27 hours ago Our classification of transferred patients as either “slow transfer” or “rapid transfer” was determined by examining the time recorded in the chart when the first criterion was met on the ward and the time of transfer to the ICU. Patients transferred to the ICU more than 4 hours after first meeting any of the physiologic threshold criteria were labeled as “slow transfer” while … >> Go To The Portal
Physician progress notes within each record were collected for up to ten consecutive calendar days depending on the length of hospital stay: up to 2 days in ICU before transfer, the day of transfer, and up to 7 days after transfer to the accepting hospital ward. Notes were photocopied, de-identified, and assigned a unique identifier for analysis.
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Although transfer to the medical floors is a positive step toward physical recovery, it can be equally traumatic, and many patients and their families exhibit stress, fear, and anxiety associated with relocation from ICU. 7,25 The transfer from the ICU to the medical-surgical floors is also a traumatic event for the family. 22 (p114)
Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.
There is a variety of controversial approaches about the need of sedation, use of end-tidal CO2monitoring, and manual versus mechanical ventilation based on different evidence. The objective of this review was to recommend safer options of critical patient transfer to the ICU that help reduce patient morbidity and mortality. Methods.
Evidence shows inconsistency and variability on the use of standardized protocols during critical patient transfer and handover to the ICU. There is a variety of controversial approaches about the need of sedation, use of end-tidal CO2monitoring, and manual versus mechanical ventilation based on different evidence.
Intensive care is appropriate for patients requiring or likely to require advanced respiratory support, patients requiring support of two or more organ systems, and patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ.
What is an ICU? ICU cares for people who have life-threatening conditions, such as a serious injury or illness, where they receive around-the-clock monitoring and life support. It differs from other hospital wards in that: ICU provides 24-hour care from a highly-trained team of specialists.
Every intensive care unit (ICU) should strictly follow protocols for investigating alarms. Monitoring usually includes measurement of vital signs (temperature, blood pressure, pulse, and respiration rate), quantification of all fluid intake and output, and often daily weight.
Most ICU patients are continuously monitored with beat-by-beat measurements via the electrocardiogram (ECG) and blood pressure (via noninvasive cuff or invasive arterial catheter monitor). Use this information and integrate it with the patient's clinical status.
The most common heart problem leading to ICU admission is heart failure.
Students learn quickly if they have one missing or poor quality assignment, their grade is sick and needs attention. Students with missing or poor quality assignments have their names placed on an ICU list that can be viewed by all staff members.
The bedside cardiac monitor (oscilloscope) in the ICU provides a continuous display of not only the patient's ECG, which includes heart rate (measured as the number of QRS complexes) and rhythm, but also the oxygen saturation (SpO2).
The most basic monitors show your heart rate, blood pressure, and body temperature. More advanced models also show how much oxygen your blood is carrying or how fast you're breathing.
Tests and proceduresAirway management.Bone marrow transplant.Cardiovascular monitoring.Central venous catheterization.Chest drainage tube insertion.Colonoscopy.Continuous renal replacement therapy.CPR.More items...•
emergency call; determining scene safety, taking BSI precautions, noting the mechanism of injury or patient's nature of illness, determining the number of patients, and deciding what, if any additional resources are needed including Advanced Life Support.
Patient assessment commences with assessing the general appearance of the patient. Use observation to identify the general appearance of the patient which includes level of interaction, looks well or unwell, pale or flushed, lethargic or active, agitated or calm, compliant or combative, posture and movement.
General Assessment means the statewide summative assessment used to measure student achievement of the content standards for English Language Arts/Literacy, Mathematics, Science and Social Studies.
Abstract: Transfers from the ICU to the medical ward pose a number of unique risks to patients recovering from critical illness. Several studies have identified communication breakdown among physicians and nurses at the time of transfer as a key vulnerability. This dilemma is particularly challenging in the context of tertiary institutions with high levels of patient acuity and complexity. Unfortunately, no studies are available to provide guidance as to the optimal transfer mechanism in this setting. To describe an innovative reorganization of the transfer process at Wake Forest Baptist Health. Our aim was to collaboratively involve transferring physicians, nurse managers, and hospital bed logistics personnel in a proactive multi-disciplinary daily handoff process.
Best practices about ICU transfer include Stepdown Units, discharge strategy checklists, and staffing strategies. We highlight a few key studies below which address best practices in ICU transfer.
On one hand, an SDU alleviates ICU congestion by providing a safe environment for post-ICU patients before they are stable enough to be transferred to the general wards . On the other hand, an SDU can take capacity away from the already over-congested ICU.
There is a growing body of evidence that suggests transitions of care are vulnerable moments in health-care delivery associated with medical errors, adverse events, poor patient satisfaction with care, increased health-care costs, and increased mortality.
The chosen topic for the case study is the delivery of care in transferring critically ill patients in Intensive Care Unit. It is related to core competency 3 aspect of care on Hygiene, Mobility and Tissue Viability. Martin (2012) stated that transportation of critically ill patients has deranged physiology, require organ support and invasive monitoring, it poses an important risk (Beckmann et al,2004). The aim of this assignment is to evaluate causes, outcomes and preventing factors associated with adverse incidents on intra hospital and inter hospital transport. Critical analysis and evaluation will be done in conjunction with the nursing and medical intervention based on best practice guidelines and gold standard evidenced based research to provide safe transfer.
The goal every transfer should be the continuation of high quality ICU care, preventing deterioration and adverse events.
In addition to, important factors in determining transport in determining transportability of clinically ill patients are escorting personnel and transport facilities, the severity of illness is of minor importance. Most important issues on transfer are equipment, either unavailable or malfunctioning.
Adverse incidents happened before and during patient transfer. It involved ineffective communication with the porters collecting the patient not on the agreed time and patient was not stabilised for transfer. Insufficient time to prepare and connect the patient to the equipment needed for safe transfer.
An observational study was conducted in the Netherlands in 2009 comparing adverse incidents and patient stability during Mobile Intensive Care Unit (MICU) transfer and transport with standard ambulance.
Inotrope infusion was being administered, inotropes is a group of medication that increases the myocardial contraction improving cardiac output thereby increasing mean arterial blood pressure and maintaining perfusion to vital organs and tissues (Berry and Mc Kenzie,2010).
This should include details of the patient’s condition, the reason for transfer, the names of the referring and accepting consultants, the patient’s clinical status prior to transfer, and details of vital signs, clinical events, and therapy given before and during transfer.
This refers to transfers that take place within the hospital setting either as part of the admission or discharge process , or to enable surgery, specialist procedures, or diagnostic tests. Although the patient remains within the hospital, they are still exposed to high-risk and unfamiliar environments, and staff need to be mindful of this when undertaking the transfer (see Table 20.2 ).
If the transfusion is only commenced in transit, all routine checks must be applied (i.e. check patient details against the blood component, and check that integrity, expiry date, and the blood group of the patient match the blood component).
In addition to the physiological effects of speed, acceleration, and deceleration on the patient during and in the hours subsequent to the transfer, there are other environmental effects, including temperature, noise, light, vibration, and atmospheric pressure. (p. 521)
Modern transport ventilators have a continuous flow of gas in the circuit to allow for flow triggering of spontaneous breaths (terms used include ‘bias flow’, ‘flow-by’, or ‘base flow’). This creates a small amount of gas consumption in addition to the patient’s minute volume, and should be included in the calculation of how long a cylinder will last. The amount of continuous flow will vary according to the ventilator:
ICUsteps have produced a range of literature, including Intensive Care: a guide for patients and relatives and Guide to Setting up a Patients and Relatives Intensive Care Support Group. The literature and further information are available from their website ( http://icusteps.org ).
Although the majority of patients report that relocation is a stressful experience, patients also regard transfer to a ward as a sign of improvement in their condition and relief from the stress of the critical care environment.
The intervention, “ transfer or discharge from ICU,” means all transfers and discharges that occurred in all adult ICUs to the medical-surgical floors. The outcomes of interest are the findings reported as impact of transfer or discharge from ICU from the perceptions of patients, their families, and nurses.
The findings of the studies reviewed demonstrated that transfer out or discharge from ICU to the medical-surgical floors is a stress- and anxiety-producing event to patients and their families. Discharge from ICU is equally as traumatic as admission. Some effects on the nurses are also noted. Although there are positive impact of discharge to the general care unit among patients, their families, and nurses, these are few. It is evident that there are more negative aftermaths of this aspect of care (refer to Table 7 ). There appears to be a myriad of physical, psychological/emotional, and environmental sequelae as well as effects in the provision of care related to patient’s discharge from critical care. This impact to patients, their families, and including the nurses should be identified and addressed.
Both ICU and ward notes routinely documented clinical plans, but rarely provided a decision-making rationale for plans requiring further justification (e.g., medications started and stopped, and clinical interventions applied without explanation or outcomes) (Additional file 5: Table S5). For example, in the chart of patient 001 (Hospital A), “family meeting to discuss prognosis…goals of care” was documented, however, no follow-up note was added to describe the nature or outcome of this conversation. Absence of decision-making documentation was a key observation during the transition of care from ICU to hospital ward.
Physician progress notes within each record were collected for up to ten consecutive calendar days depending on the length of hospital stay: up to 2 days in ICU before transfer, the day of transfer, and up to 7 days after transfer to the accepting hospital ward.
Staff physician notes (ICU and ward) across all hospitals were structured in a non-standardized format, but had broad similarities in the sequence of information documented ( i.e., patient history, exam (s)/interventions completed, and clinical plan). Trainee notes in nine of the ICUs and many most hospital wards followed a more standardized format that resembled the SOAP note structure [ 31 ]. One exception was that across all hospitals, surgical specialty notes were less structured and contained less detailed information than other notes in the sample (regardless of level of seniority) (Additional file 5: Table S5).
Two subthemes emerged in the analysis of note structure: order of information, and style and accessibility of notes.
The bars represent the mean number of total lines of text in physician progress notes according to each day within the 10-day time period. 95% confidence intervals are displayed on each bar