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Patil SJ, Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We Do Better? Indian J Crit Care Med 2023; 27:163-165. [PMID: 36960106 PMCID: PMC10028712 DOI: 10.5005/jp-journals-10071-24415] [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: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 03/05/2023] Open
Abstract
Patient safety is an important step in providing high-quality health care. Every intensive care unit (ICU) is unique and its needs would be different; it is thus necessary to build a safety culture based on local and cultural characteristics. Various measures such as regular training, the use of bundles of care, and a blame-free environment can promote patient safety in ICUs. These measures are simple to implement even in resource-limiting settings and can go a long way in improving patient outcomes in our country. How to cite this article Patil SJ, Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We Do Better? Indian J Crit Care Med 2023;27(3):163-165.
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Affiliation(s)
- Sanika Jayant Patil
- Department of Intensive Care Medicine, North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, United Kingdom
- Sanika Jayant Patil, Department of Intensive Care Medicine, North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, United Kingdom, Phone: +07591399551, e-mail:
| | - Reshma Ambulkar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Ko SJ, Cho J, Choi SM, Park YS, Lee CH, Yoo CG, Lee J, Lee SM. Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit. PLoS One 2021; 16:e0259092. [PMID: 34705879 PMCID: PMC8550369 DOI: 10.1371/journal.pone.0259092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The intensive care unit (ICU) staffing model affects clinical outcomes of critically ill patients. However, the benefits of a closed unit model have not been extensively compared to those of a mandatory critical care consultation model. METHODS This retrospective before-after study included patients admitted to the medical ICU. Anthropometric data, admission reason, Acute Physiology and Chronic Health Evaluation II score, Eastern Cooperative Oncology Group grade, survival status, length of stay (LOS) in the ICU, duration of mechanical ventilator care, and occurrence of ventilator-associated pneumonia (VAP) were recorded. The staffing model of the medical ICU was changed from a mandatory critical care consultation model to a closed unit model in September 2017, and indices before and after the conversion were compared. RESULTS A total of 1,526 patients were included in the analysis. The mean age was 64.5 years, and 954 (62.5%) patients were men. The mean LOS in the ICU among survivors was shorter in the closed unit model than in the mandatory critical care consultation model by multiple regression analysis (5.5 vs. 6.7 days; p = 0.005). Central venous catheter insertion (38.5% vs. 51.9%; p < 0.001) and VAP (3.5% vs. 8.6%; p < 0.001) were less frequent in the closed unit model group than in the mandatory critical care consultation model group. After adjusting for confounders, the closed unit model group had decreased ICU mortality (adjusted odds ratio 0.65; p < 0.001) and shortened LOS in the ICU compared to the mandatory critical care consultation model group. CONCLUSION The closed unit model was superior to the mandatory critical care consultation model in terms of ICU mortality and LOS among ICU survivors.
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Affiliation(s)
- Sung Jun Ko
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail: (JL); (SML)
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail: (JL); (SML)
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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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Ogunbiyi O, Sanusi A, Osinaike B, Yakubu S, Rotimi M, Fatungase O. An overview of intensive care unit services in Nigeria. J Crit Care 2021; 66:160-165. [PMID: 34330559 DOI: 10.1016/j.jcrc.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To have a current overview of the state of critical care services in Nigeria, with a view to having information about the basic infrastructure, personnel, equipment, and processes in place to complement the acute peri-operative and medical emergencies in Nigeria. MATERIALS AND METHODS This was a cross-sectional survey of public and private intensive care units (ICUs) in Nigeria at the instance of the Intensive and Critical Care Society of Nigeria. Structured questionnaires were sent and collated over a 4-month period. Information on the institutions, ICU equipment and personnel were collected and analyzed using SPSS version 21(Chicago, Illinois). Data are presented in numbers, percentages, medians, and interquartile ranges (IQR) as appropriate. RESULTS A total of 30 ICUs spread within all the six geo-political zones in Nigeria took part in this survey. Majority (63.3%) of them were located in teaching hospitals. The median number of ICU beds and equipment in hospitals surveyed were beds, 5(4-6), ventilators, 3 (1-4); multiparameter monitor, 4 (3-5.25) and arterial blood gas machine, 0(0-1). The anaesthetists led in running 90% of the units. CONCLUSION This survey showed a low ICU bed capacity and deficits in basic and advanced haemodynamic monitoring equipment. There is also shortage of trained ICU Physicians.
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Affiliation(s)
- Obashina Ogunbiyi
- Intensive and Critical Care Society of Nigeria, c/o Department of Anaesthesia, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Arinola Sanusi
- Department of Anaesthesia, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Babatunde Osinaike
- Department of Anaesthesia, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria.
| | - Saidu Yakubu
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Muyiwa Rotimi
- Department of Anaesthesia, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Oluwabunmi Fatungase
- Department of Anaesthesia, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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Ramakrishnan N, Baronia AK, Divatia JV, Bhagwati A, Chawla R, Iyer S, Jani CK, Joad S, Kamat V, Kapadia F, Mehta Y, Myatra SN, Nagarkar S, Nayyar V, Padhy S, Rajagopalan R, Ray B, Sahu S, Sampath S, Todi S. Critical care delivery in intensive care units in India: Defining the functions, roles and responsibilities of a consultant intensivist. Indian J Crit Care Med 2020. [DOI: 10.5005/ijccm-17-s1-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sendur SN, Topeli A. The effect of the first-year residents orientation period on intensive care and hospital mortality, in a medical intensive care unit, within a developing country. J Crit Care 2019; 51:105-110. [PMID: 30798097 DOI: 10.1016/j.jcrc.2019.02.020] [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: 10/22/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine whether the adaptation of junior residents, during their first week rotation period within the ICU, has any effect on ICU and hospital mortality rates, in a developing country. MATERIALS AND METHODS Patients who were admitted to the ICU were included, with 1207 out of 1547 of the admitted patients being eligible. The effect of age, gender, co-morbidities, the cause of the ICU admission, the presence of hospital-acquired infections, residents rotation week, admission time (weekday vs. weekend), number of patients admitted on the same day (one vs. two or more) and APACHE II score upon the ICU and hospital mortality rates were evaluated. RESULTS The first rotation week of junior residents is an independent risk factor determining hospital mortality (OR (95% CI) = 2.42 (1.23-4.76); p = .010). The effect of the first rotation week on intensive care mortality was not statistically significant (1.92 (0.97-3.84); p = .063). In addition, the presence of malignancy, sepsis-septic shock, hospital-acquired infection and high APACHE II score were found to be other independent determinants of increased hospital mortality. CONCLUSION The junior residents first rotation week is an independent risk factor on hospital mortality, in a tertiary medical intensive care unit, within a developing country.
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Affiliation(s)
- Suleyman Nahit Sendur
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Arzu Topeli
- Division of Intensive Care Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Divatia JV, Amin PR, Ramakrishnan N, Kapadia FN, Todi S, Sahu S, Govil D, Chawla R, Kulkarni AP, Samavedam S, Jani CK, Rungta N, Samaddar DP, Mehta S, Venkataraman R, Hegde A, Bande BD, Dhanuka S, Singh V, Tewari R, Zirpe K, Sathe P. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study. Indian J Crit Care Med 2016; 20:216-25. [PMID: 27186054 PMCID: PMC4859158 DOI: 10.4103/0972-5229.180042] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). Patients and Methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. Conclusions: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.
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Affiliation(s)
- Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India
| | - Pravin R Amin
- Department of Medicine and Critical Care, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - Farhad N Kapadia
- Department of Medicine and Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Subhash Todi
- Department of Critical Care Medicine, AMRI Hospitals Dhakuria, Kolkata, West Bengal, India
| | - Samir Sahu
- Department of Critical Care and Pulmonology, AMRI Hospitals, Bhubaneswar, Odisha, India
| | - Deepak Govil
- Institute of Anesthesia and Critical Care, Medanta The Medicity, Gurgaon, Haryana, India
| | - Rajesh Chawla
- Department of Pulmonary and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Atul P Kulkarni
- Division of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India
| | - Srinivas Samavedam
- Department of Critical Care Medicine, Century Super Speciality Hospital, Banjara Hills, Hyderabad, Telangana, India
| | - Charu K Jani
- Department of Critical Care Medicine, Saifee Hospital, Mumbai, India
| | - Narendra Rungta
- Department of Critical Care Medicine, Jeevan Rekha Critical Care and Trauma Hospital, Jaipur, Rajasthan, India
| | - Devi Prasad Samaddar
- Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Sujata Mehta
- Department of Medicine and Critical Care, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Ashit Hegde
- Department of Medicine and Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - B D Bande
- Department of Critical Care, KEM Hospital, Pune, Maharashtra, India
| | - Sanjay Dhanuka
- Department of Critical Care Medicine, Greater Kailash Hospital, Indore, Madhya Pradesh, India
| | - Virendra Singh
- Department of Pulmonology, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Reshma Tewari
- Department of Critical Care Medicine, Artemis Health Institute, Gurgaon, Haryana, India
| | - Kapil Zirpe
- Department of Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prachee Sathe
- Department of Critical Care Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
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Timmers TK, Verhofstad MHJ, Leenen LPH. Intensive care organisation: Should there be a separate intensive care unit for critically injured patients? World J Crit Care Med 2015; 4:240-243. [PMID: 26261775 PMCID: PMC4524820 DOI: 10.5492/wjccm.v4.i3.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/12/2015] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
In the last two decennia, the mixed population general intensive care unit (ICU) with a “closed format” setting has gained in favour compared to the specialized critical care units with an “open format” setting. However, there are still questions whether surgical patients benefit from a general mixed ICU. Trauma is a significant cause of morbidity and mortality throughout the world. Major or severe trauma requiring immediate surgical intervention and/or intensive care treatment. The role and type of the ICU has received very little attention in the literature when analyzing outcomes from critical injuries. Severely injured patients require the years of experience in complex trauma care that only a surgery/trauma ICU can provide. Should a trauma center have the capability of a separate specialized ICU for trauma patients (“closed format”) next to its standard general mixed ICU
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Kabbani MS, Hijazi O, Elbarbary M, Ismail S, Shaath G, Jijeh A. Pediatric cardiac intensive care at the King Abdulaziz Cardiac Center. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/suu017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Singh S, Goyal R, Ramesh GS, Ravishankar V, Sharma RM, Bhargava DV, Singh SK, John MK, Sharma A. Control of hospital acquired infections in the ICU: A service perspective. Med J Armed Forces India 2014; 71:28-32. [PMID: 25609860 DOI: 10.1016/j.mjafi.2014.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 08/08/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The service setting has some unique strengths and weaknesses that must be kept in mind when organizing Hospital acquired infections (HAI) prevention interventions. METHODS Following an initial study to gather data regarding HAI in the Surgical intensive care unit (ICU) we put into place various infection control interventions. The present study was carried out to analyse the effect of these interventions on the incidence of HAI in the ICU. RESULTS The total admissions to the ICU were 253 patients. Eighty eight patients (34.78%) were admitted for more than 48 hr, 165 patients stayed for less than 48 h. The frequency of HAI was 7.95% (95% CI 3.54, 15). Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%) (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000 ventilator days. Bloodstream infection was detected in 3 out of 88 patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections per 1000 Central Venous Catheter days. Urinary tract infection was observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per 1000 catheter days. As compared to the previous study we found that there was a decline of HAI ranging from 60 to 70%. CONCLUSION Our study demonstrated that by meticulously following infection control protocols especially tailored to the service setting the incidence of HAI's can be reduced. However, the challenge is in maintaining the gains achieved since there is a rapid turnover of manpower in the ICU and a lack of a structured ICU design model.
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Affiliation(s)
- Shivinder Singh
- Senior Adviser (Anaesthesiology & Critical Care), Command Hospital (Western Command), C/O 56 APO, India
| | - Rakhee Goyal
- Senior Advisor (Anaesthesiology), Command Hospital (Southern Command), Pune 411040, India
| | - G S Ramesh
- Ex-Professor & Head, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India
| | - V Ravishankar
- Commandant, Command Hospital (Southern Command), Pune 411040, India
| | - R M Sharma
- Associate Professor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India
| | - D V Bhargava
- Clinical Tutor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India
| | - S K Singh
- Assistant Professor, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India
| | - M K John
- Resident, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India
| | - Anoop Sharma
- Resident, Dept. of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, India
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Abstract
Although critical care medicine has been established as a separate specialty in the rest of the world it is still in its initial stages of development in Nepal and intensive care units (ICUs) here are still in primitive stages. This article describes the history, the types and current status of ICUs, the challenges, and academic training and certification in critical care medicine in Nepal, compared with existing ICUs in other parts of the world.
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Affiliation(s)
- Subhash Prasad Acharya
- Tribhuvan University Teaching Hospital, Institute of Medicine (IOM), Maharajgunj, Kathmandu, Nepal
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Do Intensivist Staffing Patterns Influence Hospital Mortality Following ICU Admission? A Systematic Review and Meta-Analyses*. Crit Care Med 2013; 41:2253-74. [DOI: 10.1097/ccm.0b013e318292313a] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Balachandran R, Nair SG, Gopalraj SS, Vaidyanathan B, Kumar RK. Dedicated pediatric cardiac intensive care unit in a developing country: Does it improve the outcome? Ann Pediatr Cardiol 2012; 4:122-6. [PMID: 21976869 PMCID: PMC3180967 DOI: 10.4103/0974-2069.84648] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION AND AIM Focussed cardiac intensive care is known to produce better outcomes. We have evaluated the benefits of a dedicated Pediatric Cardiac Intensive Care Unit (PCICU) in the early postoperative outcomes of patients undergoing surgery for congenital heart disease. METHODS Prospectively collected data of 634 consecutive patients who underwent congenital heart surgery from September 2008 to September 2009 were analyzed. Midway through this period a dedicated PCICU was started. The patients who were treated in this new PCICU formed the study group (Group B, n = 318). The patients who were treated in a common postoperative cardiac surgery ICU formed the control group (Group A, n = 316). Early postoperative outcomes between the two groups were compared. RESULTS The two groups were comparable with respect to demographic data and intraoperative variables. The duration of mechanical ventilation in the dedicated pediatric cardiac ICU group (32.22 ± 52.02 hours) was lower when compared with the combined adult and pediatric surgery ICU group (42.92 ± 74.24 hours, P= 0.04). There was a shorter duration of ICU stay in the dedicated pediatric cardiac ICU group (2.69 ± 2.9 days vs. 3.43 ± 3.80 days, P = 0.001). The study group also showed a shorter duration of inotropic support and duration of invasive lines. The incidence of blood stream infections was also lower in the dedicated pediatric ICU group (5.03 vs. 9.18%, P = 0.04). A subgroup analysis of neonates and infants <1 year showed that the advantages of a dedicated pediatric intensive care unit were more pronounced in this group of patients. CONCLUSIONS Establishment of a dedicated pediatric cardiac intensive care unit has shown better outcomes in terms of earlier extubation, de-intensification, and discharge from the ICU. Blood stream infections were also reduced.
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Affiliation(s)
- Rakhi Balachandran
- Department of Anesthesia, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
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Hackner D, Shufelt CL, Balfe DD, Lewis MI, Elsayegh A, Braunstein GD, Mosenifar Z. Do faculty intensivists have better outcomes when caring for patients directly in a closed ICU versus consulting in an open ICU? Hosp Pract (1995) 2012; 37:40-50. [PMID: 20877170 DOI: 10.3810/hp.2009.12.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intensivists have been associated with decreased mortality in several studies, but in one major study, centers with intensivist-staffed units reported increased mortality compared with controls. We hypothesized that a closed unit, in which a unit-based intensivist directly provides and coordinates care on all cases, has improved mortality and utilization compared with an open unit, in which individual attendings and consultants provide care, while intensivists serve as supervising consultants. METHODS We undertook the retrospective study of outcomes in 2 intensive care units (ICUs)-a traditional open unit managed by faculty intensivists and a second closed unit overseen by the same faculty intensivists who coordinated the care on all patients in a large community hospital. PRIMARY OUTCOME In-hospital mortality. SECONDARY OUTCOMES Hospital length of stay (LOS), ICU LOS, and relative costs of hospitalization. RESULTS From January 2006 to December 2007, we identified 2602 consecutive admissions to the 2 medical ICUs. Of all patients admitted to the closed and open units, 19.2% and 24.7%, respectively, did not survive (P < 0.001, adjusted for severity). Median hospital LOS was 10 days for the closed unit and 12 days for the open unit (P < 0.001). Median ICU LOS was 2.2 days for the closed unit and 2.4 days for the open unit (P = NS). The unadjusted cost index for the open unit was 1.11 relative to the closed unit (1.0) (P < 0.001). However, after adjusting for disease severity, cost differences were not significantly different. CONCLUSIONS We observed significant reductions in mortality and hospital LOS for patients initially admitted to a closed ICU versus an open unit. We did not observe a significant difference in ICU LOS or total cost after adjustment for severity.
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Affiliation(s)
- Dani Hackner
- Pulmonary/Critical Care Medicine Division, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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De Jong A, Jung B, Chanques G, Jaber S, Molinari N. Obesity and mortality in critically ill patients: another case of the simpson paradox? Chest 2012; 141:1637-1638. [PMID: 22670030 DOI: 10.1378/chest.11-3302] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Audrey De Jong
- Anesthesiology and Critical Care Department, Saint Eloi Hospital, University Hospital of Montpellier-INSERM, Montpellier, France
| | - Boris Jung
- Anesthesiology and Critical Care Department, Saint Eloi Hospital, University Hospital of Montpellier-INSERM, Montpellier, France
| | - Gérald Chanques
- Anesthesiology and Critical Care Department, Saint Eloi Hospital, University Hospital of Montpellier-INSERM, Montpellier, France
| | - Samir Jaber
- Anesthesiology and Critical Care Department, Saint Eloi Hospital, University Hospital of Montpellier-INSERM, Montpellier, France.
| | - Nicolas Molinari
- The Medical and Informatic Department, Lapeyronie University Hospital of Montpellier, Montpellier, France
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Osinaike BB, Akinyemi OA, Sanusi AA. ICU Cutilization by Cardio-Thoracic Patients in a Nigerian Teaching Hospital: Any Role for HDU? Niger J Surg 2012; 18:75-9. [PMID: 24027398 PMCID: PMC3762008 DOI: 10.4103/1117-6806.103108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The underlying pathological conditions in cardio-thoracic patients, anesthetic and operative interventions often lead to complex physiological interactions that necessitate ICU care. Our objectives were to determine the intensive care unit (ICU) utilization by cardio-thoracic patients in our centre, highlight the common indications for admission; and evaluate the interventions provided in the ICU and the factors that determined outcome. Materials and Methods: The intensive care unit (ICU) records of University College Hospital, Ibadan for a period of 2 years (October 2007 to September 2009) were reviewed. Data of cardio-thoracic patients were extracted and used for analysis. Information obtained included the patient demographics, indications for admission, interventions offered in the ICU and the outcome. Results: A total of 1, 207 patients were managed in the ICU and 206 cardio-thoracic procedures were carried out during the study period. However, only 96 patients were admitted into the ICU following cardio-thoracic procedures, accounting for 7.9% of ICU admissions and 46.6% of cardio-thoracic procedures done within the review period. The mean length of stay and ventilation were 5.71 ± 5.26 and 1.30 ± 2.62 days. The most significant predictor of outcome was endotracheal intubation (P = 0.001) and overall mortality was 15%. Conclusion: There is a high utilization of the ICU by cardio-thoracic patients in our review and post-operative care was the main indication for admission. Some selected cases may be managed in the HDU to reduce the burden on ICU resources. We opine that when endotracheal intubation is to continue in the ICU, a 1:1 patient ratio should be instituted.
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Affiliation(s)
- Babatunde B Osinaike
- Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Louriz M, Abidi K, Akkaoui M, Madani N, Chater K, Belayachi J, Dendane T, Zeggwagh AA, Abouqal R. Determinants and outcomes associated with decisions to deny or to delay intensive care unit admission in Morocco. Intensive Care Med 2012; 38:830-7. [PMID: 22398756 DOI: 10.1007/s00134-012-2517-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 01/17/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE To report determinants and outcomes associated with decisions to deny or to delay intensive care unit (ICU) admission in critically ill patients. METHODS An observational prospective study over a 6-month period. All adult patients triaged for admission to a medical ICU were included prospectively. Age, gender, reasons for requesting ICU admission, severity of underlying disease, severity of acute illness, mortality and ICU characteristics were recorded. Multinomial logistic regression analysis was used for evaluating predicting factors of refused ICU admission. RESULTS ICU admission was requested for 398 patients: 110 were immediately admitted (27.8%), 142 were never admitted (35.6%), and 146 were admitted at a later time (36.6%). The reasons for refusal were: too sick to benefit (31, 10.8%), too well to benefit (55, 19.1%), unit full (117, 40.6%), and more data about the patient were needed to make a decision (85, 29.5%). Multivariate analysis revealed that late ICU admission was associated with the lack of available ICU beds (OR 1.91; 95% CI 1.46-2.50; p = 0.003), cardiac disease (OR 7.77; 95% CI 2.41-25.04; p < 0.001), neurological disease (OR 3.78; 95% CI 1.40-10.26; p = 0.009), shock and sepsis (OR 2.55; 95% CI 1.06-6.13; p = 0.03), and metabolic disease (OR 2.84; 95% CI 1.11-7.30; p = 0.02). Factors for ICU refusal for never admitted patients were: severity of acute illness (OR 4.83; 95% CI 1.11-21.01; p = 0.03), cardiac disease (OR 14.26; 95% CI 3.95-51.44; p < 0.001), neurological disease (OR 4.05; 95% CI 1.33-12.28; p = 0.01) and lack of available ICU beds (OR 6.26; 95% CI 4.14-9.46; p < 0.001). Hospital mortality was 33.3% (37/110) for immediately admitted patients, 43.8% (64/146) for patients admitted later and 49.3% (70/142) for never admitted patients. CONCLUSION Refusal of ICU admission was correlated with the severity of acute illness, lack of ICU beds and reasons for admission request. Further efforts are needed to define which patients are most likely to benefit from ICU admission and to improve the accuracy of data on ICU refusal rates.
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Affiliation(s)
- Maha Louriz
- Medical Intensive Care Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco
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18
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Surgical intensive care unit--the trauma surgery perspective. Langenbecks Arch Surg 2011; 396:429-46. [PMID: 21369845 DOI: 10.1007/s00423-011-0765-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/21/2011] [Indexed: 01/04/2023]
Abstract
PURPOSE This review addresses and summarizes the key issues and unique specific intensive care treatment of adult patients from the trauma surgery perspective. MATERIALS AND METHODS The cornerstones of successful surgical intensive care management are fluid resuscitation, transfusion protocol and extracorporeal organ replacement therapies. The injury-type specific complications and unique pathophysiologic regulatory mechanisms of the traumatized patients influencing the critical care treatment are discussed. CONCLUSIONS Furthermore, the fundamental knowledge of the injury severity, understanding of the trauma mechanism, surgical treatment strategies and specific techniques of surgical intensive care are pointed out as essentials for a successful intensive care therapy.
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Abstract
Critical care is often described as expensive care. However, standardized methodology that would enable determination and international comparisons of cost is currently lacking. This article attempts to review this important issue and develop a framework through which cost of critical care in India could be analyzed.
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Affiliation(s)
- Raja Jayaram
- Department of Anesthesiology, John Radcliffe Hospital, Oxford, UK
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20
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Macleod JBA, Jones T, Aphivantrakul P, Chupp M, Poenaru D. Evaluation of fundamental critical care course in Kenya: knowledge, attitude, and practice. J Surg Res 2009; 167:223-30. [PMID: 20031171 DOI: 10.1016/j.jss.2009.08.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 08/08/2009] [Accepted: 08/27/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Critical care training for medical personnel is crucial for the survival of the highest acuity patients. The Fundamental Critical Care Course (FCCS), a critical care course developed by the Society of Critical Care Medicine, permits course adaption and, thus, has potential for global dissemination. The FCCS course was provided in two Kenyan hospitals after minimal adaption. Participant knowledge and confidence gain as well as FCCS applicability to an African context were evaluated. METHODS Questionnaires and a multiple-choice test were administered to assess knowledge, attitude, and self-reported confidence or self-efficacy. For applicability, the pre-course questionnaire assessed participant expectations and existing levels of confidence/knowledge in the care of the critically ill patient. Post-course, the participant evaluated the overall quality of the course, lectures, and skill stations along with context applicability questions. RESULTS There were 100 participants, 45 doctors, 45 nurses, and 10 clinical officers. There was a 22.7% gain in the mean test score (P < 0.0001) after the course, with 98% of participants showing improvement. Confidence to perform new skills post-course, or self-efficacy, was demonstrated by a median of 4 or greater on a Likert scale of 5 (most confident) in 10 of 12 clinical scenarios and in 11 of 14 new procedures. There was a consistency between areas reported as needed expertise, and participant evaluation of similar lecture and skill station's quality and appropriateness. The most common areas reported were mechanical ventilation, patient monitoring, and their related procedures. CONCLUSIONS The FCCS course met participant's expectations and was reported as applicable for the Kenyan context with minimal adaption. Post-course, knowledge improved and confidence increased for implementation of new skills in clinical care situations. We confirmed the effectiveness and relevancy of the FCCS course for other resource-constrained health care settings.
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Affiliation(s)
- Jana B A Macleod
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Glenn Memorial Building, 69 Jesse Hill Jr. Ave., Suite No. 315, Atlanta, GA 30303, USA.
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Organizational characteristics of the austere intensive care unit: the evolution of military trauma and critical care medicine; applications for civilian medical care systems. Crit Care Med 2008; 36:S275-83. [PMID: 18594253 DOI: 10.1097/ccm.0b013e31817da825] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Critical care in the U.S. military has significantly evolved in the last decade. More recently, the U.S. military has implemented organizational changes, including the use of multidisciplinary teams in austere environments to improve outcomes in severely injured polytrauma combat patients. Specifically, organizational changes in combat support hospitals located in combat zones during Operation Iraqi Freedom have led to decreased intensive care unit mortality and length of stay as well as resource use. These changes were implemented without increases in logistic support or the addition of highly technologic equipment. The mechanism for improvement in mortality is likely attributable to the adherence of basic critical care medicine fundamentals. This intensivist-directed team model provides sophisticated critical care even in the most austere environments. To optimize critically injured patients' outcomes, intensive care organizational models similar to the U.S. military, described in this article, can possibly be adapted to those of civilian care during disaster management to meet the challenges of emergency mass critical care.
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Laghi F. Weaning: can the computer help? Intensive Care Med 2008; 34:1746-8. [PMID: 18651131 DOI: 10.1007/s00134-008-1227-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 07/09/2008] [Indexed: 11/29/2022]
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Role of the pediatric intensivist in the management of pediatric trauma. ACTA ACUST UNITED AC 2008; 63:S101-5; discussion S106-12. [PMID: 18091199 DOI: 10.1097/ta.0b013e31815acc59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a substantial body of evidence supporting the importance of the intensivist, and the importance of active involvement of the intensivist in day-to-day management of patients, although there are much fewer data for pediatric trauma. Postoperative management of the pediatric trauma patient is complex and includes many nonsurgical areas of expertise, such as management of respiratory and renal failure, nutritional support, metabolic support, prevention and management of infection, and sepsis. Collaborative multidisciplinary care of these children should include the active and officially acknowledged involvement of pediatric intensivists side by side with their surgical colleagues.
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Abstract
The question of who should direct the care of critically ill patients is both multifaceted and timely. Currently, only about 30% of critical care units in the United States are staffed by dedicated intensivists. This number is likely to increase as groups such as Leapfrog financially reward hospitals that have dedicated intensivists around the clock. The problem, however, is that the supply of intensivists by training is not projected to increase, whereas the demand for health care, by all accounts, will significantly increase in the near future. There is an increasing body of literature suggesting not only morbidity and mortality benefits but decreased length of stay and profound cost savings when a team directed by critical care physicians cares for patients in the intensive care unit. Despite this, many have argued that a consultant-based unit (so called open unit) is less alienating to a patient's primary care physician or surgeon and promotes continuity of care. In addition, although much of the literature has suggested purported benefit derived from a dedicated intensivist staffing model, little has been published regarding optimal intensivist/patient ratios. If dedicated critical care teams decrease complications in the intensive care unit, one may logically reason that as the intensivist/patient ratio decreases, morbidity or mortality, or both, might increase. This, however, has not yet been shown. This article will address many of these issues, discuss the history of critical care medicine in the United States, and review the pertinent literature. With the projected shortage of critical care-trained physicians and an increasingly aging population, it is imperative that health professionals evaluate this issue sooner rather than later.
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Affiliation(s)
- Jacob T Gutsche
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
OBJECTIVE The goal of this concise review is to provide an overview of some of the most important intensive care unit issues and approaches that are unique to trauma patients as compared with the general intensive care unit population. STUDY SELECTION Clinical trials in trauma patients focusing on hemorrhage control, issues in resuscitation, staged operative repair of multiple injuries, the diagnosis and therapy of the abdominal compartment syndrome, and the treatment of traumatic brain injury were identified on PubMed. CONCLUSIONS The intensive care unit care of the trauma patient differs from that of other intensive care unit patients in many ways, one of the most important being the need to continuously integrate operative and nonoperative therapy. Although progress in the care of the injured has been made, death due to uncontrolled bleeding, severe head injury, or the development of multiple organ dysfunction syndrome remains all too common in this patient population. Furthermore, due to the potential nature of the injuries, the conundrum not infrequently arises that the optimal treatment for one injury or organ system, such as preoperative permissive hypotension in actively bleeding patients, may result in suboptimal or even deleterious therapy in the presence of another injury, such as traumatic brain injury. LEARNING OBJECTIVES On completion of this article, the reader should be able to:Dr. Deitch has disclosed that he is/was the recipient of grant/research funds from Celgene. Dr. Dayal has disclosed that she has no financial relationships with or interests in any commercial companies pertaining to this educational activity. Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.
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Affiliation(s)
- Edwin A Deitch
- Department of Surgery, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark, USA
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The trauma surgeon as intensivist: the Argentine vision. Curr Opin Crit Care 2006. [DOI: 10.1097/01.ccx.0000235220.02107.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Applying evidence-based practice: lessons from dying surgical critical patients in Saudi Arabia. Curr Opin Crit Care 2006. [DOI: 10.1097/01.ccx.0000235218.94483.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nathens AB, Maier RV, Jurkovich GJ, Monary D, Rivara FP, Mackenzie EJ. The delivery of critical care services in US trauma centers: is the standard being met? ACTA ACUST UNITED AC 2006; 60:773-83; disucssion 783-4. [PMID: 16612297 DOI: 10.1097/01.ta.0000196669.74076.50] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although there is substantial evidence supporting the benefits of an intensivist model of critical care delivery, the extent to which this model has been adopted by trauma centers across the United States is unknown. We set out to evaluate how critical care is delivered in Level I and II trauma centers and the extent to which these centers implement evidence-based patient care practices known to improve outcome. METHODS All Level I and Level II trauma centers in the United States were surveyed using a previously validated questionnaire pertaining to the organizational characteristics of critical care units. Questions identifying the impediments to the implementation of an intensivist model of critical care delivery were added to the original survey. An intensivist model intensive care unit (ICU) was defined as one meeting all of the following criteria: a) the physician director was board certified in critical care; b) >50% of physicians responsible for care were board certified in critical care; c) an intensivist made daily rounds on the patients; and d) an intensive care team had the authority to write orders on the patients. The survey respondents were also queried regarding the extent to which they complied with evidence-based guidelines for care in the ICU. RESULTS The overall response rate was 65% (295 centers). Only 61% of Level I centers and 22% of Level II centers provided an intensivist model of critical care delivery. Sixty-nine percent of centers had a form of collaborative care with an intensivist, but few centers had dedicated intensivists without responsibilities outside the ICU. The most common reason cited for not involving an intensivist in the delivery of critical care services was a concern regarding a loss of continuity of care. There was limited implementation of evidence-based practices in the ICU; the model of critical care delivery had no effect on rates of implementation of these practices. CONCLUSION The process of trauma center verification and designation should assure a high quality of trauma care. In keeping with these expectations of quality, the delivery of critical care services in trauma centers should evolve to a model that both includes the trauma surgeon in the care of the injured and allows for collaboration with a dedicated intensivist, who may or may not be a surgeon. The benefits of an intensivist model might be distinct from the utilization of evidence-based practices, suggesting that there might be incremental benefit in using these practices as markers of quality.
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Affiliation(s)
- Avery B Nathens
- Division of Trauma and General Surgery, Harborview Medical Center, Seattle, WA 98104, USA.
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Ramakrishnan N, Baronia AK, Divatia JV, Bhagwati A, Chawla R, Iyer S, Jani CK, Joad S, Kamat V, Kapadia F, Mehta Y, Myatra SN, Nagarkar S, Nayyar V, Padhy S, Rajagopalan R, Ray B, Sahu S, Sampath S, Todi S. Critical care delivery in intensive care units in India: Defining the functions, roles and responsibilities of a consultant intensivist. Indian J Crit Care Med 2006. [DOI: 10.5005/ijccm-10-1-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mock C, Kobusingye O, Joshipura M, Nguyen S, Arreola-Risa C. Strengthening trauma and critical care globally. Curr Opin Crit Care 2005; 11:568-75. [PMID: 16292061 DOI: 10.1097/01.ccx.0000186373.49320.65] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Trauma is an increasingly significant health problem globally, especially in low-income and middle-income countries. Trauma care is often compromised by economic restrictions. Many capable individuals are attempting to meet this challenge in their own countries, however. This review summarizes such efforts and assesses how they might be expanded in a comprehensive, global fashion. RECENT FINDINGS Options for improving trauma care in the prehospital setting have been explored, including strengthening existing, basic formal emergency medical services (including ambulances); instituting new formal emergency medical services, where none had previously existed; and exploring novel ways to strengthen existing, although informal, systems of prehospital care when formal emergency medical services would be unfeasible. Affordable ways by which to strengthen hospital care have been addressed for several specific injuries, including open fractures, burns, and vascular injuries. Especially notable are growing efforts to better monitor outcomes and address factors contributing to preventable deaths. The Essential Trauma Care Project has defined and promoted core essential trauma care services that every injured person in the world realistically can and should be able to receive. This project is a collaborative effort of the World Health Organization and the International Society of Surgery. SUMMARY Individual efforts must be built upon to make progress in a comprehensive, global fashion. This review summarizes the background, achievements, and future potential of the Essential Trauma Care Project and several related efforts.
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Affiliation(s)
- Charles Mock
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington 98104, USA.
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Simpson’s Paradox. Crit Care Med 2005. [DOI: 10.1097/01.ccm.0000170185.05101.be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ERRATUM. Crit Care Med 2005. [DOI: 10.1097/00003246-200504000-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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