A nurse-led critical care outreach program to reduce readmission to the intensive care unit: A quasi-experimental study with a historical control group.

INTRODUCTION: Various critical care outreach services have been developed and evaluated worldwide; however, the conflicting findings indicate the need to strengthen the outreach service research. This study aimed to evaluate the effects of a nurse-led critical care follow-up program on intensive care unit (ICU) readmission and hospital mortality in patients with respiratory problems discharged from the ICU in Hong Kong. METHODS: A quasi-experimental study design, with a historical control and a prospective intervention for 13 months, was used. The intervention group received a nurse-led, multidisciplinary ICU follow-up program in addition to the usual care. The outcome measures included ICU readmission within 72 h after ICU discharge, all ICU readmission (ICU readmission irrespective of the time frame after ICU discharge), hospital mortality, and 90-day mortality rate. Logistic regression analysis was used to determine the predictors for ICU readmission within 72 h. RESULTS: A total of 369 participants (the intervention group: 185; the control group: 184) were recruited. A significant reduction in ICU readmission within 72 h was observed in the intervention group compared to the control group (p = 0.001), even after controlling for confounders (odds ratio: 0.158, p = 0.007). The intervention group also demonstrated a significant reduction in all ICU readmission (p < 0.001) and hospital mortality (p = 0.042), but not on 90-day mortality (p = 0.081), when compared with the control group. This nurse-led ICU follow-up program was shown to be cost-effective, saving an estimated US$ 145,614 for a period of 13 months. CONCLUSION: The findings demonstrated that a nurse-led multidisciplinary ICU follow-up program was a beneficial and cost-saving strategy to avert ICU readmission in patients with respiratory problems after ICU discharge. It also highlighted the competent role of ICU nurses in planning and leading the implementation of a multidisciplinary program. The results contributed to the database of an innovative follow-up program to inform the practice worldwide.

Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study.

BACKGROUND: In unconscious ventilated patients, various eye protective measures have been used to prevent corneal abrasions. Two randomized controlled studies in Australia had compared the effectiveness of polyethylene films and eye instillations to prevent corneal abrasions but results were inconsistent. The local acceptance of polyethylene films as a standard eye protective measure is still limited. OBJECTIVES: Our study aims to compare the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment in the prevention of corneal abrasions in critically ill patients. DESIGN: A prospective randomized controlled study was conducted between April 2004 and December 2005. SETTING AND PARTICIPANTS: One hundred and twenty ventilated patients admitted to the intensive care unit (ICU) were randomly assigned to receive either polyethylene covers or lanolin eye ointment to prevent corneal abrasions. METHODS: All participants received a standard eye care regime together with the eye protective interventions. A fluorescein stain test was performed by the eye care team daily and then weekly to detect any corneal abrasions. RESULTS: Four participants were not included in the data analysis as they died soon after commencement of the study. A total of 116 patients were included in the final analysis. Of the seven patients (6.0%) that had a positive fluorescein test, four (6.8%) were in the polyethylene covers group (n=59) and three (5.3%) were in the lanolin eye ointment group (n=57). This was not statistically significant (p=0.519). One patient in the lanolin eye ointment group had an eye infection. Upon follow-up of those patients with positive fluorescein test results, two patients spontaneously converted to stain negative within 24h and two patients died before the ophthalmologist's assessment. The remaining three patients were diagnosed to have epithelial cell loss without corneal abrasions. CONCLUSIONS: With the implementation of a standardized eye care protocol, polyethylene cover is found to be equally effective in preventing corneal abrasions when compared with lanolin eye ointment. The additional benefit of polyethylene cover as a physical barrier to protect patients' eyes needed further evaluation.

Perception of stressors by patients and nurses of critical care units in Hong Kong.

The frightening experience in critical care units, whether it be associated with the disease process or related to the critical care environment, has an important impact on clients' recovery and rehabilitation. A comparative descriptive study was conducted in the critical units of two major hospitals in Hong Kong to assess the perception of stressors by patients and nurses. A Chinese version of the Intensive Care Unit Environmental Stressor Scale (ICUESS) was used. Significant similarities and differences were noted between patients and nurses on their perceptions of stressors in the critical care environment. Critical care nurses, apart from maintaining their efforts to minimize the negative effects of the stressful critical care environment, needed to equally focus on the patients' psychological needs through measures in re-establishing patients' self-control and minimizing the emotional stress.