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Winterbottom F, Katz AW, Skinner S, Carpenter D, Williams LM, Kleinpell R. Acute Care Advanced Practice Providers' Use of Telehealth During the COVID-19 Pandemic. AACN Adv Crit Care 2023; 34:343-349. [PMID: 38033211 DOI: 10.4037/aacnacc2023516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Advanced practice registered nurses and physician assistants, collectively termed advanced practice providers (APPs), have been part of telehealth for many years. During the COVID-19 pandemic, APPs experienced the growth in roles, responsibilities, and tools used for telehealth care delivery. This article uses examples from 3 health systems to highlight the ways in which telehealth use was expanded due to the pandemic, how APP roles were altered across the United States during and after the pandemic, and implications for future practice.
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Affiliation(s)
- Fiona Winterbottom
- Fiona Winterbottom is Clinical Nurse Specialist, Critical Care Medicine, Ochsner Health, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70448
| | - Adam W Katz
- Adam W. Katz is Senior Director, Advanced Practice Provider Services, and Critical Care Advanced Practice Provider Program, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Sarah Skinner
- Sarah Skinner is Clinical Coordinator for Critical Care Advanced Practice Providers, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Dawn Carpenter
- Dawn Carpenter is Associate Professor of Nursing, UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, and Nurse Practitioner, Surgical ICU and Trauma Team, Guthrie Healthcare System, Sayre, Pennsylvania
| | - Lisa-Mae Williams
- Lisa-Mae Williams is Operations Director, Telehealth Center, Tele-Critical Care and Virtual Sepsis Unit, Baptist Health, Coral Gables, Florida
| | - Ruth Kleinpell
- Ruth Kleinpell is Associate Dean for Clinical Scholarship and Professor, Vanderbilt University School of Nursing, Nashville, Tennessee
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Williams G, Pirret A, Credland N, Odell M, Raftery C, Smith D, Winterbottom F, Massey D. A practical approach to establishing a critical care outreach service: An expert panel research design. Aust Crit Care 2023; 36:151-158. [PMID: 35341667 DOI: 10.1016/j.aucc.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/18/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting. AIM The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting. METHOD An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed. FINDINGS There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation. CONCLUSION An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is diverse and lacking a single approach to practice.
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Affiliation(s)
- Ged Williams
- School of Nursing & Midwifery, Griffith University, Australia; South Metropolitan Health Service, Perth, Australia.
| | - Alison Pirret
- Critical Care Complex, Middlemore Hospital, Auckland, New Zealand; Massey University, Auckland, New Zealand
| | - Nicki Credland
- Reader in Critical Care Education, University of Hull, United Kingdom; Chair British Association of Critical Care Nurses (BACCN), United Kingdom
| | - Mandy Odell
- Critical Care, Royal Berkshire Hospital, NHS FT, Reading, United Kingdom
| | - Chris Raftery
- School of Nursing, Queensland University of Technology, Australia; Gold Coast Health, Queensland, Australia
| | - Duncan Smith
- City, University of London, Northampton Square, London, UK; Honorary Charge Nurse - Patient Emergency Response & Resuscitation Team, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Debbie Massey
- Southern Cross University, Australia; Intensive Care Unit John Flynn Hospital, Tugun, Australia
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Winterbottom F, Jenkins M, Alonzo M. Sepsis Update: A New Core Measure of Quality. J Contin Educ Nurs 2017; 47:204-6. [PMID: 27124072 DOI: 10.3928/00220124-20160419-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This column provides an update on the current literature related to sepsis as a new quality core measure. Sepsis care for adult patients in the acute care setting is outlined. J Contin Educ Nurs. 2016;47(5):204-206.
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Winterbottom F, Castex J, Campbell A. Rapid response systems update. J Contin Educ Nurs 2013; 44:242-3. [PMID: 23738806 DOI: 10.3928/00220124-20130523-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rapid response is a mature concept that is undergoing metamorphosis. The ideal structure and function of these safety teams has not yet been realized but new developments in the field of rapid response systems are evolving.
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Affiliation(s)
- Fiona Winterbottom
- Critical Care, Ochsner Medical Center-New Orleans, New Orleans, LA 70121, USA.
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Abstract
Telemedicine in critical care offers opportunities to improve quality and safety by connecting bedside care teams with off-site tele-ICU staff using advanced software and continuous remote monitoring technology. This leads to more proactive care, fewer complications, and timely decisions regarding care.
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Seoane L, Winterbottom F, Nash T, Behrhorst J, Chacko E, Shum L, Pavlov A, Briski D, Thibeau S, Bergeron D, Rafael T, Sundell E. Using quality improvement principles to improve the care of patients with severe sepsis and septic shock. Ochsner J 2013; 13:359-66. [PMID: 24052765 PMCID: PMC3776511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Sepsis, an inflammatory response to an infection that may lead to severe organ dysfunction and death, is the leading cause of death in medical intensive care units. The Society of Critical Care Medicine has issued guidelines and promoted protocols to improve the management of patients with severe sepsis and septic shock. Generally, the medical community has been slow to adopt these guidelines because of the system challenges associated with protocol implementation. We describe an interdisciplinary team approach to the development and implementation of management protocols for treating patients with severe sepsis and septic shock. METHODS To determine the effectiveness of the bundled emergency department and critical care order sets developed by the Sepsis Steering Committee, we performed a case review of 1,105 sequential patients admitted to a large academic tertiary referral hospital with a diagnosis of severe sepsis or septic shock between July 2008 and January 2012. RESULTS Implementation of the protocol led to improved order set use over time, a significant decrease in the median time to antibiotics of 140 (range 1-820) minutes in 2008 to 72 (range 1-1,020) minutes in 2011 (P≤0.001), and a decrease in median length of stay from 8 days (range 1-54) in 2008 to 7 days (range 1-33) in 2011 (P=0.036). CONCLUSION A multidisciplinary team approach to sepsis management using protocols and early goal-directed therapy is feasible in a large academic medical center to improve the process of care and outcomes.
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Affiliation(s)
- Leonardo Seoane
- Department of Pulmonary and Critical Care Medicine, Ochsner Clinic Foundation
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans
| | - Fiona Winterbottom
- Department of Pulmonary and Critical Care Medicine, Ochsner Clinic Foundation
| | | | | | - Elen Chacko
- Center for Quality Excellence, Ochsner Clinic Foundation
- Department of Medical Informatics, Ochsner Clinic Foundation
| | - Lucas Shum
- Department of Medical Informatics, Ochsner Clinic Foundation
| | - Andrey Pavlov
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans
| | - David Briski
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans
| | | | | | - Tiffany Rafael
- Department of Emergency Medicine, Ochsner Clinic Foundation
| | - Erik Sundell
- Department of Emergency Medicine, Ochsner Clinic Foundation
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Abstract
Nurses play a critical role in detecting early sepsis-related manifestations and improving adherence to implementation of early goal-directed therapy. Educating staff about sepsis management through translation of best practices is critical to improving sepsis-related outcomes.
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Winterbottom F, Seoane L. Crossing the quality chasm: it takes a team to build the bridge. Ochsner J 2012; 12:389-393. [PMID: 23267270 PMCID: PMC3527871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
The paradigm shifts in healthcare delivery now more than ever call for interdisciplinary teamwork to deliver the best patient care. The lessons from the Institute of Medicine's To Err Is Human: Building a Safer Health System report are painful but elucidate the problems with training and working in silos and the consequent inconsistent communication between healthcare providers. We review the literature regarding interprofessional training and describe some strategies and innovations. This article proposes that healthcare professional schools embed interprofessional education into the curriculum to meet the challenges of providing high-quality, efficient, and safe patient care.
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Affiliation(s)
| | - Leonardo Seoane
- Department of Pulmonary/Critical Care, Ochsner Clinic Foundation
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Winterbottom F, Jennings B, Webre H. Rethinking Resuscitation: Novel Modalities In Cardiac Care. Journal of Vascular Nursing 2010. [DOI: 10.1016/j.jvn.2010.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ahmed M, Apps C, Bramwell M, Cooper J, Hughes C, Reinhardt K, Whitehead J, Winterbottom F, Hopkirk A. Fluorescence excitation spectroscopy of some haloethenes, CF2 = CXY (XY ≡ FCl, Cl2, FH), excited in the vacuum ultraviolet (70–180 nm). Chem Phys 1997. [DOI: 10.1016/s0301-0104(97)00114-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ball SM, Hancock G, Pinot de Moira JC, Sadowski CM, Winterbottom F. Time-of-flight measurements of the kinetic energies of the O2(a1Δg) fragment from the photolysis of ozone between 287 and 331 nm. Chem Phys Lett 1995. [DOI: 10.1016/0009-2614(95)01047-d] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Apps C, Bramwell M, Cooper J, Whitehead J, Winterbottom F. The fluorescence excitation spectrum of deuterated ammonia in the region 105–200 nm: the states of ND3. Mol Phys 1994. [DOI: 10.1080/00268979400101931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Scott D, Winterbottom F, Scholefield M, Goyal S, Reisler H. Kinetic energy effects on product state distributions in the C(3P) + N2O (X̃ 1Σ+) reaction. Energy partitioning between the NO(X 2Π) and CN(X 2Σ+) products. Chem Phys Lett 1994. [DOI: 10.1016/0009-2614(94)00380-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Reid S, Winterbottom F, Scott D, de Juan J, Reisler H. A crossed beam study of the reaction C(3P) + N2O: energy partitioning between the NO(X 2Π) and CN(X 2Σ+) products. Chem Phys Lett 1992. [DOI: 10.1016/0009-2614(92)85227-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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