ethics board. Publication of results is anticipated in 2019. If this intervention is found to improve patient- and unit-directed outcomes, with evidence of cost-effectiveness, it would support the utilisation of such a scorecard as a quality standard in CCM.

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Guidelines and Levels of Care for Pediatric Intensive Care Units

PEDIATRICS ◽

10.1542/peds.92.1.166 ◽

1993 ◽

Vol 92 (1) ◽

pp. 166-175 ◽

Cited By ~ 2

Author(s):

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

American Academy ◽

Pediatric Intensive Care Unit ◽

Hospital Care ◽

Pediatric Intensive Care ◽

Critical Care Medicine ◽

Pediatric Critical Care ◽

American Academy Of Pediatrics

Pediatric critical care medicine has matured dramatically during the past two decades. Knowledge of the pathophysiology of life-threatening processes and the technologic capacity to monitor and treat pediatric patients suffering from them have advanced rapidly during this period. Along with the scientific and technical advances has been the evolution of the pediatric intensive care unt (PICU), where the special needs of critically ill or injured children can be met by pediatric specialists. In 1985, the American Board of Pediatrics recognized the new subspecialty of Pediatric Critical Care Medicine and established criteria for subspecialty certification. The American Boards of Medicine, Surgery, and Anesthesiology gave similar recognition to the subspecialty. In 1990, the Residency Review Committee of the Accreditation Council for Graduate Medical Education completed its first accreditation of Pediatric Critical Care Medicine Training Programs. In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit. This policy represents the consensus of the three above-mentioned groups who believe the recommendations that follow are current, necessary, and attainable in 1993. The guidelines are not intended as a statement of the ideal or ultimate requirements for PICUs. We expect standards for PICUs to rise as critical care medicine continues to develop and appropriately trained providers become more readily available. In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit.

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Pain, Agitation, and Delirium Guidelines: Nurses’ Involvement in Development and Implementation

Critical Care Nurse ◽

10.4037/ccn2015824 ◽

2015 ◽

Vol 35 (3) ◽

pp. 17-31 ◽

Cited By ~ 11

Author(s):

Judy E. Davidson ◽

Chris Winkelman ◽

Céline Gélinas ◽

Anna Dermenchyan

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Clinical Practice ◽

Practice Guidelines ◽

Guideline Implementation ◽

Critical Care Medicine ◽

Staff Nurse ◽

Nurse Leader ◽

Professional Guidelines

The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses’ involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation.

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Critical Care Medicine and the Surgical Intensive Care Unit

Archives of Surgery ◽

10.1001/archsurg.1982.01380340001001 ◽

1982 ◽

Vol 117 (10) ◽

pp. 1265 ◽

Cited By ~ 1

Author(s):

JEROME H. MODELL

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critical Care Medicine ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care

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The Intensive care unit specialist: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Journal of Critical Care ◽

10.1016/j.jcrc.2016.06.001 ◽

2016 ◽

Vol 35 ◽

pp. 223-228 ◽

Cited By ~ 9

Author(s):

Pravin Amin ◽

Alison Fox-Robichaud ◽

J.V. Divatia ◽

Paolo Pelosi ◽

Defne Altintas ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Task Force ◽

Critical Care Medicine ◽

World Federation

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Feasibility of a Nurse-Managed Pain, Agitation, and Delirium Protocol in the Surgical Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2017528 ◽

2017 ◽

Vol 37 (6) ◽

pp. 24-34 ◽

Cited By ~ 1

Author(s):

Alan Rozycki ◽

Andrew S. Jarrell ◽

Rachel M. Kruer ◽

Samantha Young ◽

Pedro A. Mendez-Tellez

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Adult Patients ◽

Critical Care Medicine ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Nursing Assessment ◽

Protocol Adherence

BACKGROUND Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed. OBJECTIVES To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol. METHODS Data on all adult patients admitted to a surgical intensive care unit from January 2013 through September 2013 who were assessed at least once by using a pain, sedation, and delirium protocol were retrospectively reviewed. Protocol adherence was evaluated for interventions implemented after a nursing assessment. Patients were further divided into 2 groups on the basis of adherence, and achievement of pain and sedation goals was evaluated between groups. RESULTS Data on 41 patients were included. Of the 603 pain assessments, 422 (70.0%) led to an intervention adherent to the protocol. Of the 249 sedation assessments, 192 (77.1%) led to an adherent intervention. Among patients with 75% or greater adherent pain interventions, all interventions met pain goals with significantly less fentanyl than that used in interventions that did not meet goals. Despite 75% or greater adherence with interventions for sedation assessments, only 8.7% of the interventions met sedation goals. CONCLUSIONs A nurse-managed pain, agitation, and delirium protocol can be feasibly implemented in a surgical intensive care unit.

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