Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of a ventilatory management team

Cohen, Ian L.; N, Bari; Strosberg, Martin A.; Weinberg, Peter F.; Wacksman, Richard; Millstein, Barbara; Fein, I. Alan

doi:10.1097/00003246-199110000-00010

Cited by 115 publications

(48 citation statements)

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“…Third, we only incorporated three professional groups. Indeed, the lowest recognition rate in our study was related to ventilators; this argues for the importance of having a respiratory therapist during interprofessional rounds, which has previously been shown to improve communication of ventilator data, increase in ventilator-free days, and an accurate assessment of the patient's changing respiratory status (Cohen et al, 1991;King, Conrad, & Ahmed, 2013). Fourth, given the limitations of a simulation and the lack of an actual patient, workflows could not be perfectly replicated.…”

Section: Discussionmentioning

confidence: 83%

Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

Sakata

Stephenson

Mulanax

et al. 2016

Journal of Interprofessional Care

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During interprofessional intensive care unit (ICU) rounds each member of the interprofessional team is responsible for gathering and interpreting information from the electronic health records (EHR) to facilitate effective team decision-making. This study was conducted to determine how each professional group reviews EHR data in preparation for rounds and their ability to identify patient safety issues. Twenty-five physicians, 29 nurses, and 20 pharmacists participated. Individual participants were given verbal and written sign-out and then asked to review a simulated record in our institution's EHR, which contained 14 patient safety items. After reviewing the chart, subjects presented the patient and the number of safety items recognised was recorded. About 40%, 30%, and 26% of safety issues were recognised by physicians, nurses, and pharmacists, respectively (p = 0.0006) and no item recognised 100% of the time. There was little overlap between the three groups with only 50% of items predicted to be recognised 100% of the time by the team. Differential recognition was associated with marked differences in EHR use, with only 3/152 EHR screens utilised by all three groups and the majority of screens used exclusively only by one group. There were significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR. Preferential identification of safety issues by certain professional groups may be attributed to differences in EHR use. Future studies will be needed to determine if shared decision-making during rounds can improve recognition of safety issues.

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Section: Discussionmentioning

confidence: 83%

Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

Sakata

Stephenson

Mulanax

et al. 2016

Journal of Interprofessional Care

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“…These are especially important in the 'off hours' (4:00 PM to 08:00 AM and the weekend) in the ICU [26]. In one study, the authors stated that implementation of the weaning process on weekends shortened sedation usage and IMV duration [27]. In the present study, the percentage of weekend extubation was 3 times higher in the 24-hour intensivist model than in the model with a periodic intensivist (25.3% versus 7.1%).…”

Section: Discussionmentioning

confidence: 99%

Full-Time ICU Staff in the Intensive Care Unit: Does It Improve the Outcome?

Adıgüzel¹,

Karakurt²,

Moçin³

et al. 2015

Tur Toraks Der

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OBJECTIVES:Patients with various severities are cared for in the intensive care unit (ICU) by an experienced ICU physician. We aimed to assess whether there is any difference in intubated ICU patient management when undertaken by a 24-hour intensivist versus a periodic experienced specialist in the ICU. MATERIAL AND METHODS:A retrospective, cross-sectional, observational study was done in a tertiary teaching hospital ICU. Patients receiving invasive mechanical ventilation (IMV) were classified into: group 1, managed by an experienced ICU pulmonary specialist during night shifts in 2006-2007, and group 2, managed by an intensivist around the clock in 2011. Patients were excluded if they were <18 years old, tracheostomized, or transferred from another ICU. Patient demographics and ICU data (IMV duration, sedation doses and duration, weekend extubation, ICU severity score [APACHE II], length of ICU stay, and mortality) were recorded, and groups were compared. RESULTS:In group 1, 131 of 215 IMV patients were included in the study, and in group 2, 294 of 374 patients were included. The sedation infusion rate, duration of IMV, self-extubation rate, and lenght of stay (LOS) of ICU were significantly increased in group 1 compared with group 2 (72.5% vs. 40.8%, p<0.0001; 152 vs. 68 hours, p<0.001; 24.4% vs. 13.9%, p<0.006; 13 vs. 8 days, p<0.0001, respectively). The weekend extubation rate and APACHE II scores were significantly lower in group 1 compared with group 2 (7.1% vs. 25.3%, p<0.0001; 22 vs. 25, p<0.017, respectively). Mortality rates were similar in the two groups (35.9% vs. 37.4%, p=0.76). CONCLUSION:A 24-hour intensivist appears to be better for decreasing IMV duration and LOS in the ICU. These results may be useful to address decreasing morbidity and, as a result, cost of ICU stays by 24-hour intensivist coverage, especially for patients with IMV. KEY WORDS:Twenty-four-hour intensivist, length of ICU stay, mortality INTRODUCTIONThe intensive care unit (ICU) is available 24 hours a day, 7 days a week (24/7) for admission of critically ill patients. The importance of the 'golden' hours for initial assessment and timely management of critically ill patients in the ICU is well known. The 24-hour availability of an intensivist may result in more prompt and accurate diagnostic evaluation and appropriate therapeutic decisions.The models of organization and management of ICUs are different in several countries, and even from hospital to hospital, there is a large difference with respect to training [1]. There is a controversial approach to mandatory 24-hour versus on-demand intensivist staffing [2,3].Several studies suggest that an around-the-clock intensivist improves ICU outcomes with respect to decreased morbidity and mortality [4][5][6][7][8]. However, this around-the-clock intensivist model is expensive due to the shortage of intensivists [9][10][11], although it has been shown to be better for the intensivist with respect to decreasing 'burnout' [12]. We proposed that this model might be more relevant in intub...

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“…Lower mortality rates have been associated with better process performance (12), and with full-time staffing by medical and surgical resident teams (15). Cohen and coworkers (16) found in a study of a large teaching hospital that reductions in duration of ventilation and in frequency of some invasive procedures was accomplished by placing an interdisciplinary team in the ICU to supervise ventilatory management. However, the study by Knaus and coworkers (12) found that a full-time intensive care physician team was not essential if nursing-physician coordination was strong.…”

mentioning

confidence: 99%

Outreach Education to Improve Quality of Rural ICU Care

Hendryx

et al. 1998

Am J Respir Crit Care Med

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This study tests whether an outreach educational program tailored to institutional specific patient care practices would improve the quality of care delivered to mechanically ventilated intensive care unit (ICU) patients in rural hospitals. The study was conducted as a randomized control trial using 20 rural Iowa hospitals as the unit of analysis. Twelve randomly selected hospitals received an outreach educational program. After review of the medical records of eligible patients, a multidisciplinary team of intensive care unit specialists from an academic medical center delivered an educational program with content specific to the findings and capacity of the hospital. The outcome measures included patient care processes, patient morbidity and mortality outcomes, and resource use. Results indicated that the outreach program significantly improved many patient care processes (lab work, nursing, dietary management, ventilator management, ventilator weaning). The program marginally reduced hospital ventilator days. Both total length of stay and ICU length of stay fell markedly in the intervention group (by an average of 3.2 and 2.1 d, respectively), while the control group fell only 0.6 and 0.3 d, respectively. However, these effects did not reach statistical significance. Unfortunately, the program had no detectable effects on the clinical outcomes of mortality or nosocomial events. We conclude that an outreach program of this type can effectively improve processes of care in rural ICUs. However, improving processes of care may not always translate into improvement of specific outcomes.

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Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of a ventilatory management team

Cited by 115 publications

References 0 publications

Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

Full-Time ICU Staff in the Intensive Care Unit: Does It Improve the Outcome?

Outreach Education to Improve Quality of Rural ICU Care

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