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Johnson NL, Moeckli J. Conceptualizations of interprofessional communication in intensive care units: findings from a scoping review. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:130-142. [PMID: 38197399 DOI: 10.1080/17538068.2023.2297124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Clinical errors in intensive care units (ICUs) are consistently attributed to communication errors. Despite its importance for patient safety and quality in critical care settings, few studies consider interprofessional communication as more than the basic exchange of information. METHODS We conducted a scoping review of interprofessional communication in ICUs to (1) characterize how communication is defined and measured and (2) identify contributions the field of health communication can make to team communication in ICUs. Through a series of queries in PubMed and Communication and Mass Media Complete databases, we identified and compared persistent gaps in how communication is framed and theorized in 28 publications from health services and 6 from social science outlets. We identified research priorities and suggested strategies for discussing communication more holistically in future health services research. RESULTS 34 articles published from 1999 to 2021 were included. Six explicitly defined communication. Six were published in social science journals, but none were authored by a communication studies scholar. Half of the articles addressed communication as a transaction focused on information transfer, and the other half addressed communication as a process. CONCLUSIONS Methodological implications are identified with the intent to encourage future interdisciplinary collaboration for studying communication in ICUs. We discuss the importance of (1) using language to describe communication that facilitates interdisciplinary engagement, (2) prioritizing communication as a process and using qualitative methods to provide insight, and (3) engaging health communication theories and experts to assist in developing more fruitful research questions and designs.
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Affiliation(s)
- Nicole L Johnson
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jane Moeckli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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3
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Vatani H, Sharma H, Azhar K, Kochendorfer KM, Valenta AL, Dunn Lopez K. Required data elements for interprofessional rounds through the lens of multiple professions. J Interprof Care 2024; 38:453-459. [PMID: 33190565 DOI: 10.1080/13561820.2020.1832447] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
The lack of a proper system for ongoing open interprofessional communication among care providers increases miscommunications and medical errors. Seamless access to patient information is important for care providers to prevent miscommunication and improve patient safety. A shared understanding of the information needs of different care providers in an interprofessional team is lacking. Our purpose is to identify care providers' information needs from the perspective of different professions for communication, shared understanding about the patient, and decision-making. We conducted semi-structured interviews with 10 subject matter experts representing eight professions, including dentistry, dietetics, medicine, nursing, occupational therapy, pharmacy, physical therapy, and social work in a 465-bed academic hospital at a large urban Midwestern city. We used an in-house rounding tool presenting physicians' information needs and a hypothetical patient scenario to collect participants' feedback. Interview notes were coded using direct content analysis. We identified 22 additional essential data elements for an interprofessional rounding tool. We categorized those into six domains: discharge-related, social determinants of health, hospital safety, nutrition, interprofessional situation awareness, and patient history. A well-designed validated rounding tool that includes an interprofessional team of care providers' information needs could improve communication, care planning, and decision-making among them.
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Affiliation(s)
- Haleh Vatani
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Himanshu Sharma
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Kamel Azhar
- Department of Family Medicine, University of Illinois, Chicago, IL, USA
| | | | - Annette L Valenta
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
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4
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Gunnels MS, Thompson SL, Jenifer Y. Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review. Crit Care Nurse 2024; 44:31-40. [PMID: 38555969 DOI: 10.4037/ccn2024942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Intensive care units are complex settings that require effective communication and collaboration among professionals in many disciplines. Rounding checklists are frequently used during interprofessional rounds and have been shown to positively affect patient outcomes. OBJECTIVE To identify and summarize the evidence related to the following practice question: In an adult intensive care unit, does the use of a rounding checklist during interprofessional rounds affect the perceived level of staff collaboration or communication? METHODS An integrative review was performed to address the practice question. No parameters were set for publication year or specific study design. Studies were included if they were set in adult intensive care units, involved the use of a structured rounding checklist, and had measured outcomes that included staff collaboration, communication, or both. RESULTS Seven studies with various designs were included in the review. Of the 7 studies, 6 showed that use of rounding checklists improved staff collaboration, communication, or both. These results have a variety of practice implications, including the potential for better patient outcomes and staff retention. CONCLUSIONS Given the complexity of the critical care setting, optimizing teamwork is essential. The evidence from this review indicates that the use of a relatively simple rounding checklist tool during interprofessional rounds can improve perceived collaboration and communication in adult intensive care units.
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Affiliation(s)
- Marshall S Gunnels
- Marshall S. Gunnels is a nurse in the neuroscience intensive care unit at Mayo Clinic, Rochester, Minnesota
| | - Susan L Thompson
- Susan L. Thompson is a clinical nurse specialist in the multispecialty intensive care unit at Mayo Clinic
| | - Yvette Jenifer
- Yvette Jenifer is a clinical nurse specialist at Johns Hopkins Bayview Medical Center and the Doctor of Nursing Practice Advanced Practice project coordinator at Johns Hopkins School of Nursing, Baltimore, Maryland
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5
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Cagle WE, Bagwell KB, Poisson MO, Petro AM, Verdone K. IDEAL PICU Rounds: Improving Daily Efficiency by Applying Lean Principles. Am J Med Qual 2023; 38:279-286. [PMID: 37908030 DOI: 10.1097/jmq.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
The objective of this project was to improve communication, patient throughput, and rounding efficiency. Primary outcome studied was transfer/discharge order entry time and secondary outcomes included medication order entry time, staff perception, and time spent per patient. The location was a level one pediatric intensive care unit in an academic children's hospital. Utilizing Lean Six methodologies the major contributor to increased variability was different attending physician rounding patterns. These patterns were evaluated by a multidisciplinary committee, and the most efficient was adopted by all attending physicians during the study period. Data was collected by secret observers and a pre-post staff perception survey. Transfer/discharge order entry improved by 45 minutes/patient. Medication order entry improved by 89 minutes/order. Staff survey showed increased satisfaction in 9 of 12 aspects. Time spent per patient increased by 20%. In conclusion, standardization of rounds improved patient throughput, medication order entry, and staff satisfaction while increasing value-added time during rounds.
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Affiliation(s)
| | | | | | - Amy Marien Petro
- Children's Hospital of Georgia at Augusta University, Augusta, GA
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6
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Abu-Rish Blakeney E, Baird J, Beaird G, Khan A, Parente VM, O’Brien KD, Zierler BK, O’Leary KJ, Weiner BJ. How and why might interprofessional patient- and family-centered rounds improve outcomes among healthcare teams and hospitalized patients? A conceptual framework informed by scoping and narrative literature review methods. Front Med (Lausanne) 2023; 10:1275480. [PMID: 37886364 PMCID: PMC10598853 DOI: 10.3389/fmed.2023.1275480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 10/28/2023] Open
Abstract
Poor communication within healthcare contributes to inefficiencies, medical errors, conflict, and other adverse outcomes. A promising model to improve outcomes resulting from poor communication in the inpatient hospital setting is Interprofessional Patient- and Family-Centered rounds (IPFCR). IPFCR brings two or more health professions together with hospitalized patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. A growing body of literature focuses on implementation and outcomes of IPFCR to improve healthcare quality and team and patient outcomes. Most studies report positive changes following IPFCR implementation. However, conceptual frameworks and theoretical models are lacking in the IPFCR literature and represent a major gap that needs to be addressed to move this field forward. The purpose of this two-part review is to propose a conceptual framework of how IPFCR works. The goal is to articulate a framework that can be tested in subsequent research studies. Published IPFCR literature and relevant theories and frameworks were examined and synthesized to explore how IPFCR works, to situate IPFCR in relation to existing models and frameworks, and to postulate core components and underlying causal mechanisms. A preliminary, context-specific, conceptual framework is proposed illustrating interrelationships between four core components of IPFCR (interprofessional approach, intentional patient and family engagement, rounding structure, shared development of a daily care plan), improvements in communication, and better outcomes.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Jennifer Baird
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Genevieve Beaird
- School of Nursing, Virginia Commonwealth University, Richmond, VA, United States
| | - Alisa Khan
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Boston Children's Hospital, Boston, MA, United States
| | | | - Kevin D. O’Brien
- Department of Cardiology, School of Medicine, University of Washington, Seattle, WA, United States
| | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Kevin J. O’Leary
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Bryan J. Weiner
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, United States
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Abstract
Data science has the potential to greatly enhance efforts to translate evidence into practice in critical care. The intensive care unit is a data-rich environment enabling insight into both patient-level care patterns and clinician-level treatment patterns. By applying artificial intelligence to these novel data sources, implementation strategies can be tailored to individual patients, individual clinicians, and individual situations, revealing when evidence-based practices are missed and facilitating context-sensitive clinical decision support. To achieve these goals, technology developers should work closely with clinicians to create unbiased applications that are integrated into the clinical workflow.
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Affiliation(s)
- Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA; Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA.
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8
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King AJ, Angus DC, Cooper GF, Mowery DL, Seaman JB, Potter KM, Bukowski LA, Al-Khafaji A, Gunn SR, Kahn JM. A voice-based digital assistant for intelligent prompting of evidence-based practices during ICU rounds. J Biomed Inform 2023; 146:104483. [PMID: 37657712 PMCID: PMC10591951 DOI: 10.1016/j.jbi.2023.104483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/21/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To evaluate the technical feasibility and potential value of a digital assistant that prompts intensive care unit (ICU) rounding teams to use evidence-based practices based on analysis of their real-time discussions. METHODS We evaluated a novel voice-based digital assistant which audio records and processes the ICU care team's rounding discussions to determine which evidence-based practices are applicable to the patient but have yet to be addressed by the team. The system would then prompt the team to consider indicated but not yet delivered practices, thereby reducing cognitive burden compared to traditional rigid rounding checklists. In a retrospective analysis, we applied automatic transcription, natural language processing, and a rule-based expert system to generate personalized prompts for each patient in 106 audio-recorded ICU rounding discussions. To assess technical feasibility, we compared the system's prompts to those created by experienced critical care nurses who directly observed rounds. To assess potential value, we also compared the system's prompts to a hypothetical paper checklist containing all evidence-based practices. RESULTS The positive predictive value, negative predictive value, true positive rate, and true negative rate of the system's prompts were 0.45 ± 0.06, 0.83 ± 0.04, 0.68 ± 0.07, and 0.66 ± 0.04, respectively. If implemented in lieu of a paper checklist, the system would generate 56% fewer prompts per patient, with 50%±17% greater precision. CONCLUSION A voice-based digital assistant can reduce prompts per patient compared to traditional approaches for improving evidence uptake on ICU rounds. Additional work is needed to evaluate field performance and team acceptance.
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Affiliation(s)
- Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Gregory F Cooper
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Offices at Baum 4th Floor, 5607 Baum Blvd, Pittsburgh, PA 15206, USA.
| | - Danielle L Mowery
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Blockley Hall 8th Floor, 423 Guardian Drive, Philadelphia, PA 19104, USA.
| | - Jennifer B Seaman
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| | - Kelly M Potter
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Leigh A Bukowski
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Ali Al-Khafaji
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Scott R Gunn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Scaife Hall Suite 600, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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9
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Herzog TL, Sawatsky AP, Kelm DJ, Nelson DR, Park JG, Niven AS. The Resident Learning Journey in the Medical Intensive Care Unit. ATS Sch 2023; 4:177-190. [PMID: 37533538 PMCID: PMC10391714 DOI: 10.34197/ats-scholar.2022-0103oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/27/2023] [Indexed: 08/04/2023] Open
Abstract
Background The medical intensive care unit (MICU) offers rich resident learning opportunities, but traditional teaching strategies can be difficult to employ in this fast-paced, high-acuity environment. Resident perspectives of learning within this environment may improve our understanding of the common challenges residents face and inform novel approaches to transform the MICU educational experience. Objective We conducted a qualitative study of internal medicine residents to better understand their approach to learning the critical care activities that they are entrusted to perform in the MICU. Methods Using a thematic analysis approach, we conducted six focus group interviews with 15 internal medicine residents, separated by postgraduate year. A trained investigator led each interview, which was audio-recorded and transcribed verbatim for analysis. Our diverse research team, representing different career stages across the continuum of learning to minimize interpretive bias, identified codes and subsequent themes inductively. We refined these themes through group discussion and sensitizing social learning theory concepts using Wenger's community of practice and organized them to create learner archetypes and a conceptual framework of resident learning in the MICU. Results We identified three thematic resident learning categories: learning goals and motivation, clinical engagement, and interprofessional collaboration. We distinguished three learner archetypes, the novice, experiential learner, and practicing member, to describe progressive resident development within the interprofessional MICU team, the challenges they frequently encounter, and potential teaching strategies to facilitate learning. Conclusion We developed a conceptual framework that describes the resident's journey to becoming a trusted, collaborating member of the interprofessional MICU team. We identified common developmental challenges residents face and offer educational strategies that may support their progress. These findings should inform future efforts to develop novel teaching strategies to promote resident learning in the MICU.
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Affiliation(s)
| | - Adam P. Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Diana J. Kelm
- Division of Pulmonary and Critical Care Medicine and
| | | | - John G. Park
- Division of Pulmonary and Critical Care Medicine and
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10
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Warren C, Chignell M, Pinkney SJ, Armstrong BA, Guerguerian AM, Laussen PC, Trbovich PL. Effects of Unit Census and Patient Acuity Levels on Discussions During Patient Rounds. Pediatr Crit Care Med 2023; 24:e253-e257. [PMID: 36815778 PMCID: PMC10153663 DOI: 10.1097/pcc.0000000000003194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES PICU teams adapt the duration of patient rounding discussions to accommodate varying contextual factors, such as unit census and patient acuity. Although studies establish that shorter discussions can lead to the omission of critical patient information, little is known about how teams adapt their rounding discussions about essential patient topics (i.e., introduction/history, acute clinical status, care plans) in response to changing contexts. To fill this gap, we examined how census and patient acuity impact time spent discussing essential topics during individual patient encounters. DESIGN Observational study. SETTING PICU at a university-affiliated children's hospital, Toronto, ON, Canada. SUBJECTS Interprofessional morning rounding teams. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We observed 165 individual patient encounters during morning rounds over 10 weeks. Regardless of census or patient acuity, the duration of patient introductions/history did not change. When census was high versus low, acute clinical status discussions significantly decreased for both low acuity patients (00 min:50 s high census; 01 min:39 s low census; -49.5% change) and high acuity patients (01 min:10 s high census; 02 min:02 s low census; -42.6% change). Durations of care plan discussions significantly reduced as a function of census (01 min:19 s high census; 02 min:52 s low census; -54.7% change) for low but not high acuity patients. CONCLUSIONS Under high census and patient acuity levels, rounding teams disproportionately shorten time spent discussing essential patient topics. Of note, while teams preserved time to plan the care for acute patients, they cut care plan discussions of low acuity patients. This study provides needed detail regarding how rounding teams adapt their discussions of essential topics and establishes a foundation for consideration of varying contextual factors in the design of rounding guidelines. As ICUs are challenged with increasing census and patient acuity levels, it is critical that we turn our attention to these contextual aspects and understand how these adaptations impact clinical outcomes to address them.
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Affiliation(s)
- Carly Warren
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mark Chignell
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Sonia J. Pinkney
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Bonnie A. Armstrong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Humanera, Office of Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Peter C. Laussen
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Patricia L. Trbovich
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Humanera, Office of Research and Innovation, North York General Hospital, Toronto, ON, Canada
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11
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Witz I, Lucchese S, Valenzano TJ, Penney T, Lodge R, Topolovec-Vranic J, Bellicoso D. Perceptions on implementation of a new standardized reporting tool to support structured morning rounds: Recommendations for interprofessional teams and healthcare leaders. J Med Imaging Radiat Sci 2022; 53:S85-S92. [PMID: 35798671 DOI: 10.1016/j.jmir.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022]
Abstract
Structured morning rounds have been used to improve communication, provide learning opportunities, and support patient care in various healthcare settings. The leadership team in an inner-city Inpatient Mental Health Unit identified a gap in the structure of morning rounds; to remedy this, a standardized reporting tool and structured morning rounding process were implemented. This short communication reports on an evaluation of staff...s perceptions on the outcomes of using a standardized reporting tool and structured rounding process to improve efficiency and communication regarding patient care among an interprofessional team. Feedback was provided on logistics, attendance, supporting factors that ensured ease of use for the new structure, and benefits of the program. While this evaluation focuses on the opinions of nurses, it serves as an example for leadership in various healthcare units on the benefits of a structured rounding program, and key factors that contribute to making the process successful. This short communication also provides an example for an efficient communication tool that can be adapted to meet the needs of various groups of healthcare disciplines.
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Affiliation(s)
- Ifat Witz
- Inpatient Mental Health Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Stephanie Lucchese
- Inpatient Mental Health Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Teresa J Valenzano
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada; Health Disciplines Practice and Education, Unity Health Toronto, Toronto, Canada; Interprofessional Practice Based Research, Interprofessional Practice, Unity Health Toronto, Toronto, Canada
| | - Tasha Penney
- Inpatient Mental Health Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Rachel Lodge
- Inpatient Mental Health Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Jane Topolovec-Vranic
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada; Interprofessional Practice Based Research, Interprofessional Practice, Unity Health Toronto, Toronto, Canada
| | - Daniela Bellicoso
- Interprofessional Practice Based Research, Interprofessional Practice, Unity Health Toronto, Toronto, Canada.
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12
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Dos Santos Alves DF, Moraes ÉS, Conti PBM, Bueno GCV, de Souza TH, Pereira EOP, Brandão MB, Peterlini MAS, Pedreira MLG. A Pediatric Intensive Care Checklist for Interprofessional Rounds: The R-PICniC Study. Am J Crit Care 2022; 31:383-389. [PMID: 36045045 DOI: 10.4037/ajcc2022533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The use of checklists in the pediatric intensive care unit can help improve the quality of care and patient safety. OBJECTIVES To build and validate a checklist for use in interprofessional rounds in a pediatric intensive care unit. METHODS This methodological study was conducted in a 20-bed pediatric intensive care unit serving children up to 14 years old. A checklist prototype was constructed through review of the literature and achievement of consensus among the professionals providing care in the unit. Content validation was performed using a modified Delphi technique involving specialists with more than 5 years of experience in pediatric intensive care, methodological studies, and patient safety. Content validity ratios were calculated for the elements of the checklist, which were considered valid when they reached values greater than 0.78. The checklist was tested for usability, application time, and effects on patient care, and feedback was obtained from potential users. RESULTS Before content validation, the checklist contained 11 domains, 32 items, and 6 daily goals. The invitation to validate content was sent to 86 specialists, and content validity was achieved after 2 rounds of evaluation, with the checklist elements having content validity ratios ranging from 0.94 to 0.97. The mean application time of the checklist was 5 minutes. The final version consisted of 11 domains, 33 items, and 8 daily goals. CONCLUSIONS This study resulted in a useful and valid instrument for application in interprofessional rounds that was tailored to the needs of local health care professionals.
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Affiliation(s)
- Daniela Fernanda Dos Santos Alves
- Daniela Fernanda dos Santos Alves is a professor of pediatric nursing, School of Nursing, State University of Campinas, Brazil, and a postdoctorate fellow, São Paulo School of Nursing, Federal University of São Paulo, São Paulo, Brazil
| | - Érika Sana Moraes
- Érika Sana Moraes is a PhD student, Clinical Hospital, State University of Campinas
| | | | | | | | | | | | - Maria Angélica Sorgini Peterlini
- Maria Angélica Sorgini Peterlini is a professor of pediatric nursing, São Paulo School of Nursing, Federal University of São Paulo
| | - Mavilde Luz Gonçalves Pedreira
- Mavilde Luz Gonçalves Pedreira is a professor of pediatric nursing, São Paulo School of Nursing, Federal University of São Paulo
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13
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Chan SJ, Archibald HL, Conner SM. NET Rounding: a novel approach to efficient and effective rounds for the modern clinical learning environment. BMC MEDICAL EDUCATION 2022; 22:600. [PMID: 35927659 PMCID: PMC9351275 DOI: 10.1186/s12909-022-03599-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Rounds are a foundational practice in patient care and education in the inpatient healthcare environment, but increased demands on inpatient teams have led to dissatisfaction with inefficient, ineffective rounds. In this study, we describe the design, implementation, and evaluation of a novel rounding framework ("NET Rounding") that provides behaviorally-based strategies to inpatient teams to achieve efficient rounds while preserving patient safety and education. METHODS NET Rounding consists of nine recommendations divided into three categories: Novel rounding strategies, shared Expectations, and Time management. This framework was introduced as a bundled intervention at a single-site, quaternary-care, academic hospital from March-May 2021. Eighty-three residents and 64 attendings rotated on the inpatient teaching service during the intervention period. Participants were surveyed before, during, and after their rotation about rounding's contribution to educational value, patient safety, resident duty hour violations and rotation experience. Additionally, rounding duration was recorded daily by team attendings. RESULTS Thirty-two residents (38.5%) and 45 attendings (70%) completed post-intervention surveys. Rounding duration was recorded on 529/626 rounding days (80.6%) and resulted in achieving efficient rounds on 412/529 days (77.9%). Residents reported improvement in perceived patient safety (54 to 84%, p = 0.0131) and educational value of rounds (38 to 69%, p = 0.0213) due to NET Rounding; no change was observed amongst attendings in these areas (79 to 84% and 70 to 80%, p = 0.7083 and 0.4237, respectively). Overall, 29/32 residents (91%) and 33/45 attendings (73%) reported a positive impact on rotation experience. CONCLUSIONS NET Rounding enabled inpatient teaching teams to complete rounds more efficiently while preserving patient safety and education.
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Affiliation(s)
- Shirley J Chan
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA
| | - Hannah L Archibald
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA
| | - Stephanie M Conner
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA.
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Effect of Early Low-Calorie Enteral Nutrition Support in Critically Ill Patients: A Systematic Review and Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7478373. [PMID: 35832844 PMCID: PMC9273443 DOI: 10.1155/2022/7478373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Objective The purpose of this research was to rigorously assess the impact of early low-fever enteral feeding supplementation in critically sick patients. Methods PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were searched for randomized controlled trials related to enteral nutrition support of critically ill patients (retrieval time was limited to June 30, 2021); data were extracted after screening the literature, and the quality of meta-analysis was evaluated. Results When compared to adequate caloric enteral nutrition support, early low caloric enteral nutrition support reduces the incidence of intolerance to nutrition support (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13) and the insulin dose during enteral nutrition support (MD = -17.21, 95 percent CI: -19.91 to -14.51, P = 0.00001). However, it had no effect on intensive care unit (ICU) treatment duration (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13), in-hospital mortality (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13), or infection incidence (OR = 1.00, 95 percent CI: 0.85, 1.19, P = 0.98). Conclusion When compared to sufficient caloric enteral nutrition support, early low-calorie enteral nutrition support lowers the risk of severe illness. The rate of intolerance to nutritional assistance and the decrease in insulin dosage supplied had no effect on the length of ICU therapy, patient death, or infection incidence.
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dos Santos Alves DF, da Silva SO, Ullman A, Maia FDOM. Effectiveness of checklists in multidisciplinary rounds for improving patient safety in the pediatric intensive care unit: a systematic review protocol. JBI Evid Synth 2022; 20:1835-1841. [DOI: 10.11124/jbies-21-00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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16
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Mao JY, Zhang HM, Liu DW, Wang XT. Visual Rounds Based on Multiorgan Point-of-Care Ultrasound in the ICU. Front Med (Lausanne) 2022; 9:869958. [PMID: 35692540 PMCID: PMC9174546 DOI: 10.3389/fmed.2022.869958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) is performed by a treating clinician at the patient's bedside, provides a acquisition, interpretation, and immediate clinical integration based on ultrasonographic imaging. The use of POCUS is not limited to one specialty, protocol, or organ system. POCUS provides the treating clinician with real-time diagnostic and monitoring information. Visual rounds based on multiorgan POCUS act as an initiative to improve clinical practice in the Intensive Care Unit and are urgently needed as part of routine clinical practice.
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Affiliation(s)
- Jia-Yu Mao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiao-Ting Wang
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Implementing Rounding Checklists in a Pediatric Oncologic Intensive Care Unit. CHILDREN 2022; 9:children9040580. [PMID: 35455624 PMCID: PMC9025551 DOI: 10.3390/children9040580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
Standardized rounding checklists during multidisciplinary rounds (MDR) can reduce medical errors and decrease length of pediatric intensive care unit (PICU) and hospital stay. We added a standardized process for MDR in our oncologic PICU. Our study was a quality improvement initiative, utilizing a four-stage Plan–Do–Study–Act (PDSA) model to standardize MDR in our PICU over 3 months, from January 2020 to March 2020. We distributed surveys to PICU RNs to assess their understanding regarding communication during MDR. We created a standardized rounding checklist that addressed key elements during MDR. Safety event reports before and after implementation of our initiative were retrospectively reviewed to assess our initiative’s impact on safety events. Our intervention increased standardization of PICU MDR from 0% to 70% over three months, from January 2020 to March 2020. We sustained a rate of zero for CLABSI, CAUTI, and VAP during the 12-month period prior to, during, and post-intervention. Implementation of a standardized rounding checklist may improve closed-loop communication amongst the healthcare team, facilitate dialogue between patients’ families and the healthcare team, and reduce safety events. Additional staffing for resource RNs, who assist with high acuity patients, has also facilitated bedside RN participation in MDR, without interruptions in clinical care.
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Lai CH, Li KW, Hu FW, Su PF, Hsu IL, Huang MH, Huang YT, Liu PY, Shen MR. Integration of an ICU Visualization Dashboard (i-Dashboard) as a Platform to Facilitate Multidisciplinary Rounds: A Cluster Randomized Controlled Trial (Preprint). J Med Internet Res 2022; 24:e35981. [PMID: 35560107 PMCID: PMC9143774 DOI: 10.2196/35981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/20/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Multidisciplinary rounds (MDRs) are scheduled, patient-focused communication mechanisms among multidisciplinary providers in the intensive care unit (ICU). Objective i-Dashboard is a custom-developed visualization dashboard that supports (1) key information retrieval and reorganization, (2) time-series data, and (3) display on large touch screens during MDRs. This study aimed to evaluate the performance, including the efficiency of prerounding data gathering, communication accuracy, and information exchange, and clinical satisfaction of integrating i-Dashboard as a platform to facilitate MDRs. Methods A cluster-randomized controlled trial was performed in 2 surgical ICUs at a university hospital. Study participants included all multidisciplinary care team members. The performance and clinical satisfaction of i-Dashboard during MDRs were compared with those of the established electronic medical record (EMR) through direct observation and questionnaire surveys. Results Between April 26 and July 18, 2021, a total of 78 and 91 MDRs were performed with the established EMR and i-Dashboard, respectively. For prerounding data gathering, the median time was 10.4 (IQR 9.1-11.8) and 4.6 (IQR 3.5-5.8) minutes using the established EMR and i-Dashboard (P<.001), respectively. During MDRs, data misrepresentations were significantly less frequent with i-Dashboard (median 0, IQR 0-0) than with the established EMR (4, IQR 3-5; P<.001). Further, effective recommendations were significantly more frequent with i-Dashboard than with the established EMR (P<.001). The questionnaire results revealed that participants favored using i-Dashboard in association with the enhancement of care plan development and team participation during MDRs. Conclusions i-Dashboard increases efficiency in data gathering. Displaying i-Dashboard on large touch screens in MDRs may enhance communication accuracy, information exchange, and clinical satisfaction. The design concepts of i-Dashboard may help develop visualization dashboards that are more applicable for ICU MDRs. Trial Registration ClinicalTrials.gov NCT04845698; https://clinicaltrials.gov/ct2/show/NCT04845698
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Affiliation(s)
- Chao-Han Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kai-Wen Li
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Fang-Wen Hu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Pei-Fang Su
- Department of Statistics, College of Management, National Cheng Kung University, Tainan City, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Min-Hsin Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ping-Yen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Clinical Medical Research, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Meng-Ru Shen
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Bani Hani DA, Alshraideh JA, Alshraideh B. Patients' experiences in the intensive care unit in Jordan: A cross-sectional study. Nurs Forum 2022; 57:49-55. [PMID: 34523138 DOI: 10.1111/nuf.12650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/18/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
AIMS The purpose of this study was to describe the experiences of Jordanian patients during their stay in intensive care unit (ICU) and to explore associated factors. BACKGROUND Various factors can negatively affect patients' experiences and lead to negative consequences that can affect their outcomes. MATERIALS & METHODS A descriptive, correlational design was used to collect data from 150 patients using the Intensive Care Experience Questionnaire through structured interviews after being transferred from medical and surgical ICUs to general wards. RESULTS The results showed that the longer the length of ICU stay (LOS) (>7 days) the higher frightening experience (r = 0.2, p < 0.05), the lower awareness of surrounding (r = -0.28, p < 0.01), and the lower satisfaction with care (r = -0.22, p < 0.01). The results showed a negative correlation between receiving sedation and awareness of surroundings (r = -0.33, p < 0.01), and recall of ICU experiences (r = -0.23, p < 0.01), and a positive correlation with frightening experiences (r = 0.2, p < 0.05). CONCLUSION Health care activities, clinical and socio-demographic factors can affect the psychological experiences of patients in the ICU. Longer ICU stay is associated with more negative experiences.
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Affiliation(s)
- Dania Ahmad Bani Hani
- Department of Clinical Nursing, School of Nursing, University of Jordan, Amman, Jordan
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Shivananda S, Osiovich H, de Salaberry J, Hait V, Gautham KS. Improving Efficiency of Multidisciplinary Bedside Rounds in the NICU: A Single Centre QI Project. Pediatr Qual Saf 2022; 7:e511. [PMID: 35071954 PMCID: PMC8782118 DOI: 10.1097/pq9.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 08/18/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Inconsistent workflow, communication, and role clarity generate inefficiencies during bedside rounds in a neonatal intensive care unit. These inefficiencies compromise the time needed for essential activities and result in reduced staff and family satisfaction. This study’s primary aim was to reduce the mean duration of bedside rounds by 25% within 3 months by redesigning the rounding processes and applying QI principles. The secondary aims were to improve staff and family experience. Methods: We conducted this work in an academic 50-bed neonatal intensive care unit involving 350 staff members. The change interventions included: (i) reinforcing essential value-added activities like standardizing rounding time, the sequencing of patients rounded, sequencing each team member rounding presentations, team preparation, bedside presentation content, and time management; (ii) reducing non-value-added activities; and (iii) moving value-added nonessential activities outside of the rounds. Results: The mean duration of rounds decreased from 229 minutes in the pre-implementation to 132 minutes in the postimplementation phase. The proportion of staff showing satisfaction regarding various components of the rounds increased from 5% to 60%, and perceived staff involvement during the rounds increased from 70% to 77%. Ninety-three percent of family experience survey respondents expressed satisfaction at being invited for bedside reporting and being involved in decision-making or care planning. The staff did not report any adverse events related to the new rounds process. Conclusion: Redesigning bedside rounds improved staff engagement and workflow, resulting in efficient rounds and better staff experience.
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21
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Au SS, Roze des Ordons AL, Blades KG, Stelfox HT. Best practices toolkit for family participation in ICU rounds. J Eval Clin Pract 2021; 27:1066-1075. [PMID: 33230927 DOI: 10.1111/jep.13517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/25/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Guidelines recommend inviting family members of intensive care unit (ICU) patients to rounds. We aimed to create a toolkit to support family participation in ICU bedside rounds, based upon evidence from research and in collaboration with ICU family member representatives and healthcare providers. METHODS Ethnographic observations of rounds and interviews and focus groups with family members and ICU healthcare providers were analyzed for key themes, barriers and facilitators of participation, and suggestions. A full day workshop with family representatives and providers (physicians, nurses, social workers, and unit managers) from a diverse range of adult ICUs in Western Canada, including several community ICUs and a majority of large, urban ICUs enabled the collaborative development of key toolkit elements. RESULTS We have developed an evidence-informed approach to patient-and-family-centered rounds that highlights the importance of six key elements foundational to patient and family centered rounds: Invitation, Orientation, Engagement, Summary, Questions, and Communication Follow-Up. We describe strategies, techniques, and templates to optimize these elements and interactions so that communication is more meaningful, and to facilitate the ability of family members to adopt a meaningful role as contributing members of the care team. CONCLUSION There is consensus on general strategies for facilitating family participation in rounds and meaningful communication between family and the healthcare team during rounds as an important element of the continuum of communication in the ICU. The incorporation of these elements should be standardized, though tailored to user needs.
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Affiliation(s)
- Selena S Au
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Amanda L Roze des Ordons
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Division of Palliative Care, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth G Blades
- Ward of the 21st Century Research & Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Geva A, Albert BD, Hamilton S, Manning MJ, Barrett MK, Mirchandani D, Harty M, Morgan EC, Kleinman ME, Mehta NM. eSIMPLER: A Dynamic, Electronic Health Record-Integrated Checklist for Clinical Decision Support During PICU Daily Rounds. Pediatr Crit Care Med 2021; 22:898-905. [PMID: 33935271 PMCID: PMC8490208 DOI: 10.1097/pcc.0000000000002733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration. DESIGN Before-after quality-improvement study. SETTING Quaternary PICU in an academic, free-standing children's hospital. PATIENTS All patients in the PICU during daily morning rounds. INTERVENTIONS Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record. MEASUREMENTS AND MAIN RESULTS The prior daily rounding checklist, eSIMPLE, was implemented for 49,709 patient-days (7,779 patients) between October 30, 2011, and October 7, 2018. eSIMPLER was implemented for 5,306 patient-days (971 patients) over 6 months. Checklist completion rates were similar (eSIMPLE: 95% [95% CI, 88-98%] vs eSIMPLER: 98% [95% CI, 92-100%] of patient-days; p = 0.40). eSIMPLER required less time per patient (28 ± 1 vs 47 ± 24 s; p < 0.001). Users reported improved satisfaction with eSIMPLER (p = 0.009). Several checklist-driven process measures-discordance between electronic health record orders for stress ulcer prophylaxis and user-recorded indication for stress ulcer prophylaxis, rate of venous thromboembolism prophylaxis prescribing, and recognition of reduced renal function-improved during the eSIMPLER phase. CONCLUSIONS eSIMPLER, a dynamic, electronic health record-informed checklist, required less time to complete and improved certain care processes compared with a prior, static checklist with limited electronic health record data. By focusing on the "Five Rights" of clinical decision support, we created a well-accepted clinical decision support tool that was integrated efficiently into daily rounds. Generalizability of eSIMPLER's effectiveness and its impact on patient outcomes need to be examined.
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Affiliation(s)
- Alon Geva
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Ben D. Albert
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Susan Hamilton
- Department of Cardiovascular and Critical Care Nursing, Medical-Surgical Intensive Care Unit, Boston Children’s Hospital, Boston, MA
| | - Mary-Jeanne Manning
- Department of Cardiovascular and Critical Care Nursing, Medical-Surgical Intensive Care Unit, Boston Children’s Hospital, Boston, MA
| | - Megan K. Barrett
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Dimple Mirchandani
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Matthew Harty
- Anesthesia Information Services, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Erin C. Morgan
- Anesthesia Information Services, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Monica E. Kleinman
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Nilesh M. Mehta
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
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Noritomi DT, Ranzani OT, Ferraz LJR, Dos Santos MC, Cordioli E, Albaladejo R, Serpa Neto A, Correa TD, Berwanger O, de Morais LC, Schettino G, Cavalcanti AB, Rosa RG, Biondi RS, Salluh JI, Azevedo LCP, Pereira AJ. TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE): protocol for a cluster-randomised clinical trial on adult general ICUs in Brazil. BMJ Open 2021; 11:e042302. [PMID: 34155070 PMCID: PMC8217943 DOI: 10.1136/bmjopen-2020-042302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Daily multidisciplinary rounds (DMRs) consist of systematic patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on care performance will reduce ICU length of stay compared with a control group. METHODS AND ANALYSIS A multicentre, controlled, cluster-randomised superiority trial including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised to a complex-intervention composed by daily rounds carried out through Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8 ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an intensivist, specialised or step-down units. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board (IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for submission before the end of patient's enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each participating unit. TRIAL REGISTRATION NUMBER NCT03920501; Pre-results.
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Affiliation(s)
- Danilo Teixeira Noritomi
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Clinical Governance, DASA, Sao Paulo, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Otavio T Ranzani
- Pulmonary Division, Heart Institute, Hospital das Clinicas, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Catalunya, Spain
| | | | - Maura C Dos Santos
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo Cordioli
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Ary Serpa Neto
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
| | - Thiago D Correa
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
| | - Otávio Berwanger
- Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
| | - Lubia Caus de Morais
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Guilherme Schettino
- Institute of Social Responsibility, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- HCor Research Institute, Sao Paulo, SP, Brazil
| | - Regis Goulart Rosa
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Intensive Care, HMV, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Santos Biondi
- Instituto de Cardiologia do Distrito Federal, Brasília, Distrito Federal, Brazil
- Hospital Brasília, Brasília, DF, Brazil
| | - Jorge If Salluh
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Luciano Cesar Pontes Azevedo
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil
- Emergency Medicine Department, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Adriano Jose Pereira
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Postgraduate Program of Health Sciences, Universidade Federal de Lavras, Lavras, MG, Brazil
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Lane-Fall MB, Christakos A, Russell GC, Hose BZ, Dauer ED, Greilich PE, Hong Mershon B, Potestio CP, Pukenas EW, Kimberly JR, Stephens-Shields AJ, Trotta RL, Beidas RS, Bass EJ. Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial. Implement Sci 2021; 16:63. [PMID: 34130725 PMCID: PMC8204062 DOI: 10.1186/s13012-021-01131-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings. METHODS The Handoffs and Transitions in Critical Care-Understanding Scalability (HATRICC-US) study is a Type 2 hybrid effectiveness-implementation trial of standardized operating room (OR) to intensive care unit (ICU) handoffs. This mixed methods study will use a stepped wedge design with randomized roll out to test the effectiveness of a customized protocol for structuring communication between clinicians in the OR and the ICU. The study will be conducted in twelve ICUs (10 adult, 2 pediatric) based in five United States academic health systems. Contextual inquiry incorporating implementation science, systems engineering, and human factors engineering approaches will guide both protocol customization and identification of protocol implementation determinants. Implementation mapping will be used to select appropriate implementation strategies for each setting. Human-centered design will be used to create a digital toolkit for dissemination of study findings. The primary implementation outcome will be fidelity to the customized handoff protocol (unit of analysis: handoff). The primary effectiveness outcome will be a composite measure of new-onset organ failure cases (unit of analysis: ICU). DISCUSSION The HATRICC-US study will customize, implement, and evaluate standardized procedures for OR to ICU handoffs in a heterogenous group of United States academic medical center intensive care units. Findings from this study have the potential to improve postsurgical communication, decrease adverse clinical outcomes, and inform the implementation of other evidence-based practices in critical care settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04571749 . Date of registration: October 1, 2020.
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Affiliation(s)
| | - Athena Christakos
- 3400 Spruce Street 6th Floor Dulles Building, Philadelphia, PA 19104 USA
| | - Gina C. Russell
- 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104 USA
| | - Bat-Zion Hose
- 423 Guardian Drive, 333 Blockley Hall, Philadelphia, PA 19104 USA
| | | | | | | | | | | | - John R. Kimberly
- 3620 Locust Walk, 2109 Steinberg-Dietrich Hall, Philadelphia, PA 19104 USA
| | | | | | | | - Ellen J. Bass
- Drexel University, 3675 Market Street, Suite 1000, Philadelphia, PA 19104 USA
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Structure and concept of ICU rounds: the VIS-ITS survey. Med Klin Intensivmed Notfmed 2021; 117:276-282. [PMID: 34125258 PMCID: PMC9061682 DOI: 10.1007/s00063-021-00830-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022]
Abstract
Objective To gather data about structural and procedural characteristics of patient rounds in the intensive care unit (ICU) setting. Design A structured online survey was offered to members of two German intensive care medicine societies. Measurements and main results Intensivists representing 390 German ICUs participated in this study (university hospitals 25%, tertiary hospitals 23%, secondary hospitals 36%, primary hospitals 16%). In 90% of participating ICUs, rounds were reported to take place in the morning and cover an average of 12 intensive care beds and 6 intermediate care beds within 60 min. With an estimated bed occupancy of 80%, this averaged to 4.3 min spent per patient during rounds. In 96% of ICUs, rounds were stated to include a bedside visit. On weekdays, 86% of the respondents reported holding a second ICU round with the attendance of a qualified decision-maker (e.g. board-certified intensivist). On weekends, 79% of the ICUs performed at least one round with a decision-maker per day. In 18%, only one ICU round per weekend was reported, mostly on Sundays. The highest-qualified decision-maker present during rounds on most ICUs was an ICU attending (57%). Residents (96%) and intensive care nurses (87%) were stated to be always or usually present during rounds. In contrast, physiotherapists, respiratory therapists or medical specialists such as pharmacists or microbiologist were not regular members of the rounding team on most ICUs. In the majority of cases, the participants reported examining the medical chart directly before or during the bedside visit (84%). An electronic patient data management system (PDMS) was available on 31% of ICUs. Daily goals were always (55%) or usually (39%) set during rounds. Conclusion This survey gives a broad overview of the structure and processes of ICU rounds in different sized hospitals in Germany. Compared to other mostly Anglo-American studies, German ICU rounds appear to be shorter and less interdisciplinary.
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Roze des Ordons AL, Au S, Blades K, Stelfox HT. Family participation in ICU rounds-Working toward improvement. J Eval Clin Pract 2020; 26:1620-1628. [PMID: 31916653 DOI: 10.1111/jep.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Family participation in Intensive Care Unit (ICU) bedside rounds has been advocated as a way to improve communication between families and health care providers; however, the associated impact and modulators have not been fully described. The purpose of this study was to explore benefits, drawbacks, barriers, and facilitators to family participation in ICU rounds in order to inform ways to improve how families are integrated into rounds. METHODS This was a qualitative exploratory study of ICU patients' family members (n = 29) and health care providers (n = 35) who work in ICU settings. Interviews and focus groups were conducted, and thematic analysis was used for data analysis. RESULTS Benefits and drawbacks for families were related to knowledge and emotional impact and for health care providers were related to knowledge and transparency, with rapport as an additional benefit and logistical impact as a drawback. Barriers and facilitators during rounds and outside of rounds were identified, and suggestions for improvement included preparing and orienting families, summarizing, teaching modifications, follow-up, and organizational culture. CONCLUSIONS Our study provides insight into the multiple processes involved in family participation in ICU rounds, along with suggestions for improvement. Our findings may help guide development of a structured approach to family participation in ICU rounds that can be adapted to local contexts.
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Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine; Department of Anesthesiology; Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Selena Au
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kenneth Blades
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
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Fordyce CB, Katz JN, Alviar CL, Arslanian-Engoren C, Bohula EA, Geller BJ, Hollenberg SM, Jentzer JC, Sims DB, Washam JB, van Diepen S. Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e379-e406. [DOI: 10.1161/cir.0000000000000909] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU. This scientific statement evaluates strategies to avoid the potentially preventable complications encountered within contemporary CICUs, focusing on those that are most applicable to the CICU environment. This scientific statement reviews evidence-based practices derived in non–CICU populations, assesses their relevance to CICU practice, and highlights key knowledge gaps warranting further investigation to attenuate patient risk.
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Chapman LB, Kopp KE, Petty MG, Hartwig JLA, Pendleton KM, Langer K, Meiers SJ. Benefits of collaborative patient care rounds in the intensive care unit. Intensive Crit Care Nurs 2020; 63:102974. [PMID: 33262010 DOI: 10.1016/j.iccn.2020.102974] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Improving care of critically ill patients requires using an interprofessional care model and care standardisation. OBJECTIVES Determine whether collaborative patient care rounds in the intensive care unit increases practice consistency with respect to common considerations such as delirium prevention, device use, and indicated prophylaxis, among others. Secondary objective to assess whether collaborative interprofessional format improved nursing perceptions of collaboration. METHODS Single centre, pre- and post- intervention design. collaborative patient care rounding format implemented in three intensive care units in an academic tertiary care centre. format consisted of scripted nursing presentation, provider checklist of additional practice considerations, and daily priority goals documentation. measurements included nursing participation, consideration of selected practice items, daily goal verbalisation, and nursing perception of collaboration. RESULTS Pre- and post-intervention measurements indicate gains in consideration of eight of thirteen bundle items (p < 0.05), with the greatest gains seen in nurse-presented items. Increases were observed in verbalisation of daily goals (59.8% versus 89.1%, p < 0.0001), nurse participation (83.9% versus 91.8%, p = 0.056), and nurse collaboration ratings (p < 0.0001). CONCLUSION This study describes implementation of collaborative patient care rounds with corresponding increases in consideration of selected practice items, verbalisation of daily goals, and perceptions of collaboration.
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Affiliation(s)
- Leah B Chapman
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States; University of Minnesota Medical Center, Minneapolis, MN, United States.
| | - Kathleen E Kopp
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States; University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Michael G Petty
- University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Jodi L A Hartwig
- University of Minnesota Medical Center, Minneapolis, MN, United States
| | - Kathryn M Pendleton
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Kimberly Langer
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States
| | - Sonia J Meiers
- Department of Graduate Nursing, Winona State University, Rochester, MN, United States
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Hartfiel N, Sadera G, Treadway V, Lawrence C, Tudor Edwards R. A clinical librarian in a hospital critical care unit may generate a positive return on investment. Health Info Libr J 2020; 38:97-112. [PMID: 33196136 DOI: 10.1111/hir.12332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit. OBJECTIVE The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital. METHODS Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention. Total costs included salary and equipment costs. Total monetised benefits included time saving for hospital staff, support for professional development and improved patient care. RESULTS When total monetised benefits were compared with total costs, the 15-month clinical librarian intervention generated a positive ROI of £1.18-£3.03 for every £1 invested. DISCUSSION Using outcome measures derived from previous research, this novel study generated promising results indicative for commissioners seeking to improve patient care and deliver value for money. To improve generalisability, multisite studies using standardised ROI tools are recommended. CONCLUSION Employing a clinical librarian in a critical care unit can generate a positive ROI.
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Affiliation(s)
- Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Girendra Sadera
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Victoria Treadway
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Catherine Lawrence
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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Custer JW, Simone S, Bhutta AT. Bedside Rounds in Intensive Care Units during the COVID-19 Pandemic and Beyond. J Pediatr Intensive Care 2020; 10:210-215. [PMID: 34395039 DOI: 10.1055/s-0040-1716578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022] Open
Abstract
A survey-based pilot study was performed to examine the feasibility of videoconferencing to facilitate multidisciplinary rounds following the initiation of strict isolation and social distancing policies in a pediatric intensive care unit (PICU). The use of a mobile workstation was implemented as the central hub for rounding at the bedside by the attending physicians, while other members of the multidisciplinary and multispecialty team joined rounds from other locations with maintaining appropriate social distance. Fifty-eight staff members who participated in videoconferencing rounds completed the postimplementation survey. Eighty-eight per cent of staff agreed that the use of videoconferencing to facilitate rounds was an effective strategy to maintain social distancing between team members during the pandemic. Sixty-four percent of staff agreed that the use of videoconferencing improved participation of the PICU team and consultants by increasing access to rounds. Over 50% of staff agreed that the use of videoconferencing improved the efficiency of rounds and team productivity. Only 4% of staff responded that videoconferencing increased the duration of rounds and 37% responded that it decreased resident and team education. Fifty-five percent of staff agreed that videoconferencing was used to promote parental participation during this pandemic month. Videoconferencing was found to be a feasible solution to safely conduct multidisciplinary rounds while maintaining social distancing, and participants found it effective without interfering with normal workflow. Incorporating videoconferencing into traditional rounding practices may be advantageous following the pandemic to improve team and family access to rounds and workflow efficiency and rounding structure.
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Affiliation(s)
- Jason W Custer
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Shari Simone
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Adnan T Bhutta
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
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Kydonaki K, Takashima M, Mitchell M. Family ward rounds in intensive care: An integrative review of the literature. Int J Nurs Stud 2020; 113:103771. [PMID: 33080477 DOI: 10.1016/j.ijnurstu.2020.103771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The involvement of family members in the ward rounds is a novel but under-researched family-centered care intervention in adult intensive care units, with limited evidence on the impact it has on patient and family-centered outcomes. OBJECTIVES This integrative review aimed to understand how family rounds are implemented in critical care and to appraise the evidence on outcomes for patients, family members, and healthcare professionals. DESIGN An integrative review methodological framework permitted the inclusion of all research designs. DATA SOURCES MEDLINE; CINAHL; PsycINFO; Cochrane Library; Web of Science Current Contents Connect; Web of Science-Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global, Embase were systematically searched. REVIEW METHODS We reviewed studies that referred to or used as an intervention the involvement of family members in daily critical care team rounds. We included primary research in adult intensive care units regardless of patients' length of stay. We excluded patients receiving end-of-life care. We considered any outcome related to the critically ill patient and/or their family member, outcomes related to the healthcare professionals, and outcomes related to clinical and/or nursing treatment. The Mixed Methods Appraisal Tool was used to appraise the quality of the studies. The review was registered in the Prospero database. RESULTS From the 541 articles initially retrieved, 15 studies met the inclusion criteria and were included in the review. Studies originated from the United States of America and Canada since 2003, and a variety of designs were used. Four before and after studies and a non-randomized experimental study explored the impact of structured family rounds on family and staff satisfaction, showing limited improvement in satisfaction. Six cross-sectional survey studies explored family members' and clinicians' perceptions and demonstrated a positive attitude towards family-centered rounds, but some concerns were raised from the nursing staff. Three qualitative studies and a mixed-methods study identified structural and cultural factors influencing healthcare professionals' and families' acceptance of family rounds. Most studies were of poor to moderate quality, with limited confidence in the outcomes reported. CONCLUSIONS Most studies reported improved family satisfaction as the main outcome. Future research should focus on longitudinal patient and family-centered outcomes, including mental health outcomes, and on qualitative data to understand the processes, barriers, and facilitators to implement family-centered rounds in intensive care units.
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Affiliation(s)
- Kalliopi Kydonaki
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, 9 Sighthill Court, EH11 4BN Edinburgh, UK.
| | - Mari Takashima
- School of Medicine, Centre for Applied Health Economics, Griffith University, Nathan campus, N16 -1.10K, QLD 4111, Australia.
| | - Marion Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Address N48 2.14, Nathan Campus, 170 Kessels Road, Nathan, QLD 4111, Australia.
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Organizational Characteristics Associated With ICU Liberation (ABCDEF) Bundle Implementation by Adult ICUs in Michigan. Crit Care Explor 2020; 2:e0169. [PMID: 32885171 DOI: 10.1097/cce.0000000000000169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation. Design We surveyed ICU physician and nurse leaders, assessing their safety culture, ICU team collaboration, and work environment. Using logistic and linear regression models, we compared these organizational characteristics to bundle element implementation, and also compared physician and nurse leaders' perceptions about organizational characteristics and bundle implementation. Setting All (n = 72) acute care hospitals with adult ICUs in Michigan. Subjects ICU physician and nurse leader pairs from each hospital's main ICU. Interventions We developed, pilot-tested, and deployed an electronic survey to all subjects over a 3 month period in 2016. Results Results from 73 surveys (28 physicians, 45 nurses, 60% hospital response rate) demonstrated significant variation in hospital and ICU size and type, organizational characteristics, and physician/nurse perceptions of ICU organization and bundle implementation. We found that a robust safety culture and collaborative work environment that uses checklists to facilitate team communication are strongly associated with bundle implementation. There is also a significant dose-response effect between safety culture, a collaborative work environment, and overall bundle implementation. Conclusions We identified several specific ICU practices that can facilitate ABCDEF Bundle implementation. Our results can be used to develop effective bundle implementation strategies that leverage safety culture, interprofessional collaboration, and routine checklist use in ICUs to improve bundle implementation and performance.
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Concha-Torre A, Alonso YD, Blanco SÁ, Allende AV, Mayordomo-Colunga J, Barrio BF. The checklists: A help or a hassle? An Pediatr (Barc) 2020. [DOI: 10.1016/j.anpede.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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[The checklists: A help or a hassle?]. An Pediatr (Barc) 2020; 93:135.e1-135.e10. [PMID: 32591318 DOI: 10.1016/j.anpedi.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022] Open
Abstract
Patient safety has become a central component of quality of care. One of the best known and most widely used security tool in all work settings is the checklist. The checklist is a tool that helps to not forget any step during the performance of a procedure, to do tasks with an established order, to control the fulfilment of a series of requirements or to collect data in a systematic way for its subsequent analysis. It is an aid to improve the efficiency of teamwork, promote communication, decrease variability, standardize care and improve patient safety. Main barriers to implementation are reviewed: staff attitudes, hierarchies, poor design, inadequate training, duplication with other work lists, work overload, cultural barriers, lack of replication or checklist closing time. Finally, its applications in Pediatrics are reviewed starting from the most widespread, the safety checklist of pediatric surgery, checklists in neonatal critical units, for safe delivery, for risk procedures, in pediatric intensive care and for pathology time-dependent emergent, e.g. pediatric trauma. It is necessary to highlight the role of leadership in the implantation of a checklist in any area of Pediatrics. There must be one or more people from the team with the support of the Heads of Service and Managers who lead the training of the personnel, direct the implementation of the LV, evaluate the results, inform the rest of the team and can modify the processes depending on the problems found.
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Beaird G, Baernholdt M, Byon HD, White KR. Interprofessional rounding design features and associations with collaboration and team effectiveness. J Interprof Care 2020; 35:343-351. [PMID: 32530333 DOI: 10.1080/13561820.2020.1768058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multiple models of interprofessional rounding (IPR) exist. However, researchers find mixed effects for the impact of IPR, pointing to the possibility that variations in design may influence the effectiveness of the practice. We explored whether IPR design variations (location, use of script, and role of the leader) are associated with team collaboration (partnership and cooperation) and team effectiveness as perceived by practitioners and patients (i.e., patient inclusion). A cross-sectional, survey-based method design was used targeting practitioners on 15 different hospital units at two academic health centers. Routinely collected Hospital Consumer Assessment of Healthcare Practitioners and Systems scores were used to capture patients' perceptions. Statistical methods included multilevel modeling with moderation analysis. There were several significant relationships among design, team collaboration, and team effectiveness. For the design, role of the leader and use of a script had a significant positive association with cooperation. Practitioners' perceptions of team effectiveness were associated with use of script, and cooperation moderated the relationships between practitioners' perceptions of team effectiveness and location, as well as the role of the leader. There was a significant inverse relationship between cooperation and patient inclusion. Results can inform organizations that are exploring, implementing, or improving IPR as well as considering alternative ways to evaluate their practices.
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Affiliation(s)
- Genevieve Beaird
- Department of Family and Community Health, Virginia Commonwealth University School of Nursing
| | | | - Ha Do Byon
- University of Virginia School of Nursing, USA
| | - Kenneth R White
- Office of the Dean, Strategic Partnerships & Innovation, University of Virginia School of Nursing
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Franklin BJ, Gandhi TK, Bates DW, Huancahuari N, Morris CA, Pearson M, Bass MB, Goralnick E. Impact of multidisciplinary team huddles on patient safety: a systematic review and proposed taxonomy. BMJ Qual Saf 2020; 29:1-2. [PMID: 32265256 DOI: 10.1136/bmjqs-2019-009911] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/16/2020] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite significant advances, patient safety remains a critical public health concern. Daily huddles-discussions to identify and respond to safety risks-have been credited with enhancing safety culture in operationally complex industries including aviation and nuclear power. More recently, huddles have been endorsed as a mechanism to improve patient safety in healthcare. This review synthesises the literature related to the impact of hospital-based safety huddles. METHODS We conducted a systematic review of peer-reviewed literature related to scheduled, multidisciplinary, hospital-based safety huddles through December 2019. We screened for studies (1) in which huddles were the primary intervention being assessed and (2) that measured the huddle programme's apparent impact using at least one quantitative metric. RESULTS We identified 1034 articles; 24 met our criteria for review, of which 19 reflected unit-based huddles and 5 reflected hospital-wide or multiunit huddles. Of the 24 included articles, uncontrolled pre-post comparison was the prevailing study design; we identified only two controlled studies. Among the 12 unit-based studies that provided complete measures of statistical significance for reported outcomes, 11 reported statistically significant improvement among some or all outcomes. The objectives of huddle programmes and the language used to describe them varied widely across the studies we reviewed. CONCLUSION While anecdotal accounts of successful huddle programmes abound and the evidence we reviewed appears favourable overall, high-quality peer-reviewed evidence regarding the effectiveness of hospital-based safety huddles, particularly at the hospital-wide level, is in its earliest stages. Additional rigorous research-especially focused on huddle programme design and implementation fidelity-would enhance the collective understanding of how huddles impact patient safety and other targeted outcomes. We propose a taxonomy and standardised reporting measures for future huddle-related studies to enhance comparability and evidence quality.
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Affiliation(s)
- Brian J Franklin
- University of Michigan Medical School, Ann Arbor, Michigan, USA .,Harvard Business School, Boston, Massachusetts, USA
| | | | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nadia Huancahuari
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charles A Morris
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michelle Beth Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Barcellos RDA, Chatkin JM. Impact of a multidisciplinary checklist on the duration of invasive mechanical ventilation and length of ICU stay. J Bras Pneumol 2020; 46:e20180261. [PMID: 32236341 PMCID: PMC7572285 DOI: 10.36416/1806-3756/e20180261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/30/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: To assess the impact that implementing a checklist during daily multidisciplinary rounds has on the duration of invasive mechanical ventilation (IMV) and length of ICU stay. Methods: This was a non-randomized clinical trial in which the pre-intervention and post-intervention duration of IMV and length of ICU stay were evaluated in a total of 466 patients, including historical controls, treated in three ICUs of a hospital in the city of Caxias do Sul, Brazil. We evaluated 235 and 231 patients in the pre-intervention and post-intervention periods, respectively. The following variables were studied: age; gender; cause of hospitalization; diagnosis on admission; comorbidities; the Simplified Acute Physiology Score 3; the Sequential Organ Failure Assessment score; days in the ICU; days on IMV; reintubation; readmission; in-hospital mortality; and ICU mortality. Results: After the implementation of the checklist, the median (interquartile range) for days in the ICU and for days on IMV decreased from 8 (4-17) to 5 (3-11) and from 5 (1-12) to 2 (< 1-7), respectively, and the differences were significant (p ≤ 0.001 for both). Conclusions: The implementation of the checklist during daily multidisciplinary rounds was associated with a reduction in the duration of IMV and length of ICU stay among the patients in our sample.
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Affiliation(s)
- Ruy de Almeida Barcellos
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - José Miguel Chatkin
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Stollings JL, Devlin JW, Lin JC, Pun BT, Byrum D, Barr J. Best Practices for Conducting Interprofessional Team Rounds to Facilitate Performance of the ICU Liberation (ABCDEF) Bundle. Crit Care Med 2020; 48:562-570. [PMID: 32205603 DOI: 10.1097/ccm.0000000000004197] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Daily ICU interprofessional team rounds, which incorporate the ICU Liberation ("A" for Assessment, Prevention, and Manage Pain; "B" for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; "C" for Choice of Analgesia and Sedation; "D" for Delirium Assess, Prevent, and Manage; "E" for Early Mobility and Exercise; "F" for Family Engagement and Empowerment [ABCDEF]) Bundle, support both the care coordination and regular provider communication necessary for Bundle execution. This article describes evidence-based practices for conducting effective interprofessional team rounds in the ICU to improve Bundle performance. DESIGN Best practice synthesis. METHODS The authors, each extensively involved in the Society of Critical Care Medicine's ICU Liberation Campaign, reviewed the pertinent literature to identify how ICU interprofessional team rounds can be optimized to increase ICU Liberation adherence. RESULTS Daily ICU interprofessional team rounds that foster ICU Liberation Bundle use support both care coordination and regular provider communication within and between teams. Evidence-based best practices for conducting effective interprofessional team rounds in the ICU include the optimal structure for ICU interprofessional team rounds; the importance of conducting rounds at patients' bedside; essential participants in rounds; the inclusion of ICU patients and their families in rounds-based discussions; and incorporation of the Bundle into the Electronic Health Record. Interprofessional team rounds in the ICU ideally employ communication strategies to foster inclusive and supportive behaviors consistent with interprofessional collaboration in the ICU. Patient care discussions during interprofessional team rounds benefit from being patient-centered and goal-oriented. Documentation of ICU Liberation Bundle elements in the Electronic Health Record may help facilitate team communication and decision-making. CONCLUSIONS Conducting high-quality interprofessional team rounds in the ICU is a key strategy to support ICU Liberation Bundle use.
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Affiliation(s)
- Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
| | - John W Devlin
- School of Pharmacy, Northeastern University, Boston, MA
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
| | - John C Lin
- Division of Pediatrics and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Brenda T Pun
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Diane Byrum
- Innovative Solutions for Healthcare Education, LLC, Charlotte, NC
| | - Juliana Barr
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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40
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Nunnally ME, Nurok M. What Does it Take to Run an ICU and Perioperative Medicine Service? Int Anesthesiol Clin 2020; 57:144-162. [PMID: 30864997 DOI: 10.1097/aia.0000000000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mark E Nunnally
- Departments of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York.,Departments of Neurology, Surgery and Medicine, NYU Langone Health, New York, New York
| | - Michael Nurok
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Abstract
OBJECTIVES Incomplete patient data, either due to difficulty gathering and synthesizing or inappropriate data filtering, can lead clinicians to misdiagnosis and medical error. How completely ICU interprofessional rounding teams appraise the patient data set that informs clinical decision-making is unknown. This study measures how frequently physician trainees omit data from prerounding notes ("artifacts") and verbal presentations during daily rounds. DESIGN Observational study. SETTING Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds. SUBJECTS Presenters (medical student or resident physician), interprofessional rounding team. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We quantified the amount and types of patient data omitted from photocopies of physician trainees' artifacts and audio recordings of oral ICU rounds presentations when compared with source electronic health record data. An audit of 157 patient presentations including 6,055 data elements across nine domains revealed 100% of presentations contained omissions. Overall, 22.9% of data were missing from artifacts and 42.4% from presentations. The interprofessional team supplemented only 4.1% of additional available data. Frequency of trainee data omission varied by data type and sociotechnical factors. The strongest predictor of trainee verbal omissions was a preceding failure to include the data on the artifact. Passive data gathering via electronic health record macros resulted in extremely complete artifacts but paradoxically predicted greater likelihood of verbal omission when compared with manual notation. Interns verbally omitted the most data, whereas medical students omitted the least. CONCLUSIONS In an academic rounding model reliant on trainees to preview and select data for presentation during ICU rounds, verbal appraisal of patient data was highly incomplete. Additional trainee oversight and education, improved electronic health record tools, and novel academic rounding paradigms are needed to address this potential source of medical error.
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Kassutto S, Seam N, Carlos WG, Kelm D, Kaul V, Stewart NH, Hinkle L. Twelve tips for conducting successful interprofessional teaching rounds. MEDICAL TEACHER 2020; 42:24-29. [PMID: 30707849 DOI: 10.1080/0142159x.2018.1545086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Inpatient bedside teaching rounds provide an opportunity to foster effective interprofessional collaboration between members of the healthcare team. Although effective interprofessional practice has been shown to improve patient satisfaction, patient outcomes, and job satisfaction, there is limited literature for successful implementation of interprofessional teaching rounds. To address this gap, we have compiled 12 tips for conducting effective interprofessional bedside teaching rounds. These tips offer strategies for creating a structured rounding system, with clear delineation of expectations, defined opportunities for learning across disciplines, and active engagement of and respect for all team members. By adopting and promoting this model of interprofessional collaborative practice, the quality and effectiveness of bedside teaching rounds can be improved for the benefit of patients, trainees, and the team as a whole.
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Affiliation(s)
- Stacey Kassutto
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nitin Seam
- Department of Critical Care Medicine, National Institutes of Health, Bethesda, MD, USA
| | - William G Carlos
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Diana Kelm
- Department of Medicine, Mayo Clinic in Rochester, Rochester, MN, USA
| | - Viren Kaul
- Division of Pulmonary & Critical Care Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Nancy H Stewart
- Division of Pulmonary & Critical Care, Creighton University Medical Center, Omaha, NE, USA
| | - Laura Hinkle
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Stollings JL, Devlin JW, Pun BT, Puntillo KA, Kelly T, Hargett KD, Morse A, Esbrook CL, Engel HJ, Perme C, Barnes-Daly MA, Posa PJ, Aldrich JM, Barr J, Carson SS, Schweickert WD, Byrum DG, Harmon L, Ely EW, Balas MC. Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative. Crit Care Nurse 2019; 39:36-45. [PMID: 30710035 DOI: 10.4037/ccn2019981] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment) improves intensive care unit patient-centered outcomes and promotes interprofessional teamwork and collaboration. The Society of Critical Care Medicine recently completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, multicenter, national quality improvement initiative that formalized dissemination and implementation strategies to promote effective adoption of the ABCDEF bundle. The purpose of this article is to describe 8 of the most frequently asked questions during the Collaborative and to provide practical advice from leading experts to other institutions implementing the ABCDEF bundle.
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Affiliation(s)
- Joanna L Stollings
- Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - John W Devlin
- John Devlin is Professor of Pharmacy, Northeastern University, and a clinical scientist, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Brenda T Pun
- Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen A Puntillo
- Kathleen Puntillo is a professor of nursing emeritus, Department of Physiological Nursing, School of Nursing, University of California, San Francisco
| | - Tamra Kelly
- Tamra Kelly is a respiratory therapist, Sutter Health, Sacramento, California
| | - Ken D Hargett
- Ken Hargett is a respiratory therapist, Houston Methodist Hospital, Houston, Texas
| | | | - Cheryl L Esbrook
- Cheryl Esbrook is an occupational therapist, University of Chicago Medicine, Chicago, Illinois
| | - Heidi J Engel
- Heidi Engel is a physical therapist, Department of Rehabilitative Services, University of California, San Francisco
| | - Christiane Perme
- Christiane Perme is a physical therapist, Houston Methodist Hospital
| | - Mary Ann Barnes-Daly
- Mary Ann Barnes-Daly is a clinical performance improvement consultant, Sutter Health
| | - Patricia J Posa
- Patricia Posa is a population health clinical integration leader, Saint Joseph Mercy Health System, Ann Arbor, Michigan
| | - J Matthew Aldrich
- J. Matthew Aldrich is the Medical Director of Critical Care Medicine and an associate clinical professor, University of San Francisco, San Francisco
| | - Juliana Barr
- Juliana Barr is a staff intensivist and anesthesiologist, VA Palo Alto Health Care System, Palo Alto, California, and an associate professor, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Shannon S Carson
- Shannon Carson is a critical care pulmonologist, University of North Carolina School of Medicine, Chapel Hill
| | - William D Schweickert
- William Schweickert is an associate professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Diane G Byrum
- Diane Byrum is a quality implementation consultant, Innovative Solutions for Healthcare Education, LLC, Charlotte, North Carolina
| | - Lori Harmon
- Lori Harmon is director of quality, Society of Critical Care Medicine, Mount Prospect, Illinois
| | - E Wesley Ely
- E. Wesley Ely is a professor of medicine, Vanderbilt University School of Medicine, and associate director, VA Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
| | - Michele C Balas
- Michele Balas is an associate professor, Center of Excellence in Critical and Complex Care, College of Nursing, and a nurse scientist, Wexner Medical Center, The Ohio State University, Columbus
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Disrupting Deficiencies in Data Delivery and Decision-Making During Daily ICU Rounds. Crit Care Med 2019; 47:478-479. [PMID: 30768508 DOI: 10.1097/ccm.0000000000003605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quality of care and safety measures of acute renal replacement therapy: Workgroup statements from the 22nd acute disease quality initiative (ADQI) consensus conference. J Crit Care 2019; 54:52-57. [DOI: 10.1016/j.jcrc.2019.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/20/2023]
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46
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A microbiologist consultant should attend daily ICU rounds. Intensive Care Med 2019; 46:372-374. [PMID: 31728567 DOI: 10.1007/s00134-019-05846-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023]
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47
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An international perspective on the frequency, perception of utility, and quality of interprofessional rounds practices in intensive care units. J Crit Care 2019; 55:28-34. [PMID: 31683119 DOI: 10.1016/j.jcrc.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe international variation in interprofessional rounds in intensive care units (ICUs). MATERIALS AND METHODS Survey of ICU clinicians on their practices and perceptions of rounds using societal mailing lists and social media. RESULTS Out of 2402 respondents, 1752 (72.8%) use rounds. Teams are mostly composed of intensivists, nurses and medical trainees. The majority of rounds (57.5%) last >2 h, and North Americans report the highest rates of rounds allowing family attendance (92.4%). Shorter rounds (1-2 h, OR 0.67, 0.52-0.86, p < 0.01; <1 h, OR 0.72, 0.53-0.97, p = 0.03), and strategies such as designating a person for writing (OR 0.73, 0.57-0.95, p = 0.01), and designating a person to assist other patients (OR 0.75, 0.57-0.98, p = 0.04) are associated with a lower perception of negative outcomes. Using daily goals during rounds is associated with a higher perception of positive outcomes (OR 1.85, 1.17-2.90, p < 0.01). CONCLUSIONS Three-quarters of respondents perform rounds, and models of rounds are heterogeneous, creating challenges for future studies on improving rounds. Respondents reporting better outcomes also experience shorter rounds, and adopt strategies such as discussion of daily goals, and designation individuals for writing or assisting other patients during rounds.
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48
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Unaka NI, Herrmann LE, Parker MW, Jerardi KE, Brady PW, Demeritt B, Lichner K, Carlisle M, Treasure JD, Hickey E, Statile AM. Improving Efficiency of Pediatric Hospital Medicine Team Daily Workflow. Hosp Pediatr 2019; 9:867-873. [PMID: 31628203 DOI: 10.1542/hpeds.2019-0094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Workflow inefficiencies by medical teams caring for hospitalized patients may affect patient care and team experience. At our institution, complexity and clinical volume of the pediatric hospital medicine (HM) service have increased over time; however, efficient workflow expectations were lacking. We aimed to increase the percentage of HM teams meeting 3 efficiency criteria (70% nurses present for rounds, rounds completed by 11:30 am, and HM attending notes completed by 5 pm) from 28% to 80% within 1 year. METHODS Improvement efforts targeted 5 HM teams at a large academic hospital. Our multidisciplinary team, including HM attending physicians, pediatric residents, and nurses, focused on several key drivers: shared expectations, enhanced physician and nursing buy-in and communication, streamlined rounding process, and data transparency. Interventions included (1) daily rounding expectations with prerounds huddle, (2) visible reminders, (3) complex care team scheduled rounds, (4) real-time nurse notification of rounds via electronic platform, (5) workflow redesign, (6) attending feedback and data transparency, and (7) resource attending implementation. Attending physicians entered efficiency data each day through a Research Electronic Data Capture survey. Annotated control charts were used to assess the impact of interventions over time. RESULTS Through sequential interventions, the percentage of HM teams meeting all 3 efficiency criteria increased from 28% to 61%. Nursing presence on rounds improved, and rounds end time compliance remained high, whereas attending note completion time remained variable. CONCLUSIONS Inpatient workflow for pediatric providers was improved by setting clear expectations and enhancing team communication; competing demands while on service contributed to difficulty in improving timely attending note completion.
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Affiliation(s)
- Ndidi I Unaka
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; .,Division of Hospital Medicine
| | - Lisa E Herrmann
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine
| | - Michelle W Parker
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine
| | - Karen E Jerardi
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine
| | - Patrick W Brady
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine.,James M. Anderson Center for Health Systems Excellence, and
| | - Brenda Demeritt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Kelli Lichner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | | | - Jennifer D Treasure
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine
| | - Erin Hickey
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Angela M Statile
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine.,James M. Anderson Center for Health Systems Excellence, and
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Abstract
OBJECTIVES Guidelines recommend offering family members of critically ill patients the option to attend interdisciplinary team rounds as a way to improve communication and satisfaction. Uncertainty remains around the benefits and risks. DESIGN We conducted an observational study to describe family participation in ICU rounds and its association with rounding processes. SETTING Rounds conducted under the leadership of 33 attending physicians in seven hospitals across three Canadian cities. PATIENTS Three hundred two individual rounds on 210 unique patients were observed. INTERVENTIONS Quantitative and qualitative data were collected using standardized observational tools. MEASUREMENTS AND MAIN RESULTS Among the 302 rounds observed, family attended in 68 rounds (23%), were present in ICU but did not attend in 59 rounds (20%), and were absent from the ICU in 175 rounds (58%). The median duration of rounds respectively for these three groups of patients was 20 minutes (interquartile range, 14-26 min), 16 minutes (interquartile range, 13-22 min), and 16 minutes (interquartile range, 10-23 min) (p = 0.01). There were no significant differences in prognostic discussions (35% vs 36% vs 36%; p = 0.99) or bedside teaching (35% vs 37% vs 34%; p = 0.88). The quality of rounds was not significantly associated with family attendance in rounds or presence in the ICU (quality score [1 (low) to 10 (high)] median 8 [interquartile range, 7-8] vs 7 [interquartile range, 6-9] vs 7 [interquartile range, 6-9]; p = 0.11). Qualitative analyses suggested that family attendance may influence relationship building, information gathering, patient and family education, team dynamics, future family meetings, workflow, and shared clinical decision-making. CONCLUSIONS Our results suggest family attendance in ICU rounds is associated with longer duration of rounds, but not the frequency of trainee teaching, discussions of prognosis, or quality of rounds. Family attendance in rounds may enhance communication and complement family conferences.
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50
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Abstract
OBJECTIVES We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. STUDY SELECTION Original articles, review articles, and systematic reviews were considered. DATA EXTRACTION Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. DATA SYNTHESIS "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. CONCLUSIONS A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
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