Why Multidisciplinary Rounds are not Multidisciplinary: Examination of a Neonatal ICU Rounding Process

2011 ◽  
Author(s):  
Huiyang Li ◽  
Sara Lu ◽  
Robert E. Schumacher ◽  
F. Jacob Seagull
Keyword(s):  
Multidisciplinary Rounds ◽  
Neonatal Icu

512 Bedside Transthoracic echography volume Assessment in the BICU

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S103-S103
Author(s):  
Michael G Chambers ◽  
Britton Garrett ◽  
Leopoldo C Cancio
Keyword(s):  
Point Of Care ◽  
Injured Patient ◽  
Bedside Ultrasound ◽  
Point Of Care Ultrasound ◽  
Ultrasound Images ◽  
Advanced Practice ◽  
Multidisciplinary Rounds ◽  
Volume Assessment ◽  
Us Findings ◽  
Image Repository

Abstract Introduction Point-of-Care Ultrasound (POCUS) has been shown to be a useful adjunct in assessment of various shock states and utilized to guide resuscitative and post-resuscitation de-escalation efforts. POCUS use for guiding resuscitation in burn injured patient has not be described. Objectives characterize the use of bedside ultrasound examinations performed by advance practice providers and treating physicians in a regional burn intensive care unit Methods Daily beside ultrasound examinations were performed utilizing a bedside ultrasound device by an advanced practice provider prior to rounds POCUS examinations consist of: Ultrasound images were archived to a centralized image repository and reviewed daily during multi-disciplinary rounds. Ultrasonographic volume assessment compared to clinical volume assessment made during daily multidisciplinary rounds. Results 100 examinations were performed of those 32 were within the initial 72 hour window: Conclusions Our results demonstrate that bedside ultrasound aides in guidance of both resuscitative and post-resuscitative efforts. We identified a cohort of patients who appeared hypervolemic clinically but US findings supported hypovolemia, we refer to as pseudohypervolemia US volume assessment provides information that changes management. We believe point of care ultrasound is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.

#69: Improving Communication About the Care and Prevention of Infections in a Pediatric Oncology Unit by Using Patient Daily Goals in Multidisciplinary Rounds

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S22-S22
Author(s):  
Escobedo-Melendez Griselda ◽  
Martinez-Albarran Manuel ◽  
Magaña-Saldivar Isadora ◽  
Jimenez Norma ◽  
Gomez-Huerta Elizabeth ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pediatric Oncology ◽  
Multidisciplinary Team ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Multidisciplinary Teams ◽  
Use Of Resources ◽  
Multidisciplinary Rounds ◽  
Prevention Of Infections ◽  
Oncology Unit

Abstract Background In children with cancer infections are the most frequent complication, with fatal outcomes if not addressed promptly. Therefore, care and prevention of infections in these patients require multidisciplinary interventions, with effective communication among healthcare providers to reduce the morbidity, length of stay, and the inappropriate use of resources. We used the Institute of Healthcare Improvement (IHI) model for improving the communication among healthcare providers by using patient daily goals after the oncology pediatric unit multidisciplinary rounds. Methods A multidisciplinary team was identified in the pediatric oncology unit. The team received weekly coaching on the IHI methodology. The methodology used included the creation of a block diagram to understand the baseline processes and a key driver diagram. Then, after a literature review, a data collection plan and measures were identified. The team identified different ideas for changes and prioritized them using an impact-effort matrix. Finally, several rounds of Plan-Do-Study-Act (PDSA) cycles reached the desired changes that organized the patient daily goals for sharing in the form of a worksheet. This worksheet was shared with nurses and pharmacist staff, a chat group was created, and the routine use of the daily goals for patient management was taught and incorporated into the rest of the care team staff. The percentage of excellent communication among all multidisciplinary teams and outcomes (length of stay, intensive care unit admission, and mortality) were recorded at baseline and endline. We determined the statistical significance of the baseline vs. endline difference by using χ 2 and t-tests. Results A total of 105 patients with suspected infections were included over a 6-month period (June through November 2019). We found a significant increase per month in the percent of agreement in excellent communication in the patient daily goals between infectious diseases specialist faculty and fellows, nurses, pharmacist, and pediatric oncology faculty and fellows (33.3% vs. 91.3%) (P = 0.004). Length of stay decreased monthly after our interventions (baseline: mean 14.7 days [SD 12.4] vs. after intervention: mean 6.7 days [SD 2.7]) (P = 0.014). There were only one ICU admission and no deaths during the implementation period. Conclusions Our approach using patient daily goals improved communication among a multidisciplinary team, leading to decreased length of stay and supporting adequate outcomes.

scholarly journals The national rate of intensive care units-acquired infections, one-year retrospective study in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Neda Izadi ◽  
Babak Eshrati ◽  
Yadollah Mehrabi ◽  
Korosh Etemad ◽  
Seyed-Saeed Hashemi-Nazari
Keyword(s):  
Intensive Care ◽  
Tract Infection ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Increased Risk ◽  
Neonatal Icu ◽  
Mortality Causes ◽  
One Year ◽  
Multi Center Study

Abstract Background Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of “hospital-ward-month”), and then, the last observation carried forward method was used to replace the missing data. Results The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran’s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83% of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier.

Decreasing Unplanned Extubations in the Neonatal ICU

2021 ◽  
pp. respcare.08203
Author(s):  
Deborah A Igo ◽  
Kimberly M Kingsley ◽  
Elisabeth M Malaspina ◽  
Alan P Picarillo
Keyword(s):  
Unplanned Extubations ◽  
Neonatal Icu

Integration of an ICU visualization dashboard (i-Dashboard) as a platform to facilitate multidisciplinary rounds: A cluster randomized trial (Preprint)

2022 ◽  
Author(s):  
Chao-Han Lai ◽  
Kai-Wen Li ◽  
Fang-Wen Hu ◽  
Pei-Fang Su ◽  
I-Lin Hsu ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Information Exchange ◽  
Time Series Data ◽  
Data Gathering ◽  
Cluster Randomized Trial ◽  
University Hospital ◽  
Care Plan ◽  
Series Data ◽  
Multidisciplinary Rounds ◽  
Cluster Randomized

BACKGROUND Multidisciplinary rounds (MDRs) are scheduled, patient-focused communication mechanisms among multidisciplinary providers in the intensive care unit (ICU). OBJECTIVE i-Dashboard is a custom-developed visualization dashboard that supports 1) key information retrieval and reorganization, 2) time-series data and 3) display on large touchscreens during MDRs. The present study aimed to evaluate the performance, including the efficiency of pre-rounding data gathering, communication accuracy and information exchange, and clinical satisfaction of integrating i-Dashboard as a platform to facilitate MDRs. METHODS A cluster randomized trial was performed in two surgical ICUs at a university hospital. Study participants included all multidisciplinary care team members. The performances and clinical satisfaction of i-Dashboard during MDRs were compared with those of the established electronic medical record (EMR) through direct observation and questionnaire survey. RESULTS Between April 26, 2021, and July 18, 2021, 78 and 91 MDRs were performed with the established EMR and i-Dashboard, respectively. For pre-rounding data gathering, the median (interquartile range [IQR]) time was 10.4 (9.1-11.8) and 4.6 (3.5-5.8) minutes using the established EMR and i-Dashboard (P<.001), respectively. During MDRs, data misrepresentations were significantly less frequent with i-Dashboard (median [IQR]: 0 [0-0]) than with the established EMR (4 [3-5]; P<.001). Also, effective recommendations were significantly more frequent with i-Dashboard than with the established EMR (P<.001). The questionnaire results revealed that participants favored using i-Dashboard in association with the enhancement of care plan development and team participation during MDRs. CONCLUSIONS i-Dashboard increases the efficiency in data gathering. Displaying i-Dashboard on large touchscreens in MDRs may enhance communication accuracy, information exchange and clinical satisfaction. The design concepts of i-Dashboard may help develop visualization dashboards that are more applicable for ICU MDRs. CLINICALTRIAL ClinicalTrials.gov NCT04845698; https://clinicaltrials.gov/ct2/show/NCT04845698

scholarly journals MRSA outbreak at neonatal ICU in Saudi Arabia

2015 ◽  
Vol 4 (S1) ◽  
Author(s):  
N Dagunton ◽  
K Salman ◽  
S Al-Saif ◽  
B Hanan
Keyword(s):  
Saudi Arabia ◽  
Neonatal Icu
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