Intensive Care Medicine in 2050: toward an intensive care unit without waste

Anesi, George L; Wagner, Jason; Halpern, Scott D.

doi:10.1007/s00134-016-4641-8

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…It raises the question of how to limit inappropriate use of intensive care at the end of life 24 and provide high-value patient-centered intensive care. 25…”

Section: Discussionmentioning

confidence: 99%

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Physicians’ predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study

et al. 2020

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Background: Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease. Aim: To determine whether physicians’ predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease. Design: A prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable. Setting/participants: ICU consultations for medical inpatients at a Swiss tertiary care hospital were included. Results: Of 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision. Conclusions: ICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.

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“…It raises the question of how to limit inappropriate use of intensive care at the end of life 24 and provide high-value patient-centered intensive care. 25…”

Section: Discussionmentioning

confidence: 99%

“…It raises the question of how to limit inappropriate use of intensive care at the end of life 24 and provide high-value patient-centered intensive care. 25 When assessing prognosis, physicians correctly identified patients with the most severe disease, as all their predictions were associated with mortality at 28 days.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study

et al. 2020

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“…Intensive care clinicians must consider every situation carefully, especially when there is progressive deterioration despite extensive treatment. While predictive models are helpful for service planning and system design, they are much less appropriate for individual patients . Effective communication, consultation with colleagues, establishment of goals of care, consideration of all treatment options, and shared decision making are essential elements for ensuring that patient welfare remains the central tenet of management .…”

mentioning

confidence: 99%

The evolving role of intensive care in health care and society

Warrillow

Raper

2019

Medical Journal of Australia

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“…[3] Therefore, it is necessary to assign all the resources within the care process according to time and demand [4] and exclude any intervention provides no-value for MVPs to get the optimum value of all care practices, decreasing the mechanical ventilation and intensive care units (ICUs) beds occupation rate and the total cost of ICU stay. [5,6] In an effort to standardize competency of the care for MVPs, new care concepts have been proposed to ICU community to maximize the value of technical and non-technical components of patients' care. [7] Lean is a systematic approach enterprise that aiming firstly to identifying waste and then eliminating these waste (non-value-added activities).…”

Section: Introductionmentioning

confidence: 99%

Lean thinking in total nursing care for mechanically ventilated patients: A new concept in ICU

Abdelaliem

Ahmed

2019

JNEP

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Background: Lean approach is one of the coming revolutions for a better, improved, high-value-based care to maximize the benefit from nursing care activities. Additionally, it can shorten the mechanical ventilation duration and the total intensive care unit stay with a time and cost effective process. Lean is an improvement strategy based on the concept of eliminating the waste and creation of value-added care practices to the patients. Applying lean strategy for mechanically ventilated patients requires critical evaluation of all steps of the care to identify which add value and which do not.Methods: A descriptive research design was used in the current study and two tools were used for data collection in this study: “Lean assessment observational checklist of total care for mechanically ventilated patients”, and “Critical care nurses’ self-report about waste during total care of mechanically ventilated patients”.Results: The differences between value added and non-value added care practice items were not statistically significant in ventilator and patient care practices items (p = .232 and .884) respectively, while there was no statistical difference between the value added and non-value added care practice items in tube care. The differences between the time consumed in all care practices items were statistically significant (p < .001). According to the nurses' self-report, direct care for patients was ranked as the first care category that can increase the cost and effort followed by the indirect care category.Conclusions: Not all care items for mechanically ventilated patients have been added value to the patients. Waste outcomes as reported by nurses resulted in increase their efforts, time of care, in addition to increase the cost of care.

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Intensive Care Medicine in 2050: toward an intensive care unit without waste

Cited by 7 publications

References 18 publications

Physicians’ predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study

Physicians’ predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study

The evolving role of intensive care in health care and society

Lean thinking in total nursing care for mechanically ventilated patients: A new concept in ICU

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