Ultrasonography for Skin and Soft Tissue Infections, Noninfectious Cysts, Foreign Bodies, and Burns in the Critical Care Setting.

There are multiple opportunities for the use of ultrasonography in the diagnosis of skin and soft tissue differentials. Ultrasonography is inexpensive, easily reproducible, and able to provide real-time data in situations where condition changes and progression are common. Not only does bedside ultrasonography provide the clinician an in-depth look beyond epidermal structures into body cavities, it remains a safe, nonionizing radiating, effective, cost-efficient, reliable, and accessible tool for the emergency management of life- and limb-threatening integumentary infections. Unnecessary invasive procedures are minimized, providing improved patient outcomes. Integumentary abnormalities secondary to trauma, surgery, and hospitalization are common among critical care patients. This article provides a brief overview and evidence-based recommendations for the use of ultrasonography in the critical care setting for integumentary system conditions, including common skin and soft tissue differentials, foreign bodies, and burn depth assessment.

Boarding of critically Ill patients in the emergency department.

OBJECTIVES: Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes. DATA SOURCES AND STUDY SELECTION: Review article. DATA EXTRACTION AND DATA SYNTHESIS: Emergency department-based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department-based interventions, hospital-based interventions, and emergency department-based resuscitation care units. CONCLUSIONS: Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department-based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.

Boarding of Critically Ill Patients in the Emergency Department.

OBJECTIVES: Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes. DATA SOURCES AND STUDY SELECTION: Review article. DATA EXTRACTION AND DATA SYNTHESIS: Emergency department-based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department-based interventions, hospital-based interventions, and emergency department-based resuscitation care units. CONCLUSIONS: Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department-based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.

Expanding Virtual Reality to Teach Ultrasound Skills to Nurse Practitioner Students.

This team has had prior successful production efforts in the use of Second Life to implement a virtual reality world into both nursing education and practice. Our current efforts center around a virtual reality application that provides learners with the opportunity to master competencies in the use of ultrasound technologies, which have surfaced in many nurse practitioner certifications as a necessary skill. Using the authoring tool of CenarioVR™, and capturing video footage of a nurse practitioner using the ultrasound equipment, students can don a VR headset for an immersive experience. This ultrasound equipment is expensive, and allowing learners to learn skills in a virtual environment poses less risk to both the equipment and the patients.Future production efforts in augmented and mixed reality applications are described to engage others in cutting edge use of VR.

Postgraduate Emergency Nurse Practitioner Fellowships: Opportunities for Specialty Education.

Specialty trained emergency nurse practitioners (ENPs) can meet the demands of an unpredictable emergency care environment within an overburdened health care system. Although existing literature supports fellowship training as a method for bridging academic knowledge with clinical experiences for the novice nurse practitioner, the currently available emergency care postgraduate fellowship programs are inconsistent in approach. Building upon descriptive data provided by the existing 9 postgraduate ENP fellowship programs, a comparison and gap analysis of program content was conducted to identify perceived standards for ENP specialty education and the congruence with published ENP competencies. Standards to curricula, didactics, clinical rotations, and measures of competency were identified in the currently established ENP fellowships. A national ENP fellowship curriculum has the potential to afford consistency among programs, support attainment of competency, and provide clarity to the role and general education of advanced practice registered nurses seeking employment in emergency care.

Emergency Nurse Practitioner Core Educational Content.

Increasing numbers of patients are presenting to national emergency departments (EDs). This is occurring simultaneously with reductions in providers along with ED closures, creating a significant gap in emergency care. According to the advanced practice registered nurse consensus model, specialty-specific knowledge and practice build upon generalist nurse practitioner (NP) population foci. Although the National Organization of Nurse Practitioner Faculties provides guidelines for educational programs at the NP population level, determination of core specialty knowledge lies with specialty organizations. Emergency nurse practitioners (ENPs) require additional specialty-specific education to manage patients spanning age and acuity continuums. Although certification mechanisms are now in place to recognize NP specialty knowledge, a nationally standardized curriculum remains to be proposed. This article proposes core educational content for ENP specialty education; the utility of this content may serve as the foundation for the development of standardized ENP academic and postgraduate fellowship programs.