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Pereira LM, Ornstein SW. A Systematic Literature Review on Healthcare Facility Evaluation Methods. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:338-361. [PMID: 37157787 DOI: 10.1177/19375867231166094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
To present a systematic literature review on predesign evaluation (PDE), postoccupancy evaluation (POE), and evidence-based design (EBD); to delimit the concepts and relationships of these terms and place them in the building life cycle framework to guide their application and indicate a common understanding and possible gaps. The preferred reporting items for systematic reviews and meta-analyses protocol was used. Inclusion criteria cover texts that present a concept, method, procedure, or tool and use the example in healthcare services or other environments. The reports were excluded if there was no evidence of a relationship between the terms, if cited rhetorically, duplicated, or if an instrument was not related to at least one other term. The identification used Scopus and Web of Science and considered reports until December 2021 (search period). When extracting the evidence, formal quality criteria were observed and sentences and other elements were collected as evidence and tabulated to segment topics of interest. The searches identified 799 reports with 494 duplicates. In the selection, 53 records were selected from 305 obtained in 14 searches. The classification extracted concepts, relationships, and frameworks. Results indicate a consistent understanding of POE and EBD and a diffuse understanding of PDE. A summary of the three concepts including two frameworks is proposed. Situations are contextualized where these frameworks are used in specific areas of research. One of these frameworks provides a basis for classifying building assessment methods, procedures, and tools but does not detail the classification criteria. Thus, more detailed adjustments should be considered in specific studies.
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Affiliation(s)
- Lucas Melchiori Pereira
- Faculty of Architecture and Urbanism at the University of São Paulo (FAUUSP), FAU Cidade Universitária. Rua do Lago, São Paulo, Brazil
| | - Sheila Walbe Ornstein
- Faculty of Architecture and Urbanism at the University of São Paulo (FAUUSP), FAU Cidade Universitária. Rua do Lago, São Paulo, Brazil
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Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open 2023; 13:e068932. [PMID: 37147093 PMCID: PMC10163491 DOI: 10.1136/bmjopen-2022-068932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022. ELIGIBILITY CRITERIA Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. CONCLUSIONS The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness. PROSPERO REGISTRATION NUMBER CRD42022311689.
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Affiliation(s)
| | | | | | | | - Rachel Ashton
- Ashton Editorial Consulting, London, UK
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Wayne Smith
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Andi Orlowski
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Halpern NA, Scruth E, Rausen M, Anderson D. Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future. Crit Care Clin 2023; 39:577-602. [DOI: 10.1016/j.ccc.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Jouppila T. Staff participation in design with multiple tools: Impact on design and POE results. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:315-330. [PMID: 34847756 DOI: 10.1177/19375867211060734] [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: 11/16/2022]
Abstract
OBJECTIVE This is a concluding part of an action research study to evaluate the impact on healthcare staff participation in the design of a new intensive care unit (ICU). Staff participated with multiple tools in the design; during the predesign phase utilizing co-design and virtual mock-ups, and also participating in the predesign evaluation (PDE) and postoccupancy evaluation (POE). Both the ICU design and evaluations were based on the principles of evidence-based design studies. METHOD Staff satisfaction was evaluated with an online survey comprising 116 statements on 13 different topics used both in PDE and POE. There was space for open-ended comments after each topic. RESULTS There was a statistically significant difference (<.001) between PDE and POE results. There were considerable improvements in privacy, accessibility, safety and security, and acoustics. It was assumed that participation in the predesign phase would positively influence POE results, but there were no statistical differences in any topics. However, as a result of collaborative predesign phase, the staff was satisfied with these jointly designed patient rooms. Open-ended questions revealed the importance to continue functional and technical support for staff after commissioning and ensure that technical solutions are practical and well-functioning. CONCLUSION The use of PDE and POE assists to set predetermined criteria and evaluate the success of design. Healthcare providers should see POE as a valuable part of design and commissioning process. Additionally, the use of POE should be made more effortless and the results more easily accessible to promote increased interest and usage.
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Saha S, Noble H, Xyrichis A, Hadfield D, Best T, Hopkins P, Rose L. Mapping the impact of ICU design on patients, families and the ICU team: A scoping review. J Crit Care 2021; 67:3-13. [PMID: 34562779 DOI: 10.1016/j.jcrc.2021.07.002] [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] [Received: 12/25/2020] [Revised: 06/25/2021] [Accepted: 07/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Scoping review to map outcomes and describe effects of intensive care unit (ICU) design features on patients, family, and healthcare professionals (HCPs). MATERIALS AND METHODS Iteratively developed search strategy executed across seven databases. We included studies (January 2007 to May 2020) exploring ICU design features using any study design. We grouped studies into 12 design features and categorized outcomes into four domains. RESULTS Of 18,577 citations screened, 44 studies met inclusion criteria. Newly built or renovated ICUs/ICU rooms were evaluated in 27 (61%) studies; 17 (39%) evaluated existing designs/features. Most commonly evaluated design features were lighting (24, 55%), single vs multi-occupancy rooms/pods (17, 39%), and family-centered design (13, 30%). We identified 63 distinct outcomes in four domains; HCP-related (20, 45%); patient-related (20, 45%); family-related (11, 25%); and environment-related (7, 16%). Eleven (25%) studies measured patient/family-reported outcomes. In studies evaluating single occupancy rooms, three reported increased family satisfaction, two reported decreased delirium burden, while six reported negative consequences on HCP wellbeing and working. CONCLUSION Studies evaluating ICU design measure disparate outcomes. Few studies included patient/ family-reported outcomes; fewer measured objective environment characteristics. Single room layouts may benefit patients and family but contribute to adverse HCP-related outcomes.
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Affiliation(s)
- Sian Saha
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Harriet Noble
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Daniel Hadfield
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Thomas Best
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Philip Hopkins
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
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Halpern NA, Anderson DC. Keeping a 2009 Design Award-Winning Intensive Care Unit Current: A 13-Year Case Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 13:190-209. [PMID: 32452232 PMCID: PMC8905547 DOI: 10.1177/1937586720918225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a complex medical center environment, the occupants of newly built or renovated spaces expect everything to "function almost perfectly" immediately upon occupancy and for years to come. However, the reality is usually quite different. The need to remediate initial design deficiencies or problems not noted with simulated workflows may occur. In our intensive care unit (ICU), we were very committed to both short-term and long-term enhancements to improve the built and technological environments in order to correct design flaws and modernize the space to extend its operational life way beyond a decade. In this case study, we present all the improvements and their background in our 20-bed, adult medical-surgical ICU. This ICU was the recipient of the Society of Critical Care Medicine's 2009 ICU Design Award Citation. Our discussion addresses redesign and repurposing of ICU and support spaces to accommodate expanding clinical or entirely new programs, new regulations and mandates; upgrading of new technologies and informatics platforms; introducing new design initiatives; and addressing wear and tear and gaps in security and disaster management. These initiatives were all implemented while our ICU remained fully operational. Proposals that could not be implemented are also discussed. We believe this case study describing our experiences and real-life approaches to analyzing and solving challenges in a dynamic environment may offer great value to architects, designers, critical care providers, and hospital administrators whether they are involved in initial ICU design or participate in long-term ICU redesign or modernization.
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Affiliation(s)
- Neil A. Halpern
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Diana C. Anderson
- Division of Geriatrics, University of California, San Francisco, CA, USA
- Founder, Dochitect
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Loveday C, Lord H, Ellwood L, Bonnici K, Decker V, Fernandez R. Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit. Aust Crit Care 2020; 34:263-268. [PMID: 32943307 DOI: 10.1016/j.aucc.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Decentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited. OBJECTIVES The objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU). METHODS Twelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data. RESULTS A total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction. CONCLUSIONS Implementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.
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Affiliation(s)
- Clare Loveday
- Intensive Care Services, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Heidi Lord
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Laura Ellwood
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Kim Bonnici
- Intensive Care Services, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Virginia Decker
- Intensive Care Services, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Ritin Fernandez
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia; School of Nursing, University of Wollongong, Australia.
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Goldfarb M, Bibas L, Burns K. Patient and Family Engagement in Care in the Cardiac Intensive Care Unit. Can J Cardiol 2020; 36:1032-1040. [PMID: 32533931 DOI: 10.1016/j.cjca.2020.03.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022] Open
Abstract
Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Lior Bibas
- Division of Cardiology, Pierre-Boucher Hospital, Longueuil, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Rapport F, Francis-Auton E, Cartmill J, Ryder T, Braithwaite J, Clay-Williams R. A mobile methods pilot study of surgical spaces: 'fit for purpose? Organisational productivity and workforce wellbeing in workspaces in hospital' (FLOURISH). BMC Health Serv Res 2020; 20:78. [PMID: 32013980 PMCID: PMC6998284 DOI: 10.1186/s12913-020-4938-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Good workspace design is key to the quality of work, safety, and wellbeing for workers, yet we lack vital knowledge about optimal hospital design to meet healthcare workforce needs. This study used novel mobile methods to examine the concept of Work-as-Done and the effect of workspace-use on healthcare professional practice, productivity, health and safety in an Australian university hospital. Methods This pilot study took place in one gastroenterological surgical unit between 2018 and 2019. Data collection involved 50 h of observations and informal conversations, followed by interpretation of five architectural plans and 45 photographs. Fieldnotes were thematically analysed and corroborated by analysis of visual data using a predefined taxonomy. Results Six themes were identified, revealing spaces that both support and hinder Work-as-Done. Fit-for-purpose spaces facilitated effective communication between staff, patients and families, conferred relative comfort and privacy, and supported effective teamwork. Unfit-for-purpose spaces were characterised by disruptions to work practices, disharmony among team members, and physical discomfort for staff. Staff employed workarounds to manage unfit-for-purpose spaces. Conclusion The results identified negative impacts of negotiating unfit-for-purpose workspaces on the work and wellbeing of staff. While the use of workarounds and adaptations enable staff to maintain everyday working practices, they can also lead to unexpected consequences. Results indicated the need to identify and support fit-for-purpose spaces and minimize the detrimental qualities of unfit-for-purpose spaces. This study showed that mobile methods were suitable for examining Work-as-Done in a fast-moving, adaptive hospital setting.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - John Cartmill
- Macquarie University Hospital, Macquarie Park, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, Mishra RC, Sharma J, Amin P, Rao BK, Khilnani GC, Mittal K, Bhattacharya PK, Baronia AK, Javeri Y, Myatra SN, Rungta N, Tyagi R, Dhanuka S, Mishra M, Samavedam S. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med 2020; 24:S43-S60. [PMID: 32205956 PMCID: PMC7085818 DOI: 10.5005/jp-journals-10071-g23185] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Indian Society of Critical Care Medicine (ISCCM) guidelines on Planning and Designing Intensive care (ICU) were first developed in 2001 and later updated in 2007. These guidelines were adopted in India, many developing Nations and major Institutions including NABH. Various international professional bodies in critical care have their own position papers and guidelines on planning and designing of ICUs; being the professional body of intensivists in India ISCCM therefore addresses the subject in contemporary context relevant to our clinical practice, its variability according to specialty and subspecialty, quality, resource limitation, size and location of the institution. Aim: To have a consensus document reflecting the philosophy of ISCCM to deliver safe & quality Critical Care in India, taking into consideration the requirement of regulatory agencies (national & international) and need of people at large, including promotion of training, education and skill upgradation. It also aiming to promote leadership and development and managerial skill among the critical care team. Material and Methods: Extensive review of literature including search of databases in English language, resources of regulatory bodies, guidelines and recommendations of international critical care societies. National Survey of ISCCM members and experts to understand their viewpoints on respective issues. Visiting of different types and levels of ICUs by team members to understand prevailing practices, aspiration and Challenges. Several face to face meetings of the expert committee members in big and small groups with extensive discussions, presentations, brain storming and development of initial consensus draft. Discussion on draft through video conferencing, phone calls, Emails circulations, one to one discussion Result: Based upon extensive review, survey and input of experts' ICUs were categorized in to three levels suitable in Indian setting. Level III ICUs further divided into sub category A and B. Recommendations were grouped in to structure, equipment and services of ICU with consideration of variation in level of ICU of different category of hospitals. Conclusion: This paper summarizes consensus statement of various aspect of ICU planning and design. Defined mandatory and desirable standards of all level of ICUs and made recommendations regarding structure and layout of ICUs. Definition of intensive care and intensivist, planning for strength of ICU and requirement of manpower were also described. HOW TO CITE THIS ARTICLE Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, et al. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU Planning and Designing, 2020. Indian J Crit Care Med 2020;24(Suppl 1):S43-S60.
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Affiliation(s)
- Narendra Rungta
- Department of Critical Care Foundation, Critical Care, MJ Rajasthan Hospital, Jaipur, Rajasthan, India, e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, , 020-25531539 / 25539538, e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail ID:
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India, , e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Jeetendra Sharma
- Department of Critical Care, Artemis Health Institute, Gurgaon, Haryana, India, , e-mail:
| | - Pravin Amin
- JLN Medical College, Jaipur, Rajasthan, India, e-mail:
| | - B K Rao
- Department of Critical care & Emergency Medicine, Sir Ganga Ram Hospital, Delhi, India, e-mail:
| | - G C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India, , e-mail:
| | - Kundan Mittal
- Department of Pediatrics, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, e-mail:
| | | | - A K Baronia
- Department of Critical Care, SGPGI, Lucknow, Uttar Pradesh, India, e-mail:
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Sheila Nainan Myatra
- Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India, e-mail:
| | - Neena Rungta
- Department of Anesthesia, JLN Medical College, Jaipur, Rajasthan, India, e-mail:
| | - Ranvir Tyagi
- Department of Anaesthesia and Critical Care Medicine, Synergy Plus hospital, NH 2 Sikandra, Agra, Uttar Pradesh, India, e-mail:
| | - Sanjay Dhanuka
- Eminent Hospital, 6/1 Old Palasia, Opposite Barwani Plaza, Indore, Madhya Pradesh, India, e-mail:
| | - Mahesh Mishra
- Department of Surgery, Mahatma Gandhi University of Medical Sciences & Technology, Riico Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, India, e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
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Barturen F, Paz-Martín D, Monedero P, Cardona-Pereto J, Fernández-Quero L, Valía JC, Peyró R, Sánchez C. Structure of the Anesthesia Intensive Care Units: Recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:506-520. [PMID: 31470981 DOI: 10.1016/j.redar.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units.
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Affiliation(s)
- F Barturen
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - D Paz-Martín
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España.
| | - P Monedero
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - J Cardona-Pereto
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - L Fernández-Quero
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - J C Valía
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - R Peyró
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
| | - C Sánchez
- Comisión Ejecutiva de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología y Reanimación, Madrid, España
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Imanipour M, Kiwanuka F, Akhavan Rad S, Masaba R, Alemayehu YH. Family members' experiences in adult intensive care units: a systematic review. Scand J Caring Sci 2019; 33:569-581. [PMID: 30866085 DOI: 10.1111/scs.12675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases. AIM This review sought to describe the experiences of family members of patients admitted in adult ICUs. DATA SOURCES Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words. METHODS Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). RESULTS Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure. CONCLUSION As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.
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Affiliation(s)
- Masoomeh Imanipour
- Nursing and Midwifery Care Research Center.,Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Frank Kiwanuka
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | | | - Ronald Masaba
- School of Nursing, Clarke International University, Kampala, Uganda
| | - Yisak Hagos Alemayehu
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Ayder Comprehensive Specialized Hospital, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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Azevedo-Santos IF, DeSantana JM. Pain measurement techniques: spotlight on mechanically ventilated patients. J Pain Res 2018; 11:2969-2980. [PMID: 30538536 PMCID: PMC6255280 DOI: 10.2147/jpr.s151169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Procedural pain is a frequent problem in intensive care units (ICUs). For that, pain assessment has been increasingly introduced to the ICU professional’s routine, and studies have been developed to show the relevance of measuring pain in critically ill patients. Objective This review aimed to describe pain measurement techniques for mechanically ventilated adult patients based on evidence and already published. Method Systematic literature search was performed on PubMed and Google Scholar. Keywords “pain”, “pain measurement”, “intensive care units” and “respiration, artificial” were combined to the Boolean operator AND. No language or publication year was limited in this search. The purpose and method of all papers were analyzed and only studies which described pain assessment in mechanically ventilated patients were included in this review. Results Objective methods were found in the literature to assess pain in mechanically ventilated adults. Behavioral scales were the most used method for pain measurement in noncommunicative patients. Vital signs were used, but the reliability of this method was questioned. Pupillometry, bispectral index and skin conductance were found and described as pain assessment methods. Conclusion This review showed that objective measures, as behavioral scales, are the gold standard tools to measure pain intensity in noncommunicative subjects. These data contribute to professionals’ knowledge about ICU pain measurement and emphasize its importance and consequences for adequate pain management.
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Affiliation(s)
- Isabela Freire Azevedo-Santos
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
| | - Josimari Melo DeSantana
- Neuroscience Research Laboratory (LAPENE), Department of Physical Therapy, Graduate Program of Health Science, Graduate Program of Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil,
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Fay L, Cai H, Real K. A Systematic Literature Review of Empirical Studies on Decentralized Nursing Stations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 12:44-68. [DOI: 10.1177/1937586718805222] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The objective of this systematic review of literature was to critically evaluate peer-reviewed evidence regarding the effectiveness of decentralized nurse stations (DNSs). Background: The DNS has become an important topic in healthcare design research and practice over the past decade with aims of improving staff efficiency and patient experience. Research has shown to be inconclusive, with studies reporting an assortment of mixed findings. Method: A systematic review of literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses search process of electronic databases, citation tracking, and manual searches of references. All authors evaluated the studies independently. Studies included were empirical, peer-reviewed investigations of DNS in hospitals over the past 15 years. Each study was evaluated using an accepted healthcare design evaluation framework. Results: Over 200 studies were identified. After exclusions, 21 studies published since 2003 were available for full evaluation. Key findings from this review include (a) there is a positive trend toward patient experience in units with DNS, (b) nursing teamwork was perceived to decline in units with DNS, (c) methodological issues may be responsible for the mixed and inconsistent findings, and (d) there is no consistent categorization of nurse station typology or standard definition for DNS. Conclusions: Based on the evaluation framework, DNS are supportive of the patient experience yet have a negative impact on nursing teamwork. Higher quality studies are needed to classify specific typologies of DNS and account for elements such as patient care models, communication, visibility, and other patient care–related factors.
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Affiliation(s)
- Lindsey Fay
- College of Design, University of Kentucky, Lexington, KY, USA
| | - Hui Cai
- School of Architecture and Design, University of Kansas, Lawrence, KS, USA
| | - Kevin Real
- College of Communication and Information, University of Kentucky, Lexington, KY, USA
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Transition to a newly constructed single patient room adult intensive care unit - Clinicians' preparation and work experience. J Crit Care 2018; 48:426-432. [PMID: 30321834 DOI: 10.1016/j.jcrc.2018.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/03/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe how clinicians were prepared for the transition to a novel single patient room (SPR) intensive care unit (ICU) and their work experience during this transition. MATERIALS AND METHODS In this qualitative descriptive study, four focus groups were conducted six months post-move with a multidisciplinary group of 29 clinicians at a hospital in Montreal, Canada. The interview guide was derived from a readiness for change conceptual framework. Audio recordings were transcribed verbatim and analyzed via thematic analysis. RESULTS Clinicians described preparation strategies such as educational resources, managerial support and personal initiatives, with some variation across professions. Clinicians felt ready for the transition especially in their adaptation to the new physical environment, yet some challenges related to teamwork dynamics and bedside care persisted after the transition. CONCLUSIONS The use of preparation strategies that are tailored to clinicians' roles helped build readiness for transition to a novel SPR ICU and facilitated the adaptation process. Challenges related to teamwork dynamics and practices in an isolating environment persisted beyond the adaptation period and must be addressed and overcome to better meet the needs and expectations of ICU clinicians.
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Petersson E, Wångdahl L, Olausson S. ICU nurses' experiences of environmental elements and their meaning for patient care at an ICU: A qualitative content analysis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2057158518778997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In an intensive care unit (ICU), the environment is highly technological and staff are constantly present. The aim of this study was to describe environmental elements of an ICU room that nurses consider central for their provision of care. Data were collected using photovoice – photographs and in-depth interviews – and analysed using a qualitative content analysis approach. The care environment highly affected ICU nurses, in particular some elements such as medical equipment, work stations and beds. These were considered as an aid, but due to confined space some care was abstained from, maintaining privacy and confidentiality were a challenge, which led to frustration and stress. To provide care in an environment with good lightning, reduced noise and adequate space increases the wellbeing of the nurses, which indicates that an investment in a better care environment would be worthwhile.
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Affiliation(s)
| | | | - Sepideh Olausson
- Institute of Health and Care Sciences,The Sahlgrenska Academy at Gothenburg University, Sweden
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17
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Abstract
There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.
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Horsten S, Reinke L, Absalom AR, Tulleken JE. Systematic review of the effects of intensive-care-unit noise on sleep of healthy subjects and the critically ill. Br J Anaesth 2017; 120:443-452. [PMID: 29452801 DOI: 10.1016/j.bja.2017.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/30/2017] [Accepted: 12/01/2017] [Indexed: 01/17/2023] Open
Abstract
Intensive-care-unit (ICU) patients exhibit disturbed sleeping patterns, often attributed to environmental noise, although the relative contribution of noise compared to other potentially disrupting factors is often debated. We therefore systematically reviewed studies of the effects of ICU noise on the quality of sleep to determine to what extent noise explains the observed sleep disruption, using the Cochrane Collaboration method for non-randomized studies. Searches in Scopus, PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were conducted until May 2017. Twenty papers from 18 studies assessing sleep of adult patients and healthy volunteers in the ICU environment, whilst recording sound levels, were included and independently reviewed by two reviewers. We found that the numbers of arousals between the baseline and the ICU noise condition in healthy subjects differed significantly (mean difference 9.59; 95% confidence interval 2.48-16.70). However, there was considerable heterogeneity between studies (I2 94%, P < 0.00001), and all studies suffered from a considerable risk of bias. The meta-analysis of results was hampered by widely varying definitions of sound parameters between studies and a general lack of detailed description of methods used. It is, therefore, currently impossible to quantify the extent to which noise contributes to sleep disruption among ICU patients, and thus, the potential benefit from noise reduction remains unclear. Regardless, the majority of the observed sleep disturbances remain unexplained. Future studies should, therefore, also focus on more intrinsic sleep-disrupting factors in the ICU environment.
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Affiliation(s)
- S Horsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
| | - L Reinke
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands.
| | - A R Absalom
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
| | - J E Tulleken
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
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A Conceptual Framework for Integration of Evidence-Based Design with Lighting Simulation Tools. BUILDINGS 2017. [DOI: 10.3390/buildings7040082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Johansson L, Lindahl B, Knutsson S, Ögren M, Persson Waye K, Ringdal M. Evaluation of a sound environment intervention in an ICU: A feasibility study. Aust Crit Care 2017; 31:59-70. [PMID: 28506741 DOI: 10.1016/j.aucc.2017.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/16/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes. OBJECTIVES (1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms. METHODS A quasi-randomized clinical trial design was chosen. The intervention consisted of a refurbished two-bed ICU patient room (experimental) with a new suspended wall-to-wall ceiling and a low frequency absorber. An identical two-bed room (control) remained unchanged. INCLUSION CRITERIA Patients >18 years old with ICU lengths of stay (LoS) >48h. The final study group consisted of 31 patients: six from the rebuilt experimental room and 25 from the control room. Methodological problems and possible solutions were continuously identified and documented. RESULTS Undertaking a full-scale intervention study with continuous measurements of acoustic data in an ICU is possible. However, this feasibility study demonstrated some aspects to consider before start. The randomization process and the sound measurement procedure must be developed. Furthermore, proper education and training are needed for determining ICU delirium. CONCLUSION This study raises a number of points that may be helpful for future complex interventions in an ICU. For a full-scale study to be completed a continuously updated cost calculation is necessary. Furthermore, representatives from the clinic need to be involved in all stages during the project.
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Affiliation(s)
- Lotta Johansson
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare, Borås University College, Sweden
| | - Susanne Knutsson
- Department of Nursing, School of Health Sciences, Jönköping University, Sweden
| | - Mikael Ögren
- Department of Occupational & Environmental Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kerstin Persson Waye
- Department of Occupational & Environmental Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mona Ringdal
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
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Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, Fowler RA, Meyfroidt G, Nakagawa S, Pelosi P, Vincent JL, Vollman K, Zimmerman J. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2017; 37:270-276. [DOI: 10.1016/j.jcrc.2016.07.015] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 12/14/2022]
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Hu RF, Hegadoren KM, Wang XY, Jiang XY. An investigation of light and sound levels on intensive care units in China. Aust Crit Care 2016; 29:62-7. [DOI: 10.1016/j.aucc.2015.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 07/18/2015] [Accepted: 08/08/2015] [Indexed: 01/22/2023] Open
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