Critical Connections June 2006
Improving Care With An Outcomes-Managed Approach
Rose Lewis, RN, MSN, CCNS, APN
University of Virginia Health System
Charlottesville, Virginia, USA
Sidenia Earven, RN, MSN,
CCRN, APN
University of Virginia Health System
Charlottesville, Virginia, USA
Charles Fisher, RN, MSN,
CCRN, APN
University of Virginia Health System
Charlottesville, Virginia, USA
Paul Merrel, RN, MSN, APN
University of Virginia Health System
Charlottesville, Virginia, USA
References
1. Burns SM, Marshall M, Burns JD, et al. Design, testing and results of an outcomes-managed approach to patients requiring prolonged mechanical ventilation. Am J Crit Care. 1998;7:45-57.
2. Cohen IL, Bari N, Strosberg MA, et al. Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of a ventilatory management team. Crit Care Med, 1991;19:1278-1284.
3. Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med. 1994;150:896-903.
4. Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995;332:345-350.
5. Rudy EB, Daly BJ, Douglas S, et al. Patient outcomes for the chronically critically ill: Special care unit versus intensive care unit. Nurs Res. 1995; 44:324-331.
6. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1854-1869.
7. Kollef MH, Shapiro SD, Silver P, et al. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25:567-574.
8. Brook AD, Ahrens TS, Shaiff P, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med. 1999;27:2609-2615.
9. Kress JP, Pohlman AS, O’Connor MF, Hall AB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471-1477.
10. Henneman E, Dracup K, Ganz T, Molayeme O, Cooper C. Effect of a collaborative weaning plan on patient outcome in the critical care setting. Crit Care Med. 2001;29:297-303.
11. Henneman E, Dracup K, Ganz T, Molayeme O, Cooper CB. Using a collaborative weaning plan to decrease duration of mechanical ventilation and length of stay in the intensive care unit for patients receiving long-term mechanical ventilation. Am J Crit Care. 2002;11:132-140.
12. Smyrnios NA, Connolly A, Wilson MM, et al. Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med. 2002;30:1224-1230.
13. Burns SM, Burns JE, & Truwit JD. Comparison of five weaning indices. American Journal of Critical Care. 1994 Sept.; 3(5): 342-52.
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Rapid Response Systems: Have They Made A Difference?
Marie R. Baldisseri, MD
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, USA
References
1. Hillman KM: Critical care without walls. Curr Opin Crit Care 2002; 8:594-599.
2. Franklin C, Matthew J: Developing strategies to prevent in-hospital cardiac arrest: Analyzing responses of physicians and nurses in the hours before the event. Crit Care Med 1994; 22:244-247.
3. Schein RMH, Hazday N, Pena M, et al: Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 1990; 98:1388-1392.
4. Hodgetts TJ, Kenward G, Vlackonikolis L, et al: Incidence, location and reasons for avoidable in-hospital cardiac arrests in a
district general hospital. Resuscitation 2002; 54:115-123.
5. Sebat F, Musthafa AA, Watnik M, et al: A multidisciplinary community hospital program for early and rapid resuscitation of shock in nontrauma patients. Chest 2005; 127:1729-1743.
6. Kerridge RK, Saul WP: The medical emergency team, evidence-based medicine and ethics. Med J Australia 2003; 179:313-315.
7. DeVita M, Braithwaite RS, Mahidhara R, et al: Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Safe Health Care 2004; 13:251-254.
8. Bellomo R, Goldsmith D, Uchino S, et al: A prospective before-and-after trial of a medical emergency team. Med J Australia 2003; 179:283-288.
9. Pittard AJ: Out of our reach? Assessing the impact of introducing a critical care outreach service. Anaesthesia 2003; 58:882-885.
10. McGloin H, Adam SK, Singer M: Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable? J Royal College Physicians London 1999; 33:255-259.
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Critical Care Nurses: Key Leaders in Improving Outcomes and Process
Kathleen M. Vollman, MSN, RN, CCNS, CCRN, FCCM
Advancing Nursing
Dearborn, Michigan, USA
Patricia J. Posa, RN, BSN, MSA
St. Joseph Mercy Hospital
Ann Arbor, Michigan, USA
References
1. Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academy Press; 2004:107-160.
2. Barden C, ed. AACN Standards for Establishing and Sustaining Healthy Work Environments. AlisoViejo, CA: American Association of Critical-Care Nurses; 2005:11-29.
3. Rousseau D, Sitkin S, Burt R, et al. Not so different after all: A cross-disciplinary view of trust. Acad Manage Rev. 1998;23:1-12.
4. Leape LL, Berwick DM. Five years after To Err Is Human: What have we learned? JAMA. 2005;293:2384-2390.
5. Ingersoll G, Fisher M, Ross B, Soja M, Kidd N. Employee response to major organizational redesign. Appl Nurs Res. 2001;14:18-28.
Are There More Critical Care Physician Trainees Today?
Eric Chandler, PhD
Manager of Professional Affairs
Society of Critical Care Medicine
Pat Langford
Membership Marketing & Foundation Manager
Society of Critical Care Medicine
References
1. Strunk, BC, Ginsburg, PC, and Banker, M. The Effect of Population Aging On Future Hospital Demand Health Affairs March 2006:141-149.
2. U.S. Department of Health and Human Services. An Aging U.S. Population and the Health Care Workforce: Factors Affecting the Need for Geriatric Care Workers Available at:
http://futurehealth.ucsf.edu/geria/062404-Geria%20Final.pdf. Accessed April 1, 2006.
3. Brotherton SE, Rockey PH, Etzel SI. US Graduate Medical Education, 2004-2005, Trends in Primary Care Specialties JAMA, 2005; 294:1075-1082.
4. Fellowship and Residency Electronic Interactive Database.Graduate’s career plans statistics. American Medical Association. Updated September 30, 2005.
5. Bell, J. Symptoms of a doctor shortage Baltimore Sun. October16, 2005:A1
6. Cooper, R. Weighing the Evidence for Expanding Physician Supply Ann Intern Med, Nov 2004; 141:705-714.
7. Accreditation Council for Graduate Medical Education. Number of accredited programs and filled positions by specialty by academic year. Available at: http://www.acgme.org/adspublic. Accessed on April 1, 2006.
8. Accreditation Council for Graduate Medical Education. Number of accredited programs and filled positions by specialty by academic year. Available at http://www.acgme.org/adspublic and US Graduate Medical Education, 2004-2005, JAMA, Sept 7, 2005 pp 1075-1082, Appendix II, Table 10
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