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Muñoz-Rey MP, Delgado-Hito P, Juvé-Udina ME, Cuzco-Cabellos C, Huertas-Zurriaga A, Romero-García M. The diary in the intensive care unit: Concept analysis. ENFERMERIA INTENSIVA 2024; 35:178-187. [PMID: 38228417 DOI: 10.1016/j.enfie.2023.08.010] [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] [Received: 03/29/2023] [Accepted: 08/13/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action. AIM This research proposes to critically examine the concept of 'Intensive Care Unit Diary' by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content. METHOD A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant. RESULTS The concept analysis shows that the 'ICU Diary' is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay. It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions. CONCLUSIONS The concept of 'UCI Diary' is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.
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Affiliation(s)
- M P Muñoz-Rey
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain; Grupo de Investigación Enfermera NURECARE-IGTP, Instituto de Investigación Germans Trias i Pujol, Badalona, Spain
| | - P Delgado-Hito
- Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Grupo de investigación enfermera del Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain; Red internacional proyecto HU-CI, Madrid, Spain.
| | - M E Juvé-Udina
- Grupo de investigación enfermera del Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain
| | - C Cuzco-Cabellos
- Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Área de Vigilancia intensiva Hospital Clínico, Barcelona, Spain
| | - A Huertas-Zurriaga
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain; Grupo de Investigación Enfermera NURECARE-IGTP, Instituto de Investigación Germans Trias i Pujol, Badalona, Spain
| | - M Romero-García
- Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Grupo de investigación enfermera del Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain; Red internacional proyecto HU-CI, Madrid, Spain
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Castellanos-Ortega Á, Broch MJ, Palacios-Castañeda D, Gómez-Tello V, Valdivia M, Vicent C, Madrid I, Martinez N, Párraga MJ, Sancho E, Fuentes-Dura MDC, Sancerni-Beitia MD, García-Ros R. Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study. Med Intensiva 2022; 46:491-500. [PMID: 36057440 DOI: 10.1016/j.medine.2022.01.001] [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] [Received: 12/07/2021] [Accepted: 01/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites. DESIGN Observational multicenter study. SETTING Thirteen Spanish ICU Departments. PARTICIPANTS Thirty six R3. INTERVENTION The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters. MAIN VARIABLES OF INTEREST Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency. RESULTS A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64-0.79). Inter-rater reliability was strong [median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65-0.97)]. Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed. CONCLUSION The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency. TRIAL REGISTRATION COBALIDATION. NCT04278976. (https://register. CLINICALTRIALS gov).
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Affiliation(s)
- Á Castellanos-Ortega
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M J Broch
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - V Gómez-Tello
- Intensive Care Department, University Hospital Moncloa, Madrid, Spain
| | - M Valdivia
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - C Vicent
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - I Madrid
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - N Martinez
- Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
| | - M J Párraga
- Intensive Care Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - E Sancho
- Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M D C Fuentes-Dura
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - M D Sancerni-Beitia
- Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
| | - R García-Ros
- Department of Developmental and Educational Psychology, University of Valencia, Spain.
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3
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Castellanos-Ortega Á, Broch M, Palacios-Castañeda D, Gómez-Tello V, Valdivia M, Vicent C, Madrid I, Martinez N, Párraga M, Sancho E, Fuentes-Dura M, Sancerni-Beitia M, García-Ros R. Competency assessment of residents of Intensive Care Medicine through a simulation-based objective structured clinical evaluation (OSCE). A multicenter observational study. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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All for One and One for All: Voluntary Physicians in the Intensive Medicine Units During the COVID-19 Outbreak in Spain. Disaster Med Public Health Prep 2020; 16:612-618. [PMID: 33040768 PMCID: PMC7737119 DOI: 10.1017/dmp.2020.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Our purpose was to determine the intensive care units' (ICU's) medical staff surge capacity during the coronavirus disease 2019 (COVID-19) outbreak in Spring 2020 in Spain. METHODS A multicenter retrospective survey was performed addressing the medical specialties present in the ICUs and the increase in bed capacity during this period. RESULTS Sixty-seven centers (62.04%) answered the questionnaire. The ICU bed capacity during the pandemic outbreak increased by 160% (95% confidence interval [CI], 128.97-191.03%). The average number of beds per intensive care medicine (ICM) specialist was 1.5 ± 0.60 and 3.71 ± 2.44 beds/specialist before and during the COVID-19 outbreak, respectively. Non-ICM specialists and residents were present in 50 (74.63%) and 23 (34.3%) ICUs during the outbreak, respectively. The number of physicians (ICM and non-ICM residents and specialists) in the ICU increased by 89.40% (95% CI, 64.26114.53%). The increase in ICM specialists was, however, 4.94% (95% CI, -1.35-11.23%). Most non-ICM physicians were anesthetists, followed by pediatricians and cardiologists. CONCLUSIONS The majority of ICUs in our study were able to rapidly expand critical care capacity by adapting areas outside of the normal ICU to manage critically ill patients, and by extending the critical care staff with noncritical care physicians working as force multipliers.
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Monedero P, Paz-Martín D, Barturen F, Fernández-Quero Bonilla L, Cardona Peretó J, Sánchez Pérez CA, Ferrando Ortolá C, Cabadas Avión R, García-Montoto Pérez F, González Celdrán R, López Sánchez C, Ojeda Betancor N, Padrón Ruiz OM, Pérez Carbonell A, Soria Gulina C, Tamayo Gómez E, Torres Pedrós V, Varela Durán M, Heredia Rodríguez M, Peyró García R. Intensive care in Spain. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:147-152. [PMID: 32093920 DOI: 10.1016/j.redar.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/01/2020] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Affiliation(s)
- P Monedero
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Departamento de Anestesia y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - D Paz-Martín
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
| | - F Barturen
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Universitari Son Espases, Palma, Illers Balears, España
| | - L Fernández-Quero Bonilla
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Cardona Peretó
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesia y UCI, Hospital de Denia-Marina Salud, Denia, Alicante, España
| | - C A Sánchez Pérez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital General Universitario de Elda, Elda, Alicante, España
| | - C Ferrando Ortolá
- Revista Española de Anestesiología y Reanimación (REDAR). SEDAR. Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, España. CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Cabadas Avión
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Povisa, Vigo, España
| | - F García-Montoto Pérez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; UCI de Anestesia, Hospital Universitario de Cáceres, Cáceres, España
| | - R González Celdrán
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Hospital General Universitario Reina Sofía, Murcia, España
| | - C López Sánchez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Universitario Marqués de Valdecilla, Santander, España
| | - N Ojeda Betancor
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - O M Padrón Ruiz
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - A Pérez Carbonell
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital General Universitario de Elche, Elche, España
| | - C Soria Gulina
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; UCI de Anestesia, Complejo Asistencial Universitario de León, León, España
| | - E Tamayo Gómez
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - V Torres Pedrós
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Hospital Universitari Son Espases, Palma, Illers Balears, España
| | - M Varela Durán
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | | | - R Peyró García
- Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Madrid, España; Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Albacete, Albacete, España
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Olaechea Astigarraga PM, Bodí Saera M, Martín Delgado MC, Holanda Peña MS, García de Lorenzo Y Mateos A, Gordo Vidal F. Document on the state of affairs of the Spanish model of Intensive Care Medicine. SEMICYUC Strategic Plan 2018-2022. Med Intensiva 2018; 43:47-51. [PMID: 29898831 DOI: 10.1016/j.medin.2018.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 12/27/2022]
Abstract
The role of Critical Care Medicine in Spain requires continuous revision and reflection. We have values and strengths that are evidenced in our daily work and by their important effects in routine hospital activity. Other medical specialties seeking to assume activities referred to critical patient care, as well as a number of other circumstances, may have a negative impact upon our routine duties. This article reflects the impressions of an important number of members of the Planning, Organization and Management Task Force of the Spanish Society of Critical Medicine Society (Grupo de Trabajo de Planificación, Organización y Gestión; GTPOG-SEMICYUC). The actions required to upgrade our Critical Care Medicine model are presented, evolving towards a broader view such as the 'ICU without walls' or 'Expanded ICU'. The subject is addressed from three complementary standpoints: actions involving the administrative authorities; actions required on the part of our scientific Society; and initiatives to be implemented locally in each Intensive Care Unit (led by the corresponding Unit representatives) at both hospital level and involving the regional authorities.
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Affiliation(s)
| | - M Bodí Saera
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
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González de Molina Ortiz FJ, Gordo Vidal F, Estella García A, Morrondo Valdeolmillos P, Fernández Ortega JF, Caballero López J, Pérez Villares PV, Ballesteros Sanz MA, de Haro López C, Sanchez-Izquierdo Riera JA, Serrano Lázaro A, Fuset Cabanes MP, Terceros Almanza LJ, Nuvials Casals X, Baldirà Martínez de Irujo J. "Do not do" recommendations of the working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of critically ill patients. Med Intensiva 2018; 42:425-443. [PMID: 29789183 DOI: 10.1016/j.medin.2018.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 02/06/2023]
Abstract
The project "Commitment to Quality of Scientific Societies", promoted since 2013 by the Spanish Ministry of Health, seeks to reduce unnecessary health interventions that have not proven effective, have little or doubtful effectiveness, or are not cost-effective. The objective is to establish the "do not do" recommendations for the management of critically ill patients. A panel of experts from the 13 working groups (WGs) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2000 to 2017 was extracted. The clinical evidence was discussed and summarized by the experts in the course of consensus finding of each WG, and was finally approved by the WGs after an extensive internal review process carried out during the first semester of 2017. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and aim to reduce those treatments or procedures that do not add value to the care process; avoid the exposure of critical patients to potential risks; and improve the adequacy of health resources.
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Affiliation(s)
- F J González de Molina Ortiz
- Servicio de Medicina Intensiva, Hospital Universitario Mutua Terrassa, Barcelona, España; Servicio de Medicina Intensiva, Hospital Universitario Quirón Dexeus, Barcelona, España.
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
| | - A Estella García
- Servicio de Medicina Intensiva, Hospital del SAS de Jerez, Jerez, Cádiz, España
| | - P Morrondo Valdeolmillos
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - J F Fernández Ortega
- Servicio de Medicina Intensiva, Complejo Hospitalario Carlos Haya, Málaga, España
| | - J Caballero López
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España
| | - P V Pérez Villares
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M A Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - C de Haro López
- Servicio de Medicina Intensiva, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | | | - A Serrano Lázaro
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Valencia, España
| | - M P Fuset Cabanes
- Servicio de Medicina Intensiva, Hospital Universitari i Politècnic la Fe, Valencia, España
| | - L J Terceros Almanza
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - X Nuvials Casals
- Servicio de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Barcelona, España
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Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, Martínez-Alonso M, Álvarez-Rodríguez J, Lorente L, Arias-Rivera S, García R, Gordo F, Añón JM, Jam-Gatell R, Vázquez-Calatayud M, Agra Y. Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program. Crit Care Med 2018; 46:181-188. [PMID: 29023261 PMCID: PMC5770104 DOI: 10.1097/ccm.0000000000002736] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The "Pneumonia Zero" project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU. DESIGN Prospective, interventional, and multicenter study. SETTING A total of 181 ICUs throughout Spain. PATIENTS All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012. INTERVENTION Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (April-June 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status. MEASUREMENTS AND MAIN RESULTS The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9.83 (95% CI, 8.42-11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22-5.84) after 19-21 months of participation. CONCLUSIONS Implementation of the bundle measures included in the "Pneumonia Zero" project resulted in a significant reduction of more than 50% of the incidence of ventilator-associated pneumonia in Spanish ICUs. This reduction was sustained 21 months after implementation.
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Affiliation(s)
- Francisco Álvarez-Lerma
- Service of Intensive Care Medicine, Spanish Society of Intensive and Critical Care Medicine and Research Group in Critical Disorders (GREPAC), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Coronary Units (SEMICYUC) Working Group on Infectious Diseases, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercedes Palomar-Martínez
- Service of Intensive Care Medicine, Spanish Society of Intensive and Critical Care Medicine and Research Group in Critical Disorders (GREPAC), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Coronary Units (SEMICYUC) Working Group on Infectious Diseases, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Sánchez-García
- Working Group on Infectious Diseases, SEMICYUC, Department of Critical Care, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Joaquín Álvarez-Rodríguez
- Service of Intensive Care Medicine, SEMICYUC Working Group on Safety, Quality and Management, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Leonardo Lorente
- Service of Intensive Care Medicine, SEMICYUC Working Group on Infectious Diseases, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Susana Arias-Rivera
- Service of Intensive Care Medicine, Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Rosa García
- Service of Anesthesiology and Resuscitation, SEEIUC, Hospital Universitario de Basurto, Bilbao, Bizkaia, Spain
| | - Federico Gordo
- Service of Intensive Care Medicine, SEMICYUC Working Group on Acute Respiratory Insufficiency, Hospital Universitario del Henares, Colsada, Madrid, Spain
| | - José M. Añón
- Service of Intensive Care Medicine, SEMICYUC Working Group on Acute Respiratory Insufficiency, CIBER of Respiratory Diseases, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Rosa Jam-Gatell
- Critical Care Center, SEEIUC, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Tauli I3P3, Sabadell, Barcelona, Spain
| | - Mónica Vázquez-Calatayud
- Area of Nursing Research Training and Development, SEEIUC, Clínica Universidad de Navarra, Pamplona, Spain
| | - Yolanda Agra
- Patient Safety Unit, Spanish Ministry of Health, Social Policy and Equality, Madrid, Spain
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Ball L, Riforgiato C, Pelosi P. Educational and Training Programs in Intensive Care Medicine are the Right Way. Turk J Anaesthesiol Reanim 2017; 45:247-248. [PMID: 29114406 DOI: 10.5152/tjar.2017.200902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lorenzo Ball
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Chiara Riforgiato
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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Hernández-Tejedor A, Peñuelas O, Sirgo Rodríguez G, Llompart-Pou J, Palencia Herrejón E, Estella A, Fuset Cabanes M, Alcalá-Llorente M, Ramírez Galleymore P, Obón Azuara B, Lorente Balanza J, Vaquerizo Alonso C, Ballesteros Sanz M, García García M, Caballero López J, Socias Mir A, Serrano Lázaro A, Pérez Villares J, Herrera-Gutiérrez M. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medine.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients. Med Intensiva 2017; 41:285-305. [PMID: 28476212 DOI: 10.1016/j.medin.2017.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/25/2017] [Accepted: 03/11/2017] [Indexed: 12/14/2022]
Abstract
The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients.
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Gordo F, Abella A. Intensive care unit without walls: seeking patient safety by improving the efficiency of the system. Med Intensiva 2014; 38:438-43. [PMID: 24661919 DOI: 10.1016/j.medin.2014.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 12/11/2022]
Abstract
The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process. At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved. It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology.
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Affiliation(s)
- F Gordo
- Intensive Care Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain; Francisco de Vitoria University, Madrid, Spain.
| | - A Abella
- Intensive Care Medicine, Hospital Universitario del Henares, Coslada, Madrid, Spain
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Relationship between volume and survival in closed intensive care units is weak and apparent only in mechanically ventilated patients. Anesthesiology 2014; 119:871-9. [PMID: 23838712 DOI: 10.1097/aln.0b013e31829c3029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. METHODS Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. RESULTS The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14-46%). Observed hospital mortality was 19% (range at hospital level: 11-35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5-1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14-60%) and observed hospital mortality was 30% (12-61%), resulting in a standardized mortality ratio of 0.96 (0.5-1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. CONCLUSION In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.
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Bittner MI, Donnelly M, van Zanten ARH, Andersen JS, Guidet B, Trujillano Cabello JJ, Gardiner S, Fitzpatrick G, Winter B, Joannidis M, Schmutz A. How is intensive care reimbursed? A review of eight European countries. Ann Intensive Care 2013; 3:37. [PMID: 24216146 PMCID: PMC3843541 DOI: 10.1186/2110-5820-3-37] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/23/2013] [Indexed: 11/17/2022] Open
Abstract
Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes-despite all of them originating from a DRG system-, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to assist the intensivist clinician and researcher in understanding neighbouring countries' approaches and in putting research into the context of a European perspective. In addition, steering committees and decision makers might find this a valuable source to compare different reimbursement schemes.
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Affiliation(s)
- Martin-Immanuel Bittner
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, Freiburg D-79106, Germany
| | - Maria Donnelly
- Department of Anaesthesia and Intensive Care, Tallaght Hospital, Dublin 24, Ireland
| | - Arthur RH van Zanten
- Intensive & Medium Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, Netherlands
| | - Jakob Steen Andersen
- Intensive Care Unit, State University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - Bertrand Guidet
- Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, Service de réanimation médicale, Paris F-75012, France
- UPMC, Univ Paris 06, Paris, France
- Inserm, Unité de Recherche en Épidémiologie Systèmes d’Information et Modélisation (U707), Paris F-75012, France
| | | | - Shane Gardiner
- Department of Anaesthesia and Intensive Care, Tallaght Hospital, Dublin 24, Ireland
| | - Gerard Fitzpatrick
- Department of Anaesthesia and Intensive Care, Tallaght Hospital, Dublin 24, Ireland
| | - Bob Winter
- Adult Intensive Care Unit, Queens Medical Centre, NG11 6PE Nottingham, United Kingdom
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, Innsbruck A-6020, Austria
| | - Axel Schmutz
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, Freiburg D-79106, Germany
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