Levels of Care in the Intensive Care Unit: A Research Program

2006 ◽  
Vol 15 (3) ◽  
pp. 269-279 ◽  
Author(s):  
Deborah Cook ◽  
Graeme Rocker ◽  
John Marshall ◽  
Lauren Griffith ◽  
Ellen McDonald ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Research Program ◽  
Life Support ◽  
Advanced Life Support ◽  
Care Providers ◽  
Term Survival ◽  
Levels Of Care ◽  
Treatment Plans

A multidisciplinary research program on levels of care was conducted in 15 adult intensive care units in North America, Europe, and Australia. The program addressed advance directives for cardiopulmonary resuscitation, provision of advanced life support, and clinicians’ discomfort with evolving treatment plans. The results indicated that the factors that determined the establishment of directives for advance life support differed from the factors that informed a decision to limit or withdraw support after admission to an intensive care unit. In addition, clinicians’ prognoses were imprecise and often an underestimation of the probability of short-term survival. Finally, some degree of discomfort was common in care providers in the intensive care unit, most often because they thought interventions were excessive and not compatible with an acceptable future quality of life. The provision of advanced life support mandates explicit decision making about how life-support measures should be used.

Documentation on Withdrawal of Life Support in Adult Patients in the Intensive Care Unit

2004 ◽  
Vol 13 (4) ◽  
pp. 328-334 ◽  
Author(s):  
Karin T. Kirchhoff ◽  
Prashanth Reddy Anumandla ◽  
Kristine Therese Foth ◽  
Shea Nicole Lues ◽  
Stephanie Ho Gilbertson-White
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Retrospective Studies ◽  
Life Support ◽  
Adult Patients ◽  
Life Care ◽  
Care Providers

• Background Patients’ charts have been a source of data for retrospective studies of the quality of end-of-life care. In the intensive care unit, most patients die after withdrawal of life support. Chart reviews of this process could be used not only to assess the quality of documentation but also to provide information for quality improvement and research.• Objective To assess the documentation of end-of-life care of patients and their families by care providers in the intensive care unit.• Method Charts of 50 adult patients who died in the intensive care unit at a large midwestern hospital after initiation of withdrawal of life support (primarily mechanical ventilation) were reviewed. A form developed for the study was used for data collection.• Results The initiation of the decision making for withdrawal was documented in all 50 charts. Sixteen charts (32%) had no information on advance directives. Eight charts (16%) had no documentation on resuscitation status. About two thirds of the charts documented nurses’ participation during the withdrawal process; only one tenth documented physicians’ participation. A total of 13 charts (26%) had no information on the time of initiation of the withdrawal process, and 11 (22%) had no documentation of medications administered for withdrawal. Thirty-seven charts (74%) had information on whether the patient was or was not extubated during withdrawal.• Conclusion Comprehensive documentation of end-of-life care is lacking.

Code Blue Events in the Neonatal and Pediatric Intensive Care Units at a Tertiary Care Children's Hospital

2020 ◽  
Author(s):  
Catherine M. Groden ◽  
Erwin T. Cabacungan ◽  
Ruby Gupta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Pediatric Intensive Care ◽  
Code Blue ◽  
Neonatal Resuscitation Program

Objective The authors aim to compare all code blue events, regardless of the need for chest compressions, in the neonatal intensive care unit (NICU) versus the pediatric intensive care unit (PICU). We hypothesize that code events in the two units differ, reflecting different disease processes. Study Design This is a retrospective analysis of 107 code events using the code narrator, which is an electronic medical record of real-time code documentation, from April 2018 to March 2019. Events were divided into two groups, NICU and PICU. Neonatal resuscitation program algorithm was used for NICU events and a pediatric advanced life-support algorithm was used for PICU events. Events and outcomes were compared using univariate analysis. The Mann–Whitney test and linear regressions were done to compare the total code duration, time from the start of code to airway insertion, and time from airway insertion to end of code event. Results In the PICU, there were almost four times more code blue events per month and more likely to involve patients with seizures and no chronic condition. NICU events more often involved ventilated patients and those under 2 months of age. The median code duration for NICU events was 2.5 times shorter than for PICU events (11.5 vs. 29 minutes), even when adjusted for patient characteristics. Survival to discharge was not different in the two groups. Conclusion Our study suggests that NICU code events as compared with PICU code events are more likely to be driven by airway problems, involve patients <2 months of age, and resolve quickly once airway is taken care of. This supports the use of a ventilation-focused neonatal resuscitation program for patients in the NICU. Key Points

scholarly journals Families' perception, knowledge, and psychological stressors associated with transition of care from the intensive care unit

2019 ◽  
Vol 2 (1) ◽  
pp. 53-56
Author(s):  
Gustavo Ferrer ◽  
Chi Chan Lee ◽  
Monica Egozcue ◽  
Hector Vazquez ◽  
Melissa Elizee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Providers ◽  
Family Members ◽  
Expected Improvement ◽  
Transition Of Care ◽  
Care Providers ◽  
Icu Discharge ◽  
Family Perceptions

Background: During the process of transition of care from the intensive care setting, clarity, and understanding are vital to a patient's outcome. A successful transition of care requires collaboration between health-care providers and the patient's family. The objective of this project was to assess the quality of continuity of care with regard to family perceptions, education provided, and psychological stress during the process. Methods: A prospective study conducted in a long-term acute care (LTAC) facility. On admission, family members of individuals admitted to the LTAC were asked to fill out a 15-item questionnaire with regard to their experiences from preceding intensive care unit (ICU) hospitalization. The setting was an LTAC facility. Patients were admitted to an LTAC after ICU admission. Results: Seventy-six participants completed the questionnaire: 38% expected a complete recovery, 61% expected improvement with disabilities, and 1.3% expected no recovery. With regard to the length of stay in the LTAC, 11% expected < 1 week, 26% expected 1 to 2 weeks, 21% expected 3 to 4 weeks, and 42% were not sure. Before ICU discharge, 33% of the participants expected the transfer to the LTAC. Also, 72% did not report a satisfactory level of knowledge regarding their family's clinical condition or medical services required; 21% did not receive help from family members; and 50% reported anxiety, 20% reported depression, and 29% reported insomnia. Conclusion: Families' perception of patients' prognosis and disposition can be different from what was communicated by the physician. Families' anxiety and emotional stress may precipitate this discrepancy. The establishment of optimal projects to eliminate communication barriers and educate family members will undoubtedly improve the quality of transition of care from the ICU.

Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection

2006 ◽  
Vol 34 (2) ◽  
pp. 354-362 ◽  
Author(s):  
H A. Cense ◽  
J B. F. Hulscher ◽  
A G. E. M. de Boer ◽  
D A. Dongelmans ◽  
H W. Tilanus ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Esophageal Resection ◽  
Term Survival ◽  
Long Term Survival

Patients’ Characteristics Associated With Readmission to a Surgical Intensive Care Unit

2012 ◽  
Vol 21 (6) ◽  
pp. e120-e128 ◽  
Author(s):  
T. K. Timmers ◽  
M. H. J. Verhofstad ◽  
K. G. M. Moons ◽  
L. P. H. Leenen
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Severity Of Illness ◽  
Total Sample ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Term Survival

Background Readmission within 48 hours is a leading performance indicator of the quality of care in an intensive care unit. Objective To investigate variables that might be associated with readmission to a surgical intensive care unit. Methods Demographic characteristics, severity-of-illness scores, and survival rates were collected for all patients admitted to a surgical intensive care unit between 1995 and 2000. Long-term survival and quality of life were determined for patients who were readmitted within 30 days after discharge from the unit. Quality of life was measured with the EuroQol-6D questionnaire. Multivariate logistic analysis was used to calculate the independent association of expected covariates. Results Mean follow-up time was 8 years. Of the 1682 patients alive at discharge, 141 (8%) were readmitted. The main causes of readmission were respiratory decompensation (48%) and cardiac conditions (16%). Compared with the total sample, patients readmitted were older, mostly had vascular (39%) or gastrointestinal (26%) disease, and had significantly higher initial severity of illness (P = .003, .007) and significantly more comorbid conditions (P = .005). For all surgical classifications except general surgery, readmission was independently associated with type of admission and need for mechanical ventilation. Long-term mortality was higher among patients who were readmitted than among the total sample. Nevertheless, quality-of-life scores were the same for patients who were readmitted and patients who were not. Conclusion The adverse effect of readmission to the intensive care unit on survival appears to be long-lasting, and predictors of readmission are scarce.

scholarly journals Intensive care unit acquired infection has no impact on long-term survival or quality of life: a prospective cohort study

Critical Care ◽  
2007 ◽  
Vol 11 (2) ◽  
pp. R35 ◽  
Author(s):  
Pekka Ylipalosaari ◽  
Tero I Ala-Kokko ◽  
Jouko Laurila ◽  
Pasi Ohtonen ◽  
Hannu Syrjälä
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Term Survival ◽  
Long Term Survival

Mobility in Healthcare for Remote Intensive Care Unit Clinical Management

2011 ◽  
pp. 83-95 ◽  
Author(s):  
Carolyn McGregor
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Management ◽  
Life Support ◽  
Personal Information ◽  
Care Facility ◽  
Health Care Facility ◽  
Personal Digital Assistants ◽  
Care Providers ◽  
Efficiency And Effectiveness

This chapter reviews current research directions in healthcare mobility and assesses its impact on the provision of remote intensive care unit (ICU) clinical management. Intensive care units boast a range of state of the art medical monitoring devices to monitor a patient’s physiological parameters. They also have devices such as ventilators to offer mechanical life support. Computing and IT support within ICUs has focused on monitoring the patients and delivering corresponding alarms to care providers. However many intensive care unit admissions are via intra and inter health care facility transfer, requiring receiving care providers to have access to patient information prior to the patient’s arrival. This indicates that opportunities exist for mobile gadgets, such as personal digital assistants (PDAs) to substantially increase the efficiency and effectiveness of processes surrounding healthcare in the ICUs. The challenge is to transcend the use of these mobile devices beyond the current usage for personal information management and static medical applications; also to overcome the challenges of screen size and memory limitations. Finally, the deployment of mobile-enabled solutions within the healthcare domain is hindered by privacy, cost and security considerations and a lack of standards. These are some of the significant topics discussed in this chapter.

Improving the Quality of Handoffs in Patient Care Between Critical Care Providers in the Intensive Care Unit

2016 ◽  
Vol 32 (4) ◽  
pp. 376-383 ◽  
Author(s):  
Sumedh S. Hoskote ◽  
Carlos J. Racedo Africano ◽  
Andrea B. Braun ◽  
John C. O’Horo ◽  
Ronaldo A. Sevilla Berrios ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Care ◽  
Care Providers
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