Excellence of the closed intensive care unit system in critically ill surgical patients

Baik, Seung Min; Yang, Na; Kim, Tae Yoon; Hong, Kyung Sook

doi:10.1371/journal.pone.0285035

Cited by 3 publications

(1 citation statement)

References 37 publications

(43 reference statements)

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“…Many critical care units in the United Kingdom operate a ‘closed unit’ philosophy, where the critical care team takes ultimate responsibility for management of the patient and therefore, of significant decision making around their care, supported by ‘primary’ and ‘secondary’ specialist teams - giving weight to staff’s calls for more effective collaboration (24). Specialist palliative and end-of-life care teams can provide support to critical care in consultative (as in UCLH) or and integrated capacity (25).…”

Section: Discussionmentioning

confidence: 99%

Understanding staff needs for Improving End-of-life Care in Critical Care Units

Tavabie,

Pearson,

Balabanovic

et al. 2024

Preprint

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Objectives: Critical care is a place of frequent death, up to a quarter of those admitted die during admission. Caring for dying people provides many challenges, practically, professionally and personally. The aim of this study was to better understand the perspectives of staff caring for dying people in critical care and identify their priorities for improvement. Method: Three multidisciplinary focus groups of critical care staff at a large central London hospitals trust were facilitated with a semi structured format and digitally transcribed. Inductive thematic analysis was conducted to extract themes. Results: N=34 (18 nursing, 7 allied health professionals, 6 medical, 3 clerical/administrative) The five themes were structured as priority statements: 'We need to recognise' included the subthemes of being 'sick enough to die' and potential rapid deteriorations in this setting; 'We need to understand' with subthemes of perspectives on dying and prioritising time for conversations; 'We need to connect' with subthemes of therapeutic relationship and physical presence; 'We need to collaborate' with subthemes of critical care working and empowerment, and cross teams working; 'We need support' with themes of experiencing support and making time to support others. Conclusion: We present an approach to identifying critical care departmental priorities for an end-of-life care improvement programme. The themes extracted will be used to evaluate systems for dying in critical care, aiming to empower staff to provide excellent care every time they look after a dying person.

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Section: Discussionmentioning

confidence: 99%

Understanding staff needs for Improving End-of-life Care in Critical Care Units

Tavabie,

Pearson,

Balabanovic

et al. 2024

Preprint

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The Advantages of "Closed" Type Management in Intensive Care Units

Nematbakhsh

2024

Trends in Anaesthesia and Critical Care

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Exploring the impact of a context-adapted decision aid and online training about shared decision making about goals of care with elderly patients in the intensive care unit: a mixed-methods study

Plaisance,

Turgeon,

Souza

et al. 2024

Preprint

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Purpose: To explore the impact of a context-adapted decision aid and an online training about shared decision-making (SDM) about goals of care on the level of involvement of elderly patients by intensivists in SDM about goals of care and quality of goals of care discussions (GCD) in an intensive care unit. Methods: This was a three-phase before-after mixed-methods implementation study conducted in an ICU in Lévis, Quebec, Canada. We followed the StaRI and COREQ reporting guidelines. We recruited patients aged ≥ 65 and their attending intensivists. We video-recorded GCD in three phases: Phase I: GCD without a decision aid; Phase II: GCD with a decision aid about goals of care but no online training; and Phase III: GCD with both a decision aid about goals of care following online training about SDM. All GCD recordings were transcribed verbatim. We measured the level of patient engagement by intensivists in SDM about goals of care through the OPTION scale and evaluated GCD quality using the Audit of Communication, Care Planning, and Documentation (ACCEPT) indicators. A qualitative thematic analysis of the encounters transcriptions was also performed. Results: Out of 359 eligible patients, the study included 21 patients (71% males; median age, 77 years; 57% without high school diploma) and 5 intensivists (80% male; median age, 35). Despite completing online training, the decision aid was never used in recorded encounters. We did not perform any tests of statistical significance to compare results in each study phase because of small sample sizes over each phase. OPTION and ACCEPT scores were low in each phase, but physicians did engage in GCD. We found that 76% of the goals of care recorded in medical records after the discussion were consistent with preferences expressed by patients during recorded observations. Several patients expressed confusion about GCD. Barriers identified by intensivists leading GCD include physician attitudes, challenges to performing GCD along with the demands of the intensive care unit, misunderstandings, and lack of training. Facilitators include a patient-centered approach, a clear decision aid, and positive patient attitudes. In future work, an environment that supports physicians in performing GCD, promotes earlier and higher quality patient GCD before admission to the intensive care unit, and encourages meaningful SDM in critical care must be assessed as pathways to successful intensive care unit GCD. Conclusion: A context-adapted decision aid about goals of care was created in addition to a complementary online training module. The online training was completed by all participating physicians but no increased involvement of patients in SDM during intensive care unit GCD was observed, and use of the decision aid was also not observed. We found several communication barriers that will need to be explored to improve intensive care unit GCD.

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Excellence of the closed intensive care unit system in critically ill surgical patients

Cited by 3 publications

References 37 publications

Understanding staff needs for Improving End-of-life Care in Critical Care Units

Understanding staff needs for Improving End-of-life Care in Critical Care Units

The Advantages of "Closed" Type Management in Intensive Care Units

Exploring the impact of a context-adapted decision aid and online training about shared decision making about goals of care with elderly patients in the intensive care unit: a mixed-methods study

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