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Alostaz Z, Rose L, Mehta S, Johnston L, Dale CM. Interprofessional intensive care unit (ICU) team perspectives on physical restraint practices and minimization strategies in an adult ICU: A qualitative study of contextual influences. Nurs Crit Care 2024; 29:90-98. [PMID: 36443064 DOI: 10.1111/nicc.12864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Guidelines advocate for minimization of physical restraint (PR) use in intensive care units (ICU). Interprofessional team perspectives on PR practices can inform the design and implementation of successful PR minimization interventions. AIM To identify ICU staff perspectives of contextual influences on PR practices and minimization strategies. STUDY DESIGN A qualitative descriptive study in a single ICU in Toronto, Canada. One-on-one semi-structured interviews were conducted with 14 ICU staff. A deductive content analysis of interviews was undertaken using the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. RESULTS Five themes were developed: risk-averse culture, leadership, practice monitoring and feedback processes, environmental factors, and facilitation. Participants described a risk-averse culture where prophylactic application of PR for intubated patients was used to prevent unplanned extubation thereby avoiding blame from colleagues. Perceived absence of leadership and interprofessional team involvement situated nurses as the primary decision-maker for restraint application and removal. Insufficient monitoring of restraint practices, lack of access to restraint alternatives, and inability to control environmental contributors to delirium and agitation further increased PR use. Recommendations as to how to minimize restraint use included a nurse facilitator to advance leadership-team collaboration, availability of restraints alternatives, and guidance on situations for applying and removing restraints. CONCLUSIONS This analysis of contextual influences on PR practices and minimization using the i-PARIHS framework revealed potentially modifiable barriers to successful PR minimization, including a lack of leadership involvement, gaps in practice monitoring, and collaborative decision-making processes. A team approach to changing behaviour and culture should be considered for successful implementation and sustainability of PR minimization. RELEVANCE TO PRACTICE The establishment of an interprofessional facilitation team that addresses risk-averse culture and promotes collaboration among ICU stakeholders will be crucial to the success of any approach to restraint minimization.
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Affiliation(s)
- Ziad Alostaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sangeeta Mehta
- Medical Surgical Intensive Care Unit, Mount Sinai Hospital, Sinai Health, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
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Henson CP, Weaver SM. Systems of Care Delivery and Optimization in the Intensive Care Unit. Anesthesiol Clin 2023; 41:863-873. [PMID: 37838389 DOI: 10.1016/j.anclin.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
As the volume and complexity of patients requiring intensive care grows, so do the barriers and challenges to the delivery of that care. This article summarizes these challenges, outlines strategies used to overcome them, and presents new developments and concepts within the care of the ICU patient.
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Affiliation(s)
- Christopher Patrick Henson
- Division of Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South - MCE 3161, Nashville, TN 37232, USA.
| | - Sheena M Weaver
- Division of Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South - MCE 3161, Nashville, TN 37232, USA
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Dasgupta S, Chandra A. Rational quality and cost of critical care systems are more important than individual considerations: a view from India. Postgrad Med J 2023; 99:1207-1209. [PMID: 37624141 DOI: 10.1093/postmj/qgad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Critical or Intensive Care Units (CCU/ICUs) play a crucial role in treating critically ill patients, but they contribute significantly to healthcare costs. In India and many other resource-limited countries, private ICU treatment is largely unaffordable for the poor and even a section of the middle class, who are not substantially insured. It is essential for all stakeholders involved in critical care to prioritize quality and cost-effectiveness. To ensure quality assurance, legally binding quality standards must be developed collaboratively by the government, professional bodies, hospital administrators, and domain experts. Regulatory benchmarks relevant to different types of ICUs can enforce adherence and transparency. Telemedicine, referral systems, and interhospital transport need improvement. Addressing attrition rates among staff and greater empowerment of formally qualified registered intensivists in the private hospitals can enhance outcomes and cost control. Long-term post-ICU recovery care is often unaffordable or unavailable in many parts of the world. Engaging families in home care and providing training in basic caregiving tasks can improve outcomes and reduce costs. In areas with limited access to qualified professionals, training of lay community caregivers and practitioners can be beneficial. Multidisciplinary post-ICU clinics and necessary telephonic handholding can support home-based patients and their families. Standardizing prices of essential necessities and promoting rational practices are crucial. System-wide efforts and novel approaches like decentralization of critical care services are necessary to ensure holistic quality and cost-effectiveness, particularly in densely populated countries with resource limitations. These innovations will not only improve care but also enhance preparedness for future pandemics.
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Affiliation(s)
- Sugata Dasgupta
- Department of Critical Care Medicine, RG Kar Medical College and Hospital, Kolkata, 700004, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, Kolkata, 700004, India
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Nawaz FA, Deo N, Surani S, Maynard W, Gibbs ML, Kashyap R. Critical care practices in the world: Results of the global intensive care unit need assessment survey 2020. World J Crit Care Med 2022; 11:169-177. [PMID: 36331973 PMCID: PMC9136725 DOI: 10.5492/wjccm.v11.i3.169] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/11/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is variability in intensive care unit (ICU) resources and staffing worldwide. This may reflect variation in practice and outcomes across all health systems.
AIM To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global scale.
METHODS The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill sets. We aimed to survey sites regarding ICU type, availability of staffing, and adherence to critical care protocols. An international survey ‘Global ICU Needs Assessment’ was created using Google Forms, and this was distributed from February 17th, 2020 till September 23rd, 2020. The survey was shared with ICU providers in 34 countries. Various approaches to motivating healthcare providers were implemented in securing submissions, including use of emails, phone calls, social media applications, and WhatsApp™. By completing this survey, providers gave their consent for research purposes. This study was deemed eligible for category-2 Institutional Review Board exempt status.
RESULTS There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities. A majority of the ICUs were mixed medical-surgical [92 (76%)]. 108 (89%) were adult-only ICUs. Total 36 respondents (29.8%) were 31-40 years of age, with 79 (65%) male and 41 (35%) female participants. 89 were consultants (74%). A total of 71 (59%) respondents reported having a 24-h in-house intensivist. A total of 87 (72%) ICUs were reported to have either a 2:1 or ≥ 2:1 patient/nurse ratio. About 44% of the ICUs were open and 76% were mixed type (medical-surgical). Protocols followed regularly by the ICUs included sepsis care (82%), ventilator-associated pneumonia (79%); nutrition (76%), deep vein thrombosis prophylaxis (84%), stress ulcer prophylaxis (84%), and glycemic control (89%).
CONCLUSION Based on the findings of this international, multi-dimensional, needs-assessment survey, there is a need for increased recruitment and staffing in critical care facilities, along with improved patient-to-nurse ratios. Future research is warranted in this field with focus on implementing appropriate health standards, protocols and resources for optimal efficiency in critical care worldwide.
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Affiliation(s)
- Faisal A Nawaz
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Neha Deo
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, United States
| | - Salim Surani
- Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Texas A&M University, College Station, TX 77843, United States
| | - William Maynard
- Internal Medicine, TriStar Centennial Medical Center, HCA Healthcare, Nashville, TN 37203, United States
| | - Martin L Gibbs
- Pulmonary and Critical Care, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Rahul Kashyap
- Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Internal Medicine, TriStar Centennial Medical Center, HCA Healthcare, Nashville, TN 37203, United States
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Legrand M, Aldrich M. Further evidence in support of closed ICUs. Anaesth Crit Care Pain Med 2021; 40:100978. [PMID: 34748939 DOI: 10.1016/j.accpm.2021.100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Matthieu Legrand
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF, San Francisco, USA.
| | - Matthew Aldrich
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF, San Francisco, USA
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Vahedian-Azimi A, Rahimibashar F, Ashtari S, Guest PC, Sahebkar A. Comparison of the clinical features in open and closed format intensive care units: A systematic review and meta-analysis. Anaesth Crit Care Pain Med 2021; 40:100950. [PMID: 34555538 DOI: 10.1016/j.accpm.2021.100950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/29/2021] [Accepted: 06/06/2021] [Indexed: 01/09/2023]
Abstract
IMPORTANCE The difference in clinical outcomes between closed and open designs of intensive care units (ICUs) is still an open question. OBJECTIVE We conducted a systematic review and meta-analysis to compare total mortality, hospital and ICU length of stay (LOS) and mortality as primary outcomes, and severity of illness based on physiological variables, organ failure assessment, age, duration of mechanical ventilation and ventilator-associated pneumonia frequency as secondary outcomes in closed and open ICUs. EVIDENCE REVIEW Medline, PubMed, Scopus, Web of Science, Cochrane database, Iran-doc and Elm-net according to the MeSH terms were searched from 1988 to October 2019. The standardised mean difference (SMD), relative risk (RR) with 95% confidence interval (CI) were applied to display summary statistics of primary and secondary outcomes. FINDINGS A total of 90 studies with 444,042 participants were analysed. ICU mortality (RR: 1.16, CI: 1.07-1.27, p < 0.001), hospital mortality (RR: 1.12, CI: 1.03-1.22, p = 0.010) and ICU LOS (SMD: 0.43, CI: 0.01-0.85, p = 0.040) were significantly higher in open ICUs. Total mortality (RR: 0.91, CI: 0.77-1.08, p = 0.28) and hospital LOS (SMD: 1.14, CI: 1.31-3.59, p = 0.36) showed no significant difference between the two types of ICU. The secondary outcome measures were also comparable between the two ICU formats (p > 0.05). CONCLUSIONS AND RELEVANCE The results demonstrated superiority of closed versus open ICUs in hospital and ICU mortality rates and ICU LOS, with no difference in total mortality, hospital LOS or severity of illness parameters. The superiority of the closed ICU format may be a result of the intensivist-led patient care and should therefore be implemented by clinicians to decrease ICU mortality rates and LOS for critically ill patients.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Centre, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimibashar
- Anaesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sara Ashtari
- Gastroenterology and Liver Diseases Research Centre, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paul C Guest
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lujan S, Petroni G, Castellani P, Bollada S, Bell MJ, Velonjara J, Vavilala MS, Mock C. The Status of Quality Improvement Programs for Pediatric Traumatic Brain Injury Care in Argentina. J Surg Res 2021; 265:71-78. [PMID: 33892460 PMCID: PMC8238872 DOI: 10.1016/j.jss.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Trauma quality improvement (QI) programs improve care and outcomes for injured patients. Information about QI programs for pediatric traumatic brain injury (TBI) is sparse in Latin America. METHODS We gathered data on the status of QI programs and activities that encompass pediatric TBI at 15 Argentine hospitals. Data were gathered during 2019 and included hospital characteristics, QI practices, presence of a queryable registry, and use of protocols for TBI care. Level of QI activities was compared between hospital types using Fisher's exact test. RESULTS Most hospitals had guidelines for pediatric TBI care, including management and/or prevention of intracranial pressure (100%) and central-line-associated infections (87%). Morbidity and mortality meetings or other types of case discussions in which quality of pediatric TBI care was discussed were held by all hospitals, with most (53%) having weekly-monthly meetings, but 27% having rare or annual meetings. Sixty percent of hospitals had adequate data for case reviews (fewer than 25% of cases with essential information missing). Fifty-three percent documented discussions that occurred at these meetings and 53% utilized computerized trauma registries. Larger hospitals (> 200 beds) more frequently had adequate data (88%) for case reviews than smaller hospitals (29%, P = 0.046). Hospital size did not affect other QI activities. CONCLUSIONS Most hospitals had guidelines for pediatric TBI care. Adequacy of care was discussed at reasonably frequent case conferences. Opportunities for improvement include increasing documentation of case reviews and improving adequacy of data for case reviews, especially at smaller hospitals. Greater use of computerized trauma registries could provide such data.
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Affiliation(s)
- Silvia Lujan
- Centro de Informática e Investigación Clínica (CIIC), Rosario, Sante Fe, Argentina
| | - Gustavo Petroni
- Centro de Informática e Investigación Clínica (CIIC), Rosario, Sante Fe, Argentina
| | - Pablo Castellani
- Hospital del Niños Sor María Ludovica, La Plata, Provincia de Buenos Aires, Argentina
| | - Sabrina Bollada
- Hospital Interzonal del Niños Eva Perón, Catamarca, Argentina
| | | | - Julia Velonjara
- Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, Seattle, Washington
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, Seattle, Washington
| | - Charles Mock
- Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, Seattle, Washington.
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Tameron AM, Ricci KB, Oslock WM, Rushing AP, Ingraham AM, Daniel VT, Paredes AZ, Diaz A, Collins CE, Heh VK, Baselice HE, Strassels SA, Santry HP. The association between self-declared acute care surgery services and critical care resources: Results from a national survey. J Crit Care 2020; 60:84-90. [PMID: 32769008 DOI: 10.1016/j.jcrc.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care. METHODS 2811 EGS-capable hospitals were surveyed to examine structures and processes including critical care domains and ACS implementation. Differences between ACS and GSOC hospitals were compared using appropriate tests of association and logistic regression models. RESULTS 272/1497 hospitals eligible for analysis (18.2%) reported they use an ACS model. EGS patients at ACS hospitals were more likely to be admitted to a combined trauma/surgical ICU or a dedicated surgical ICU. GSOC hospitals had lower adjusted odds of having 24-h ICU coverage, in-house intensivists or respiratory therapists, and 4/6 critical-care protocols. CONCLUSIONS Critical care delivery is a key component of EGS care. While harnessing of critical care structures and processes varies across hospitals that have implemented ACS, overall ACS models of care appear to have more robust critical care practices.
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Affiliation(s)
- Ashley M Tameron
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA
| | - Kevin B Ricci
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Wendelyn M Oslock
- Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH, USA
| | - Amy P Rushing
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Angela M Ingraham
- University of Wisconsin, Department of Surgery, 600 Highland Avenue, Madison, WI, USA
| | - Vijaya T Daniel
- University of Massachusetts Medical School, Department of Surgery, 55 Lake Avenue, Worcester, MA, USA
| | - Anghela Z Paredes
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Adrian Diaz
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Courtney E Collins
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Victor K Heh
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Holly E Baselice
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Scott A Strassels
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA
| | - Heena P Santry
- Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA.
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Assessment of the current capacity of intensive care units in Uganda; A descriptive study. J Crit Care 2020; 55:95-99. [DOI: 10.1016/j.jcrc.2019.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/19/2022]
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Yang Q, Du JL, Shao F. Mortality rate and other clinical features observed in Open vs closed format intensive care units: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16261. [PMID: 31277148 PMCID: PMC6635169 DOI: 10.1097/md.0000000000016261] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nowadays most of the intensive care units (ICUs) operate as a closed format in comparison to an open format. The new concept of a closed ICU is where patients are admitted under the full responsibility of a trained intensivist, whereas an open ICU is where patients are admitted under the care of another attending physician and intensivists are just available for consultation. In this analysis, we aimed to systematically compare mortality rate and other clinical features observed in open vs closed ICU formats. METHODS Biomedical and pharmacological bibliographic database Excerpta Medica database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Central and www.ClinicalTrials.gov were searched for required English publications. Mortality, the frequency of patients requiring mechanical ventilation, central line, arterial line and pulmonary arterial catheter were assessed respectively. Statistical analysis was carried out by the RevMan software. Odds ratios (OR) with 95% confidence intervals (CIs) were used to represent the data following analysis. RESULTS Five studies with a total number of 6160 participants enrolled between years 1992 to 2007 were included. Results of this analysis showed that mortality rate was significantly higher in the open format ICU (OR: 1.31, 95% CI: 1.17-1.48; P = .00001) (using a fixed effect model) and (OR: 1.31, 95% CI: 1.09-1.59; P = .005) (using a random effect model). Closed format ICUs were associated with significantly higher number of patients that required central line (OR: 0.56, 95% CI: 0.34-0.92; P = .02). Patients requiring mechanical ventilation (OR: 1.08, 95% CI: 0.65-1.78; P = .77), patients requiring arterial line (OR: 1.05, 95% CI: 0.49-2.29; P = .89) and patients requiring pulmonary arterial catheter (OR: 0.86, 95% CI: 0.40-1.87; P = .71) were similar in the open vs the closed setting. CONCLUSION This analysis showed that mortality rate was significantly higher in an open as compared to a closed format ICU. However, the frequency of patients requiring mechanical ventilation, arterial line and pulmonary arterial catheter was similarly observed. Larger trials are expected to further confirm those hypotheses.
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Pastores SM, Kvetan V, Coopersmith CM, Farmer JC, Sessler C, Christman JW, D'Agostino R, Diaz-Gomez J, Gregg SR, Khan RA, Kapu AN, Masur H, Mehta G, Moore J, Oropello JM, Price K. Workforce, Workload, and Burnout Among Intensivists and Advanced Practice Providers: A Narrative Review. Crit Care Med 2019; 47:550-557. [PMID: 30688716 DOI: 10.1097/ccm.0000000000003637] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess-by literature review and expert consensus-workforce, workload, and burnout considerations among intensivists and advanced practice providers. DESIGN Data were synthesized from monthly expert consensus and literature review. SETTING Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force. MEASUREMENTS AND MAIN RESULTS Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals. CONCLUSIONS Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.
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Affiliation(s)
- Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Craig M Coopersmith
- Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA
| | | | - Curtis Sessler
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - John W Christman
- Division of Pulmonary, Allergy, Critical Care and Sleep, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rhonda D'Agostino
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Sara R Gregg
- Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA
| | - Roozehra A Khan
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - April N Kapu
- Vanderbilt University School of Nursing, Vanderbilt University Medical Center, Nashville, TN
| | - Henry Masur
- Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Gargi Mehta
- Jay B. Langner Critical Care System, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
| | - Jason Moore
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John M Oropello
- Division of Critical Care Medicine, Department of Surgery, Mount Sinai Medical Center, New York, NY
| | - Kristen Price
- Department of Critical Care Medicine, MD Anderson Cancer Center, Houston, TX
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Lameire N, Vanmassenhove J, Lewington A. Did KDIGO guidelines on acute kidney injury improve patient outcome? Intensive Care Med 2017; 43:921-923. [PMID: 28352976 DOI: 10.1007/s00134-017-4740-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/23/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Norbert Lameire
- Renal Division, Department of Medicine, Ghent University Hospital, 185, De Pintelaan, 9000, Ghent, Belgium.
| | - Jill Vanmassenhove
- Renal Division, Department of Medicine, Ghent University Hospital, 185, De Pintelaan, 9000, Ghent, Belgium
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Evidence supports the superiority of closed ICUs for patients and families: we are not sure. Intensive Care Med 2016; 43:128-130. [PMID: 27586994 DOI: 10.1007/s00134-016-4510-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/15/2016] [Indexed: 01/09/2023]
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