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2.
Crit Care ; 24(1): 215, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393325

RESUMO

The coronavirus disease 2019 (COVID-19) has rapidly evolved into a worldwide pandemic. Preparing intensive care units (ICU) is an integral part of any pandemic response. In this review, we discuss the key principles and strategies for ICU preparedness. We also describe our initial outbreak measures and share some of the challenges faced. To achieve sustainable ICU services, we propose the need to 1) prepare and implement rapid identification and isolation protocols, and a surge in ICU bed capacity; (2) provide a sustainable workforce with a focus on infection control; (3) ensure adequate supplies to equip ICUs and protect healthcare workers; and (4) maintain quality clinical management, as well as effective communication.


Assuntos
Infecções por Coronavirus/terapia , Estado Terminal/terapia , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/normas , Unidades de Terapia Intensiva/normas , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Infecções por Coronavirus/complicações , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/provisão & distribução , Pneumonia Viral/complicações
3.
Brasília; Organização Pan-American da Saúde; abr. 10, 2020. 23 p.
Não convencional em Espanhol, Português | LILACS, Coleciona SUS | ID: biblio-1096042

RESUMO

Oferecer atendimento de saúde especializado para o tratamento de pacientes críticos com síndrome respiratória aguda grave (SRAG), encaminhados principalmente de unidades de saúde onde a capacidade das unidades de terapia intensiva tem sido sobrecarregada pelo alto volume de pacientes. A estrutura flexível de uma Equipe de Saúde de Emergência para SRAG também permite a configuração de leitos para tartar pacientes gravemente doentes que precisem de oxigenoterapia. Equipes de Saúde de Emergência para SRAG utilizam estruturas portáteis que variam de tendas a contêineres. Eles também podem ser implantados dentro de estruturas fechadas alternativas usando módulos pré-fabricados. Unidades de Saúde de Emergência para SRAG podem oferecer até 30 leitos para pacientes críticos ou gravemente doentes (10 leitos para casos críticos com suspeita de COVID-19, 10 leitos para casos críticos com COVID-19 confirmada, e 10 leitos para casos graves). Unidades de Saúde de Emergência para SRAG possuem um centro de comando para a coordenação das operações do dia a dia. Esse é um sistema modular que pode ser expandido conforme necessário, adicionando unidades de 10 leitos, o que aumenta sua resposta conforme as necessidades e os recursos existentes.


Ofrecer atención médica especializada para el tratamiento de pacientes críticos con síndrome respiratorio agudo severo (SRAS), referidos principalmente desde unidades de salud donde la capacidad de las unidades de cuidados intensivos ha sido abrumada por el alto volumen de pacientes. La estructura flexible de un Equipo de Salud de Emergencia para SRAG también permite la configuración de camas para tratar pacientes críticos que necesitan oxigenoterapia. Los equipos de salud de emergencia para SRAG utilizan estructuras portátiles que van desde carpas hasta contenedores. También se pueden implementar dentro de estructuras cerradas alternativas utilizando módulos prefabricados. Las Unidades de Salud de Emergencia para SRAG pueden ofrecer hasta 30 camas para pacientes críticos o enfermos críticos (10 camas para casos críticos con sospecha de COVID-19, 10 camas para casos críticos con COVID-19 confirmado y 10 camas para casos graves). Las Unidades de Salud de Emergencia para SRAG tienen un centro de comando para la coordinación de las operaciones diarias. Este es un sistema modular que se puede ampliar según sea necesario agregando unidades de 10 camas, lo que aumenta su respuesta de acuerdo con las necesidades y recursos existentes.


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Síndrome Respiratória Aguda Grave/prevenção & controle , Pandemias/prevenção & controle , Betacoronavirus , Número de Leitos em Hospital/normas , Unidades de Terapia Intensiva/normas
4.
Intensive Care Med ; 46(5): 854-887, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32222812

RESUMO

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy. CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new recommendations in further releases of these guidelines.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Unidades de Terapia Intensiva/normas , Pneumonia Viral/terapia , Sepse/terapia , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sepse/diagnóstico , Sepse/etiologia , Sobreviventes
7.
East Mediterr Health J ; 26(2): 198-205, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32141598

RESUMO

Background: Adequate hand hygiene is considered the most effective measure to reduce transmission of nosocomial pathogens. Aims: To determine the effectiveness of infection control intervention to improve compliance with hand hygiene in the Emergency Department, Al-Leith General Hospital, Saudi Arabia, and evaluate bacterial load on hands as a possible indicator of improvement. Methods: The study consisted of 3 phases: Phase I, measurement of basal hand hygiene compliance level; Phase II, multimodal hand hygiene educational programme was initiated; and Phase III, hand hygiene compliance level was measured again. Data were collected by direct observation of healthcare workers in the emergency department between October 2016 and March 2017, using the standardized World Health Organization method for direct observation, "Five Moments for Hand Hygiene". The intervention comprised health education sessions using direct personal contact. Hands of healthcare workers were sampled during Phases I and III by sterile bag method, and bacterial load was determined. Results: A total of 1374 opportunities for hand hygiene were observed during the triphase study. Implementation of the interventional hand hygiene educational programme significantly improved compliance with hand hygiene guidelines from 30.7% to 45.5% (P < 0.01). Log10 bacterial load per hand dropped from 4.97 (standard deviation = 0.32) to 4.57 (0.47) (P < 0.05). Conclusions: Hand hygiene educational programmes were effective in improving compliance in the emergency department, and bacterial load on hands of healthcare workers could be used as an indicator of improvement in hand hygiene compliance.


Assuntos
Infecção Hospitalar/prevenção & controle , Higiene das Mãos , Mãos/microbiologia , Pessoal de Saúde , Controle de Infecções/métodos , Educação em Saúde , Hospitais , Humanos , Unidades de Terapia Intensiva/normas , Arábia Saudita
8.
Mendoza; s.n; [2020].
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1096703

RESUMO

INTRODUCCION: El Síndrome de Agudo Respiratorio Severo por Coronavirus (SARS-CoV-2) es una enfermedad respiratoria aguda causada por un nuevo coronavirus (COVID-19 identificado por primera vez en diciembre de 2019 en Wuhan( Hubei, China) mundo. COVID-19, es un virus ARN, miembro de los coronavirus del género beta estrechamente relacionados con el SARS-CoV 2.Los signos comunes de COVID-19 incluyen fiebre, tos y dificultad para respirar. La definición de caso confirmado de la OMS establece que es la infección confirmada por laboratorio independientemente de los signos y síntomas clínicos. Al momento, no existe un tratamiento antiviral específico para COVID-19, pero la atención de apoyo puede ayudar a aliviar los síntomas y debe incluir el apoyo de las funciones vitales de los órganos en casos severos. El brote comenzó en diciembre de 2019 en Wuhan, provincia de Hubei, China, y se declaró una pandemia mundial el 11 de marzo de 2020.La distribución geográfica incluye a China, la mayor parte de Europa, Reino Unido e Irlanda, Corea del Sur. Existen 332 930 casos confirmados de enfermedad por coronavirus 2019 (COVID-19), incluidas 14 510 muertes en 151 países de todo el mundo informadas por la OMS al 23 de marzo de 2020. METODOLOGIA: Se realizó una búsqueda no sistemática en la bibliografía, consultando portales de la OMS; OPS, Medline ("(ncov[All Fields] AND "19 (Lond)"[Journal]) AND (Clinical Trial[ptyp] AND "loattrfull text"[sb])"), bases de datos de ETS (CDYork, EUnhta, HTAi, Brisa, Conitec, Cenetec) así como agencias reguladoras en salud(OSTEBA, PBAC, CADTH, NICE), con el término También se consultaron portales de Sociedades científicas, y registros de ensayos clínicos en curso ( Clinical Trials,) con el término " SARS-CoV 2 infection". Se realizaron consultas a informantes claves del Ministerio de Salud tales como neumonólogos, infectólogos y epidemiológos. VALORACION DE LAS EVIDENCIAS: a-Magnitud del problema: los brotes epidémicos generan un entorno de elevadísima incertidumbre para pacientes, equipos de salud, gestores y la sociedad en su conjunto. La pandemia de Covid-19 por sus epidemiología aún desconocida y por no contarse con tratamientos dirigidos para prevenirla (vacunas) ó mitigarla (medicamentos) ha supuesto un problema grave para los sistemas de salud, incluida nuestra región. b-Calidad de la Evidencia: Del conjunto de pautas clínicas analizadas puede establecerse que se trata de evidencias de baja calidad, la mayoría de ellas ensayos clínicos en curso y por lo tanto uso no autorizado de las tecnologías propuestas. El resto de recomendaciones son consensos de expertos que como es sabido, ocupan el nivel más bajo de calidad de la evidencia. Es probable que futuras investigaciones cambien la evidencia disponible y/o permitan valorar la magnitud del beneficio clínico. c-Impacto presupuestario y/o costo-efectividad: no valorado d- Impacto en la salud pública y en la equidad en salud:Desde la perspectiva del paciente deben considerarse que se trata de drogas sin autorización, por lo que requieren ser utilizadas bajo uso de Consentimiento informado. Desde la perspectiva del sistema de salud, son drogas con indicación para otras patologías y dada la baja calidad de la evidencia que sustenta su posible indicación en este caso y atento a las predicciones de casos en la provincia de Mendoza, podría representar además de un uso no seguro, afectando la equidad en salud. CONCLUSIONES: No existen al momento tecnologías específicas que apoyen un uso racional el tratamiento de pacientes con Síndrome agudo respiratorio por COVID-19 en unidades de cuidados críticos. Si bien existen razones plausibles para anticipar efectos entre las drogas antivirales, las mismas no han sido aún aprobadas para tal indicación. El uso de medicación sin licencia autorizada requiere resguardos éticos, tales como el consentimiento informado de los pacientes. Ofrecer a los pacientes la participación en futuros ensayos clínicos que se desarrollen en la provincia es una opción que deberá evaluarse por las autoridades y equipos de salud.


Assuntos
Humanos , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Unidades de Terapia Intensiva/normas , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
9.
J Surg Res ; 245: 492-499, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446191

RESUMO

BACKGROUND: Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care. MATERIALS AND METHODS: We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs. RESULTS: Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20). CONCLUSIONS: Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.


Assuntos
Hipotensão/epidemiologia , Unidades de Terapia Intensiva/normas , Admissão do Paciente/normas , Fraturas das Costelas/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Hipotensão/etiologia , Hipotensão/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fraturas das Costelas/complicações , Medição de Risco , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos
10.
Medicine (Baltimore) ; 98(42): e17534, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626115

RESUMO

The knowledge of weaning ventilation period is fundamental to understand the causes and consequences of prolonged weaning. In 2007, an International Consensus Conference (ICC) defined a classification of weaning used worldwide. However, a new definition and classification of weaning (WIND) were suggested in 2017. The objective of this study was to compare the incidence and clinical relevance of weaning according to ICC and WIND classification in an intensive care unit (ICU) and establish which of the classifications fit better for severely ill patients. This study was a retrospective cohort study in an ICU in a tertiary University Hospital. Patient data, such as population characteristics, mechanical ventilation (MV) duration, weaning classification, mortality, SAPS 3, and death probability, were obtained from a medical records database of all patients, who were admitted to ICU between January 2016 and July 2017. Three hundred twenty-seven mechanically ventilated patients were analyzed. Using the ICC classification, 82% of the patients could not be classified, while 10%, 5%, and 3% were allocated in simple, difficult, and prolonged weaning, respectively. When WIND was used, 11%, 6%, 26%, and 57% of the patients were classified into short, difficult, prolonged, and no weaning groups, respectively. Patients without classification were sicker than those that could be classified by ICC. Using WIND, an increase in death probability, MV days, and tracheostomy rate was observed according to weaning difficult. Our results were able to find the clinical relevance of WIND classification, mainly in prolonged, no weaning, and severely ill patients. All mechanically ill patients were classified, even those sicker with tracheostomy and those that could not finish weaning, thereby enabling comparisons among different ICUs. Finally, it seems that the new classification fits better in the ICU routine, especially for more severe and prolonged weaning patients.


Assuntos
Estado Terminal/classificação , Unidades de Terapia Intensiva/normas , Respiração Artificial/normas , Desmame do Respirador/classificação , Brasil , Consenso , Estado Terminal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Escala Psicológica Aguda Simplificada , Fatores de Tempo , Traqueostomia , Desmame do Respirador/normas
11.
Hosp Pract (1995) ; 47(4): 177-180, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31594430

RESUMO

Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data.Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California.Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group.Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0-1.2%, 5.3-44.8%, 0-0.3% and 0.6-16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL.Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.


Assuntos
Glicemia , Hospitais Rurais/organização & administração , Unidades de Terapia Intensiva/organização & administração , Monitorização Fisiológica/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Hospitais Rurais/normas , Humanos , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Unidades de Terapia Intensiva/normas , Padrões de Referência , Índice de Gravidade de Doença
13.
Anesth Analg ; 129(3): 671-678, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425206

RESUMO

BACKGROUND: We implemented a new policy at our institution where the responsibility for intensive care unit (ICU) patient transports to the operating room (OR) was changed from the anesthesia to the ICU service. We hypothesized that this approach would be associated with increased on-time starts and decreased turnover times. METHODS: In the historical model, intubated patients or those on mechanical circulatory assistance (MCA) were transported by the anesthesia service to the OR ("pre-ICU Pickup"). In our new model, these patients are transported by the ICU service to the preoperative holding area (Pre-op) where care is transferred to the anesthesia service ("post-ICU Transfer"). If judged necessary by the ICU or anesthesia attending, the patient was transported by the anesthesia service ("post-ICU Pickup"). We retrospectively reviewed case tracking data for patients undergoing surgery before (January 2014 to May 2015) and after implementation (July 2016 to June 2017) of the new policy. The primary outcome was the proportion of elective, weekday first-case, on-time starts. To adjust for confounders including comorbidities and time trends, we performed a segmented logistic regression analysis assessing the effect of our intervention on the primary outcome. Secondary outcomes were turnover times and compliance with preoperative checklist documentation. RESULTS: We identified 95 first-start and 86 turnover cases in the pre-ICU Pickup, 70 first-start and 88 turnover cases in the post-ICU Transfer, and 6 turnover cases in the post-ICU Pickup group. Ignoring time trends, the crude proportion of on-time starts increased from 32.6% in the pre-ICU Pickup to 77.1% in the post-ICU Transfer group. After segmented logistic regression adjusting for age, sex, American Society of Anesthesiologists (ASA) physical status, Sequential Organ Failure Assessment (SOFA) score, respiratory failure, endotracheal intubation, MCA, congestive heart failure (CHF), valvular heart disease, and cardiogenic and hemorrhagic shock, the post-ICU Transfer group was more likely to have an on-time start at the start of the intervention than the pre-ICU Pickup group at the end of the preintervention period (odds ratio, 11.1; 95% confidence interval [CI], 1.3-125.7; P = .043). After segmented linear regression adjusting for the above confounders, the estimated difference in mean turnover times between the post-ICU Pickup and pre-ICU Transfer group was not significant (-6.9 minutes; 95% CI, -17.09 to 3.27; P = .17). In post-ICU Transfer patients, consent, history and physical examination (H&P), and site marking were verified before leaving the ICU in 92.9%, 93.2%, and 89.2% of the cases, respectively. No adverse events were reported during the study period. CONCLUSIONS: A transition from the anesthesia to the ICU service for transporting ICU patients to the OR did not change turnover times but resulted in more on-time starts and high compliance with preoperative checklist documentation.


Assuntos
Serviço Hospitalar de Anestesia/normas , Estado Terminal/terapia , Unidades de Terapia Intensiva/normas , Transporte de Pacientes/normas , Fluxo de Trabalho , Adulto , Idoso , Serviço Hospitalar de Anestesia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transporte de Pacientes/métodos
14.
J Rehabil Med ; 51(8): 598-606, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31402389

RESUMO

OBJECTIVES: To assess the feasibility of in-reach rehabilitation for critical care survivors following discharge from the intensive care unit. To determine whether additional in-reach rehabilitation reduces hospital length-of-stay and improves outcomes in critical care survivors, compared with usual therapy. PARTICIPANTS: A total of 66 consecutively-admitted critical care survivors with an intensive care unit stay ≥ 5 days were enrolled in the study. Of these, 62 were included in the analyses. METHODS: Pilot randomized control trial with blinded assessment at 6 and 12 months. The intervention group (n = 29) received in-reach rehabilitation in addition to usual ward therapy. The usual-care group (n = 33) received usual ward therapy. The primary outcome assessed was length-of-stay. Secondary outcomes included mobility, functional independence, psychological status and quality-of-life. RESULTS: The intervention group received more physiotherapy and occupational therapy sessions per week than the usual-care group (median = 8.2 vs 4.9, p < 0.001). Total length-of-stay was variable; while median values differed between the intervention and usual care groups (median 31 vs 41 days), this was not significant and the pilot study was not adequately powered (p = 0.57). No significant differences were observed in the secondary outcomes at hospital discharge, 6- or 12-month follow-ups. CONCLUSION: Provision of intensive early rehabilitation to intensive care unit survivors on the acute ward is feasible. A further trial is needed to draw conclusions on how this intervention affects length-of-stay and functional outcomes.


Assuntos
Cuidados Críticos/psicologia , Unidades de Terapia Intensiva/normas , Reabilitação/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Sobreviventes , Resultado do Tratamento , Adulto Jovem
15.
AACN Adv Crit Care ; 30(3): 222-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31462518

RESUMO

Patients hospitalized with neurologic and medical issues in the neuroscience critical care unit have widely varying and complex disease states that can change rapidly. The large amount of data that must be reviewed regularly by medical staff members presents a challenge to the provision of high-quality care to these patients. In an effort to lessen the burden, the authors' team implemented an electronic multidisciplinary rounding tool, which facilitates team communication by allowing accurate and concise review of patient information. The rounding tool is part of an ongoing quality improvement project and has been in use for 4 years. Nurses have reported that the tool provides a comprehensive summary of the patient's hospital stay that facilitates handoff during shift changes. A survey of nursing staff members demonstrated high levels of satisfaction with the tool during both multidisciplinary rounds and handoffs.


Assuntos
Comunicação , Cuidados Críticos/normas , Registros Eletrônicos de Saúde/normas , Unidades de Terapia Intensiva/normas , Transtornos Neurocognitivos , Transferência da Responsabilidade pelo Paciente/normas , Visitas com Preceptor/normas , Guias como Assunto , Humanos
16.
S Afr Med J ; 109(8b): 613-629, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31456540

RESUMO

Background. In South Africa (SA), intensive care is faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience daily the consequences of limited resources. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are frequently necessary in SA, particularly in the publicly funded health sector. Purpose. The purpose of this consensus statement is to examine key questions that arise when considering the status of ICU resources in SA, and more specifically ICU admission, rationing and triage decisions. The accompanying guideline in this issue is intended to guide frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining a fair distribution of available resources. Fair and efficient triage is important to ensure the ongoing provision of high-quality care to adult patients referred for intensive care. Recommendations. In response to 14 key questions developed using a modified Delphi technique, 29 recommendations were formulated and graded using an adapted GRADE score. The 14 key questions addressed the status of the provision of ICU services in SA, the degree of resource restriction, the efficiency of resource management, the need for triage, and how triage could be most justly implemented. Important recommendations included the need to formally recognise and accurately quantify the provision of ICU services in SA by national audit; actively seek additional resources from governmental bodies; consider methods to maximise the efficiency of ICU care; evaluate lower level of care alternatives; develop a triage guideline to assist policy-makers and frontline practitioners to implement triage decisions in an efficient and fair way; measure and audit the consequence of triage; and promote research to improve the accuracy and consistency of triage decisions. The consensus document and guideline should be reviewed and revised appropriately within 5 years. Conclusion. In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, recommendations and a guideline have been developed to guide policy-making and assist frontline triage decision-making in SA. These documents are not a complete plan for quality practice but rather the beginning of a long-term initiative to engage clinicians, the public and administrators in appropriate triage decision-making, and promote systems that will ultimately maximise the efficient and fair use of available ICU resources.


Assuntos
Cuidados Críticos/normas , Alocação de Recursos para a Atenção à Saúde/normas , Unidades de Terapia Intensiva/normas , Admissão do Paciente/normas , Triagem/normas , Adulto , Consenso , Humanos , África do Sul
17.
S Afr Med J ; 109(8b): 630-642, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31456541

RESUMO

Background. In South Africa (SA), administrators and intensive care practitioners are faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience the consequences of limited resources daily. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are routinely necessary in SA, particularly in the publicly funded health sector. Purpose. The purpose of this guideline is to utilise the relevant recommendations of the associated consensus meeting document and other internationally accepted principles to develop a guideline to inform frontline triage policy and ensure the best utilisation of adult intensive care in SA, while maintaining the fair distribution of available resources. Recommendations. An overall conceptual framework for the triage process was developed. The components of the framework were developed on the basis that patients should be admitted preferentially when the likely incremental medical benefit derived from ICU admission justifies admission. An estimate of likely resource use should also form part of the triage decision, with those patients requiring relatively less resources to achieve substantial benefit receiving priority for admission. Thus, the triage system should maximise the benefits obtained from ICU resources available for the community. Where possible, practical examples of what the consensus group agreed would be considered appropriate practice under specified South African circumstances were provided, to assist clinicians with practical decision-making. It must be stressed that this guideline is not intended to be prescriptive for individual hospital or regional practice, and hospitals and regions are encouraged to develop specified local guidelines with locally relevant examples. The guideline should be reviewed and revised if appropriate within 5 years. Conclusion. In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, this guideline has been developed to guide policy-making and assist frontline triage decision-making in SA. This document is not a complete plan for quality practice, but rather a template to support frontline clinicians, guide administrators and inform the public regarding appropriate triage decision-making.


Assuntos
Cuidados Críticos/normas , Alocação de Recursos para a Atenção à Saúde/normas , Unidades de Terapia Intensiva/normas , Admissão do Paciente/normas , Triagem/normas , Adulto , Consenso , Humanos , África do Sul
18.
Rev Esc Enferm USP ; 53: e03471, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433013

RESUMO

OBJECTIVE: To identify the prevalence of nursing process documentation in hospitals and outpatient clinics administered by the São Paulo State Department of Health. METHOD: A descriptive study conducted through interviews with nurses responsible for 416 sectors of 40 institutions on the documentation of four phases of the Nursing Process (data collection, diagnosis, prescription and evaluation) and nursing annotations. RESULTS: Of the 416 sectors studied, 89.9% documented at least one phase; 56.0% documented the four phases; 4.3% only documented nursing annotations; 5.8% did not document any phase, nor did the nursing notes. The types of sectors which were less documented were: ambulatory, diagnostic support, surgical center and obstetric center; while the ones which were most documented included: intensive care units, emergency rooms and hospitalization units. The data collection and diagnosis were the least documented phases, both in 78.8% of the sectors. CONCLUSION: Most of the studied sectors document the Nursing Process and do nursing annotations, but there are sectors where documentation does not meet formal requirements. The viability of documentation of all the Nursing Process phases in certain types of sectors needs to be better studied.


Assuntos
Documentação/estatística & dados numéricos , Processo de Enfermagem/normas , Registros de Enfermagem/normas , Instituições de Assistência Ambulatorial/normas , Brasil , Estudos Transversais , Serviço Hospitalar de Emergência/normas , Hospitais/normas , Humanos , Unidades de Terapia Intensiva/normas , Entrevistas como Assunto , Saúde Pública
19.
Rev Esc Enferm USP ; 53: e03508, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433023

RESUMO

OBJECTIVE: To evaluate the structure and adherence to the standardized and specific precautionary measures of health professionals in the Intensive Care Unit of a teaching hospital in the Federal District of Brazil. METHOD: A descriptive, cross-sectional and prospective study. A structured questionnaire was used via observations which recorded the practices of professionals with Individual Protection Equipment and indications of precautions. The chi-square test was applied, and the p-value was calculated. RESULTS: A total of 52 professionals participated in the study, and 445 care procedures were observed in 36 audit sessions. The average adhesion rate for equipment use was 72.72%, with 94.91% for gloves, 91.43% for aprons, 80% for masks and 24.56% for safety glasses. When there was no indication and no personal protective equipment was used, the average rate was 68.01%, with 30.77% for gloves, 87.58% for aprons, 57.58% for masks, and 96.13% for safety glasses. Contact precautions were unnecessarily indicated for 35% of patients. CONCLUSION: Good adherence to using gloves, aprons and masks were observed, but there was poor adherence to using safety glasses and unnecessary use of masks and admission contact precautions.


Assuntos
Cuidados Críticos/métodos , Unidades de Terapia Intensiva/normas , Roupa de Proteção/estatística & dados numéricos , Adulto , Brasil , Cuidados Críticos/normas , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Auditoria Médica , Estudos Prospectivos , Inquéritos e Questionários
20.
J Stroke Cerebrovasc Dis ; 28(9): 2488-2495, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31277995

RESUMO

BACKGROUND AND OBJECTIVE: Current standard practice guidelines recommend ICU admission for ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). More recently, the trend in stroke care is to broaden eligibility for IV thrombolysis. Two examples are a more liberal inclusion criteria known as SMART criteria (sIV-tPA), and the transfer of patients to comprehensive stroke centers (CSC). The present study characterizes ICU interventions in these patients. Understanding which stroke patients that require ICU-level care may allow for placement of patients in the appropriate level of care at hospital admission. METHODS: We performed a retrospective review of consecutive transfer and nontransfer sIV-tPA-treated patients admitted to the ICU at a CSC. We evaluated the frequency, timing, and nature of ICU interventions. RESULTS: Three hundred and thirty one patients were treated with sIV-tPA and 42% required ICU interventions during ICU admission. Of patients requiring ICU interventions, 98% had an ICU intervention performed in triage, prior to admission. National Institute of Health Stroke Scale score only had a moderate association to requirement of ICU interventions. Neither transferring patients to a CSC nor the number of standard IV-tPA contraindications increased ICU interventions. CONCLUSIONS: Liberalized IV-tPA administration did not increase ICU interventions. Nearly all patients that required ICU interventions declared this need in triage, prior to ICU admission. This timing of ICU intervention use during triage is highly sensitive for whether a patient will require ongoing ICU-level care during hospital admission. Identifying ICU intervention use in triage may allow for more effective placement of post-IV-tPA patients in the appropriate inpatient care setting, leading to better utilization of scarce ICU resources.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Unidades de Terapia Intensiva , Admissão do Paciente , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Triagem , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Tomada de Decisão Clínica , Bases de Dados Factuais , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/normas , Seleção de Pacientes , Transferência de Pacientes , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/normas , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento , Triagem/normas
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