Integrated critical care: an approach to specialist cover for critical care in the rural setting

Hore, Craig T; Lancashire, William; Roberts, John; Fassett, Robert G.

doi:10.5694/j.1326-5377.2003.tb05444.x

Cited by 13 publications

(11 citation statements)

References 17 publications

(39 reference statements)

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“…We know that the management of deteriorating patients is poor and when left untreated leads to expensive and often unsuccessful resuscitation procedures [2-5]. In addition, it is acknowledged that non-metropolitan settings have fewer resources for managing deteriorating patients [6,7], communication and referral processes are less well established [4,8], and demands on enrolled and registered nurses have increased. However not enough is known about the educational needs, decision-making strategies and clinical practices of students in order to enhance their future practice.…”

Section: Introductionmentioning

confidence: 99%

Managing patient deterioration: a protocol for enhancing undergraduate nursing students’ competence through web-based simulation and feedback techniques

Cooper¹,

Beauchamp

Bogossian

et al. 2012

BMC Nurs

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AimsTo describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.BackgroundThere are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.Design/MethodsA mixed methods triangulated convergent design.In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.ConclusionThis project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.

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Section: Introductionmentioning

confidence: 99%

Managing patient deterioration: a protocol for enhancing undergraduate nursing students’ competence through web-based simulation and feedback techniques

Cooper¹,

Beauchamp

Bogossian

et al. 2012

BMC Nurs

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“…Should these concepts be extended to EDs as well, above and beyond existing early intervention models for stroke, myocardial infarction, and trauma? How should the ED and ICU be more closely operationally aligned, as suggested by recent papers from the UK [41,42], Canada [43], the USA [44] and Australia [45]? Also, what is the best way to spend the 'critical care budget'?…”

Section: Implications For Controlling the Cost Of Critical Carementioning

confidence: 99%

Untitled

Huang

2004

Crit Care

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498 ED = emergency department; EGDT = early goal-directed therapy; ICU = intensive care unit; LOS = length of stay; NIPPV = noninvasive positive pressure ventilation. Critical Care December 2004 Vol 8 No 6 Huang IntroductionThe cost of critical care is widely recognized as both expensive and increasing [1,2]. Government and private organizations have devoted considerable effort to devising cost control strategies for intensive care units (ICUs) [3,4]. One under-explored area of potential cost saving is how critically ill patients are managed in the emergency department (ED). Specifically, what impact does initial ED care of critically ill patients have on downstream ICU costs? There are surprisingly few data with which to address this question, but we examine what is available. Critical care delivery in the emergency departmentIt is first important to recognize that a significant amount of critical care is already performed in the ED. In the 2001 US National Hospital Ambulatory Medical Care Survey [5], 19.2% of all ED patients were classified as emergent (patients who should be seen within 15 min), and over 992,000 patients were admitted to an ICU through an ED. The average ICU bed wait time in this survey was slightly over 4 hours. Furthermore, there is evidence that the amount of critical illness in EDs is increasing. Lambe and coworkers [6] reported that, in Californian EDs, critical visits increased by 59% between 1990 and 1999, whereas nonurgent visits actually decreased by 8%. Several US single-center studies have also documented the extent of critical care delivery in EDs. Fromm and coworkers [7] reported that, during a 1-year study period in a teaching hospital, 154 patient-days of ED critical care were provided, with ED length of stays (LOSs) for these patients of up to nearly 11 hours. Nguyen and colleagues [8] estimated that an even greater amount of critical care, 464.4 patient-days, was provided annually in their large urban teaching hospital. Similarly, Nelson and coworkers [9] examined the amount of critical care provided in their urban hospital's ED and ICUs during a 3-month study, and found that 15% of all critical care was performed in the ED. Finally, Varon and coworkers [10] and Svenson and colleagues [11] reported that critically ill patients spent several hours in the ED before transfer to an ICU, and that critical care procedures were commonly performed in the ED. AbstractCritical care is both expensive and increasing. Emergency department (ED) management of critically ill patients before intensive care unit (ICU) admission is an under-explored area of potential cost saving in the ICU. Although limited, current data suggest that ED care has a significant impact on ICU costs both positive and negative. ICU practices can also affect the ED, with a lack of ICU beds being the primary reason for ED overcrowding and ambulance diversion in the USA. Earlier application in the ED of intensive therapies such as goal-directed therapy and noninvasive ventilation may reduce ICU costs by decreasing len...

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“…To the Editor: Hore and colleagues argue for “integrated critical care” as a solution to the problem of providing intensive‐care cover for patients in rural and non‐tertiary metropolitan hospitals 1 . They claim that such an approach is required uniquely in these hospitals, whereas in tertiary centres “subspecialists would be involved in each phase of the management process”.…”

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confidence: 99%