A Simulation Model to Evaluate the Patient Flow in an Intensive Care Unit Under Different Levels of Specialization

2020 ◽  
Author(s):  
Andres Alban ◽  
Stephen E. Chick ◽  
Oleksandra Lvova ◽  
Danielle Sent
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Simulation Model ◽  
Patient Flow ◽  
Different Levels

scholarly journals Behavioral Pain Indicators in Patients with Traumatic Brain Injury Admitted to an Intensive Care Unit

2018 ◽  
Vol 7 (4) ◽  
pp. 197-203 ◽  
Author(s):  
Roghieh Nazari ◽  
Saeed Pahlevan Sharif ◽  
Kelly A Allen ◽  
Hamid Sharif Nia ◽  
Bit-Lian Yee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Injury Severity ◽  
Repeated Measure ◽  
Neck Stiffness ◽  
Significant Difference ◽  
Eye Opening ◽  
Different Levels

Introduction: A consistent approach to pain assessment for patients admitted to intensive care unit (ICU) is a major difficulty for health practitioners due to some patients’ inability, to express their pain verbally. This study aimed to assess pain behaviors (PBs) in traumatic brain injury (TBI) patients at different levels of consciousness. Methods: This study used a repeated-measure, within-subject design with 35 patients admitted to an ICU. The data were collected through observations of nociceptive and non-nociceptive procedures, which were recorded through a 47-item behavior-rating checklist. The analyses were performed by SPSS ver.13 software. Results: The most frequently observed PBs during nociceptive procedures were facial expression levator contractions (65.7%), sudden eye openings (34.3%), frowning (31.4%), lip changes (31.4%), clear movement of extremities (57.1%), neck stiffness (42.9%), sighing (31.4%), and moaning (31.4%). The number of PBs exhibited by participants during nociceptive procedures was significantly higher than those observed before and 15 minutes after the procedures. Also, the number of exhibited PBs in patients during nociceptive procedures was significantly greater than that of exhibited PBs during the non-nociceptive procedure. The results showed a significant difference between different levels of consciousness and also between the numbers of exhibited PBs in participants with different levels of traumatic brain injury severity. Conclusion: The present study showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eye opening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning.

scholarly journals Behaviors Indicative of Pain in Brain-Injured Adult Patients With Different Levels of Consciousness in the Intensive Care Unit

2019 ◽  
Vol 57 (4) ◽  
pp. 761-773 ◽  
Author(s):  
Céline Gélinas ◽  
Madalina Boitor ◽  
Kathleen A. Puntillo ◽  
Caroline Arbour ◽  
Jane Topolovec-Vranic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adult Patients ◽  
Brain Injured ◽  
Different Levels

Variability in Surgical Caseload and Access to Intensive Care Services

2003 ◽  
Vol 98 (6) ◽  
pp. 1491-1496 ◽  
Author(s):  
Michael L. McManus ◽  
Michael C. Long ◽  
Abbot Cooper ◽  
James Mandell ◽  
Donald M. Berwick ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Delivery System ◽  
Care Delivery ◽  
Patient Flow ◽  
Healthcare Delivery ◽  
Hospital Data ◽  
Healthcare Delivery System ◽  
Care Services

Background Variability in the demand for any service is a significant barrier to efficient distribution of limited resources. In health care, demand is often highly variable and access may be limited when peaks cannot be accommodated in a downsized care delivery system. Intensive care units may frequently present bottlenecks to patient flow, and saturation of these services limits a hospital's responsiveness to new emergencies. Methods Over a 1-yr period, information was collected prospectively on all requests for admission to the intensive care unit of a large, urban children's hospital. Data included the nature of each request, as well as each patient's final disposition. The daily variability of requests was then analyzed and related to the unit's ability to accommodate new admissions. Results Day-to-day demand for intensive care services was extremely variable. This variability was particularly high among patients undergoing scheduled surgical procedures, with variability of scheduled admissions exceeding that of emergencies. Peaks of demand were associated with diversion of patients both within the hospital (to off-service care sites) and to other institutions (ambulance diversions). Although emergency requests for admission outnumbered scheduled requests, diversion from the intensive care unit was better correlated with scheduled caseload (r = 0.542, P < 0.001) than with unscheduled volume (r = 0.255, P < 0.001). During the busiest periods, nearly 70% of all diversions were associated with variability in the scheduled caseload. Conclusions Variability in scheduled surgical caseload represents a potentially reducible source of stress on intensive care units in hospitals and throughout the healthcare delivery system generally. When uncontrolled, variability limits access to care and impairs overall responsiveness to emergencies.

scholarly journals Sustainment of a patient flow intervention in an intensive care unit in a regional hospital in Australia: a mixed-method, 5-year follow-up study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047394
Author(s):  
Eva Ros ◽  
Axel Ros ◽  
Elizabeth E Austin ◽  
Lina De Geer ◽  
Paul Lane ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mixed Method ◽  
Patient Flow ◽  
Hospital Management ◽  
Regional Hospital ◽  
First Year ◽  
Operative Care ◽  
Sustained Effects ◽  
Improvement Interventions

ObjectiveIn 2014, an escalation plan and morning handover meetings were implemented in an intensive care unit (ICU) to reduce access block for post-operative care. In this study, the improvement intervention is revisited 5 years on with the objective to see if the changes are sustained and to understand factors contributing to sustainability.DesignA mixed-method approach was used, with quantitative analysis of ICU administrative data and qualitative analysis of interviews with hospital management and ICU staff.SettingICU with mixed surgical and non-surgical cases in a regional hospital in Australia.ParticipantsInterview participants: ICU nurses (four), ICU doctors (four) and hospital management (four).Main outcome measuresMonthly number of elective surgeries were cancelled due to unavailability of ICU beds. Staff perceptions of the interventions and factors contributed to sustainability.ResultsAfter a decline in elective surgeries being cancelled in the first year after the intervention, there was an increase in cancellations in the following years (χ2=16.38, p=0.003). Lack of knowledge about the intervention and competitive interests in the management of patient flow were believed to be obstacles for sustained effects of the original intervention. So were communication deficiencies that were reported within the ICU and between ICU and other departments. There are discrepancies between how nurses and doctors use the escalation plan and regard the availability of ICU beds.ConclusionImprovement interventions in healthcare that appear initially to be successful are not necessarily sustained over time, as was the case in this study. In healthcare, there is no such thing as a ‘fix and forget’ solution for interventions. Management commitment to support communication within and between microsystems, and to support healthcare staff understanding of the underlying reasons for intervention, are important implications for change and change management across healthcare systems.

scholarly journals Awareness of national malaria management guidelines among house officers in Khartoum state teaching hospitals. Sudan 2018

2019 ◽  
Author(s):  
Mohammed Altyb Alshykh Aboshanab
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Teaching Hospitals ◽  
Outpatient Management ◽  
Third Trimester ◽  
Cross Sectional ◽  
Management Guidelines ◽  
Complicated Malaria ◽  
Different Levels

Abstract Background: Malaria is a protozoan disease which can lead to serious complications if not treated early and correctly. The aim of this study to assess the knowledge about malaria management guidelines among house officers.Methods: this is the cross sectional observational study conducted at 6 of Khartoum teaching hospitalsResults: The study showed that among the 115 participants evaluated there were 70.4% females and 29.6% were males. 94.8% of participants knew there is malaria management guidelines and 5.2% didn't knew about presence of this guidelines, 58.3% have some information and 10.4% just hear about this guidelines. 89.6% knew the management of simple malaria is an outpatient management. 65.2% of the participants were aware about where to manage the cases of complicated malaria (inpatient or in Intensive Care Unit). 27.8% of the participants were aware about the management of simple malaria in the second and third trimester.Conclusion: Different levels of awareness about malaria management guidelines as whole: 4.3% had an overall poor level of awareness, and 74.8% had an overall average level of awareness and 20.9% had an overall good level of awareness.

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