Australian Critical Care

2010-08-01

Editorial Board

2010-08-01

Social networking and professional debriefing—Personal risk management

Judy Currey, Gavin D. Leslie — 2010-07-05

Debriefing is a healthy and necessary strategy for health professionals to deal with and reduce work-related stress, but context and content are critical. Traditionally, the tea room or change room was the hub of debriefing and for many remains so. Now, social networking sites (e.g. Facebook) are being increasingly used as an alternative communication means and often without regard to the permanence or access to personal comments; the reputation we create; or the ready access by patients, relatives, employers (current and prospective) and colleagues.

Chest X-ray quiz (Question)

2010-08-01

Quality, safety and critical care nursing

Wendy Chaboyer — 2010-05-10

This special edition focused on quality and safety in critical care. Why have we chosen to do this? In Australia and other places, up to one in ten patients suffer harm as an unintended consequence of healthcare in hospital. Adverse events have significant costs to patients, families and the health system. In fact, the direct costs related to adverse events in Australia is about $2 billion per year. But, importantly, it is also possible to learn from adverse events and near misses. For example, over five years ago a lack of accurate and timely communication was identified as a contributing factor in almost 70% of all sentinel events. This recognition has led to research into critical clinical communication situations, such as during handover, with evidence based key principles, guidelines and standard operating protocols being developed.

Quality and safety in intensive care—A means to an end is critical

Karena M. Hewson-Conroy, Doug Elliott, Anthony R. Burrell — 2010-01-18

Summary: Background: To achieve improvement in healthcare quality and safety, all four domains (outcome, process, structure and culture) must be considered in conjunction with the best available clinical evidence to improve patient care and reduce harm. A range of improvement initiatives have targeted processes of care in recognition of: (1) complexities of patient care and (2) evidence that a large portion of adverse events are preventable, occur during ongoing care, and result in poorer patient outcomes.Purpose: The aims of this paper are to: (1) outline national and international quality and safety initiatives; (2) identify evidence-based processes of care applicable to the general adult ICU patient population; (3) summarise the literature on relevant quality improvement strategies.Methods: An integrative literature review was conducted by: (1) database search of Ovid Medline, CINAHL, EMBASE and Cochrane for articles published between 1996 and October 2009; (2) identification of additional studies from articles obtained; (3) purposive internet search identifying relevant quality and safety initiatives.Findings: Quality improvement initiatives across the globe were identified, with ensuing focus on how the development, implementation and evaluation of evidence-based processes of care can lead to improvements in the delivery and outcomes of intensive care practice. Variation in practice and methodological limitations of existing studies were also noted, highlighting the need for innovative approaches to improving processes in the ICU.Conclusion: This integrative review has outlined potential for achieving practice improvements in intensive care and highlighted the need for further evaluative research to improve patient care at the bedside.

What can paper-based clinical information systems tell us about the design of computerized clinical information systems (CIS) in the ICU?

A. Miller, D. Pilcher, N. Mercaldo, T. Leong, C. Scheinkestel, J. Schildcrout — 2010-03-26

Summary: Background: Screen designs in computerized clinical information systems (CIS) have been modeled on their paper predecessors. However, limited understanding about how paper forms support clinical work means that we risk repeating old mistakes and creating new opportunities for error and inefficiency as illustrated by problems associated with computerized provider order entry systems.Purpose: This study was designed to elucidate principles underlying a successful ICU paper-based CIS. The research was guided by two exploratory hypotheses: (1) paper-based artefacts (charts, notes, equipment, order forms) are used differently by nurses, doctors and other healthcare professionals in different (formal and informal) conversation contexts and (2) different artefacts support different decision processes that are distributed across role-based conversations.Method: All conversations undertaken at the bedsides of five patients were recorded with any supporting artefacts for five days per patient. Data was coded according to conversational role-holders, clinical decision process, conversational context and artefacts. 2133 data points were analyzed using Poisson logistic regression analyses.Results: Results show significant interactions between artefacts used during different professional conversations in different contexts (χ2(df=16)=55.8, p<0.0001). The interaction between artefacts used during different professional conversations for different clinical decision processes was not statistically significant although all two-way interactions were statistically significant.Conclusions: Paper-based CIS have evolved to support complex interdisciplinary decision processes. The translation of two design principles – support interdisciplinary perspectives and integrate decision processes – from paper to computerized CIS may minimize the risks associated with computerization.

Discharge delay, room for improvement?

Teresa A. Williams, Gavin D. Leslie, Linda Brearley, Tim Leen, Keith O’Brien — 2010-03-29

Summary: Aim: Patients treated in the intensive care unit (ICU) and identified as suitable for discharge to the ward should have their discharge planned and expedited to improve patient outcomes and manage resources efficiently. We examined the hypothesis that the introduction of a critical care outreach role would decrease the frequency of discharge delay from ICU.Methods: Discharge delay was compared for two 6-month periods: (1) after introduction of the outreach role in 2008 and (2) in 2000/2001 (from an earlier study). Patients were included if discharged to a ward in the study hospital. Discharge times and reason for delay were collected by Critical Care Outreach Nurses and Critical Care Nurse Specialists.Results: Of the 516 discharges in 2008 (488 patients compared to 607 in 2000/2001), 31% of the discharges were delayed from ICU more than 8h, an increase of 6% from 2000/2001 (p<0.001). Patients in 2008 spent more in hospital from the time of their ICU admission when their discharge was delayed (p<0.001). The most common reasons for delay in 2008 were due to no bed or delay in bed availability (53%) and medical concern (24%). This is in contrast to 2000/2001 when 80% of delays were due to no bed or delay in bed availability and 9% due to medical concern. Many factors impact on patient flow and reducing ICU discharge delays requires a collaborative, multi-factorial approach which adapts to changing organisational policy on patient flow through ICU and the hospital, not just the discharge process in ICU.

Medical error and decision making: Learning from the past and present in intensive care

Tracey K. Bucknall — 2010-07-02

Summary: Background: Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area; thought to be related to the rapidly changing patient status and complex diagnoses and treatments.Purpose: The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error; (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas; and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care.Data source: Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein.Findings: Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events.Conclusion: It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.

Pain management for patients in cardiac surgical intensive care units has not improved over time

Snez Stolic, Marion L. Mitchell — 2010-06-17

Pain levels are a source of stress for patients in critical care settings. Patients frequently undergo procedures such as repositioning and suctioning and these are known to cause considerable pain. Recommendations and guideline have been developed for patients in critical care areas, however, pain continues to be a problem. The purpose of Gelina's study “was to describe the experiences of pain in postoperative cardiac surgery patients during their stay in the intensive care unit (ICU).” (p. 299)

Testing differences between two samples of continuous data

Sandra M.C. Pereira, Gavin Leslie — 2010-07-05

Summary: In this article the circumstances and techniques used to test a hypothesis by comparing information from two random samples to identify possible or existing difference amongst the target population are presented. This is based on continuous data collected from two samples after which a comparison can be made that may then be generalised to the source population. The terminology of the method is briefly explained including basic concepts such as survey errors and probabilistic chance. Hypothesis test methods are described for two types of samples: independent and dependent, and examples of some of the most commonly used test in health research are given for parametric and non-parametric source distributions.Testing difference between two samples of continuous data is an important and frequently applied process of making a decision about the main differences in a population of interest in health research.

Chest X-ray quiz (Answer and discussion)

2010-08-01

ANZICS/ACCCN Intensive Care ASM 2010

2010-08-01

6th World Congress on Pediatric Critical Care

2010-08-01

Call for Expressions of Interest Associate Editor

2010-08-01

Instructions for Authors

2010-08-01

Australian Critical Care

Contents

Editorial Board

Social networking and professional debriefing—Personal risk management

Chest X-ray quiz (Question)

Quality, safety and critical care nursing

Quality and safety in intensive care—A means to an end is critical

What can paper-based clinical information systems tell us about the design of computerized clinical information systems (CIS) in the ICU?

Discharge delay, room for improvement?

Medical error and decision making: Learning from the past and present in intensive care

Pain management for patients in cardiac surgical intensive care units has not improved over time

Testing differences between two samples of continuous data

Chest X-ray quiz (Answer and discussion)

ANZICS/ACCCN Intensive Care ASM 2010

6th World Congress on Pediatric Critical Care

Call for Expressions of Interest Associate Editor

Instructions for Authors