Reconsidering the transfer of patients from the intensive care unit to the ward: a case study approach

Evidence indicates that the poorly managed transfer of a patient from the intensive care unit (ICU) to the ward can lead to physical and psychological complications for the patient, and often require ICU readmission and rehospitalization. Reviewing this patient transfer process to improve the quality of care would be a positive step towards enhancing patients' recovery and providing skills to staff. The aim of this paper is to review case studies of transferring ICU patients to general wards in order to identify the shortcomings of this process. A literature review was conducted to evaluate current practices in the ICU transfer process. The results of this paper have clinical implications, suggest approaches to improve support for patients and their carers, and provide strategies to improve the transfer procedure.     

重症监护室患者尊严现状及其相关因素调查

目的调查重症监护室患者尊严的现状,并分析其相关因素。方法选取120例重症监护室患者,应用患者尊严量表进行调查。结果患者尊严量表总分为(72.88±18.00)分,患者尊严丧失普遍存在,其中,轻度尊严丧失占14.17%,中度尊严丧失占43.33%,重度尊严丧失占38.33%,非常严重尊严丧失占4.17%。患者年龄与患者尊严总分呈正相关(P0.05);主要照顾者的健康状况、家庭和睦状况是患者尊严丧失的重要影响因素。结论重症监护室患者尊严状况较差,普遍存在尊严丧失,提示应采取有效措施,提高患者的尊严水平。     

传染病医院ICU住院患者发生医院感染的病原菌分布及耐药性分析

目的：研究传染病医院重症监护病房（ICU）住院患者医院感染的病原菌分布及耐药性。方法回顾性分析2012年6月至2014年1月武汉市医疗救治中心接诊发生医院感染的50例ICU住院患者的临床资料,分析构成的病原菌及耐药性。结果革兰阴性菌、革兰阳性菌和真菌各占检出菌株的33．33％,三者相比差异无统计学意义（χ2=0．0000,P=1．0000）。革兰阴性菌感染中以鲍曼不动杆菌最多,占16．67％;革兰阳性菌感染中以金黄色葡萄球菌最多,占11．90％;真菌感染中以白色假单胞菌最多,占21．43％。感染部位以下呼吸道的感染最多见,占78．0％;与其他部位感染率相比,差异有统计学意义（P＜0．05）。分离的病原菌大多数有一定的耐药性,并且多重耐药的趋势明显增加。结论传染病医院ICU住院患者感染主要发生于呼吸道,革兰阴性菌居多且耐药严重。     

基于 PDCA 循环的过渡期护理对重症监护室转普通病房病人预后的影响

[目的]探讨基于 PDCA 循环的过渡期护理对重症监护室(ICU)转普通病房病人预后的影响。[方法]选取200例经 ICU 治疗后转入普通病房病人,分为对照组和观察组各100例。对照组仅给予常规护理,观察组给予 PDCA 循环管理的过渡期护理,比较两组病人过渡期不良事件发生率、重返 ICU 率、医院感染率、住院时间、抑郁量表(SDS)评分和焦虑量表(SAS)评分。[结果]观察组病人不良事件发生率、SDS 评分、SAS 评分、重返 ICU 率、医院感染发生率及住院时间均显著低于对照组,差异有统计学意义(P <0.05)。[结论]过渡期护理干预可显著降低 ICU 转普通病房病人临床预后。PDCA 循环管理模式可提高过渡期护理干预实施过程中的护理质量。     

Clinical review: impact of emergency department care on intensive care unit costs

Critical care is both expensive and increasing. Emergency department (ED) management of critically ill patients before intensive care unit (ICU) admission is an under-explored area of potential cost saving in the ICU. Although limited, current data suggest that ED care has a significant impact on ICU costs both positive and negative. ICU practices can also affect the ED, with a lack of ICU beds being the primary reason for ED overcrowding and ambulance diversion in the USA. Earlier application in the ED of intensive therapies such as goal-directed therapy and noninvasive ventilation may reduce ICU costs by decreasing length of stay and need for admission. Future critical care policies and health services research should include both the ED and ICU in their analyses.     

Discomfort and factual recollection in intensive care unit patients

Introduction

A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU stay. This study addresses the following questions. What is the incidence of discomfort reported by patients recently discharged from an ICU? What were the sources of discomfort reported? What was the degree of factual recollection during patients' stay in the ICU? Finally, was discomfort reported more often in patients with good factual recollection?

Methods

All ICU patients older than 18 years who had needed prolonged (>24 hour) admission with tracheal intubation and mechanical ventilation were consecutively included. Within three days after discharge from the ICU, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete a questionnaire consisting of 14 questions specifically concerning the environment of the ICU they had stayed in. Furthermore, they were asked whether they remembered any discomfort during their stay; if they did then they were asked to specify which sources of discomfort they could recall. A reference group of surgical ward patients, matched by sex and age to the ICU group, was studied to validate the questionnaire.

Results

A total of 125 patients discharged from the ICU were included in this study. Data for 123 ICU patients and 48 surgical ward patients were analyzed. The prevalence of recollection of any type of discomfort in the ICU patients was 54% (n = 66). These 66 patients were asked to identify the sources of discomfort, and presence of an endotracheal tube, hallucinations and medical activities were identified as such sources. The median (min–max) score for factual recollection in the ICU patients was 15 (0–28). The median (min–max) score for factual recollection in the reference group was 25 (19–28). Analysis revealed that discomfort was positively related to factual recollection (odds ratio 1.1; P < 0.001), especially discomfort caused by the presence of an endotracheal tube, medical activities and noise. Hallucinations were reported more often with increasing age. Pain as a source of discomfort was predominantly reported by younger patients.

Conclusion

Among postdischarge ICU patients, 54% recalled discomfort. However, memory was often impaired: the median factual recollection score of ICU patients was significantly lower than that of matched control patients. The presence of an endotracheal tube, hallucinations and medical activities were most frequently reported as sources of discomfort. Patients with a higher factual recollection score were at greater risk for remembering the stressful presence of an endotracheal tube, medical activities and noise. Younger patients were more likely to report pain as a source of discomfort.

     

Outcome of emergency department patients with delayed admission to an intensive care unit

Objective: To compare 30 day mortality, length of stay and cost for adult emergency department patients with a delay in intensive care unit admission of up to 24 h with a group of patients admitted directly from the emergency department to the intensive care unit. Methods: Retrospective cohort study in a 300‐bed university affiliated teaching hospital. One hundred and twenty‐two adult emergency department patients admitted to the intensive care unit either directly from the emergency department (direct group) or within 24 h of ward admission (delayed group) were identified. The main outcome measures investigated were 30 day mortality, length of stay and cost. Results: Thirty day mortality in the delayed group was significantly higher, the risk ratio being 2.46 (95% confidence interval 1.2–5.2). The length of stay and cost were similar in the direct and delayed groups. Baseline estimate of risk of death derived from the mortality probability model calculated from the emergency department data was similar for the two groups (P = 0.10). Emergency department triage categorization and emergency department staff seniority was significantly different (χ² for trends, P = 0.002 and 0.023, respectively), with patients in the delayed group more likely to be triaged as less urgent and to be initially assessed by junior staff. Conclusions: Our study shows that patients transferred to the intensive care unit within 24 h of ward admission from the emergency department had a significant increase in 30 day mortality compared with patients admitted to the intensive care unit directly from the emergency department, but no difference was found in terms of length of stay and cost.     

ICU脑卒中康复干预的针对措施和短期结局

目的 :探讨重症脑卒中的干预措施和近期目标 ,以及重症和早期康复医疗的临床意义。方法 :对患者进行临床评定 ,包括主要病情、监护指标、心功能、Glasgow昏迷量表 (GCS)、简式Fugl-Mayer评估 (FMA)等 ,对康复干预可能引起的反应和产生影响的监护指标进行观测。针对不同监护下状态采用适当康复干预措施。结果 :在本组中风ICU的主要合并症和并发症中 ,肺部感染占 73 .52 % ;心脏疾患占 38.2 4 % ;糖尿病占 2 6 .47%。虽然在康复干预后患者的运动功能仍然较低 ,但治疗组患者在实施康复治疗后GCS评分明显提高 (P <0 .0 0 1 ) ,而对照组改善不明显。治疗组FMA和对照组FMA在治疗后都有明显提高 ,而治疗组上下肢运动功能改善优于对照组 (P <0 .0 5)。结论 :ICU脑卒中患者有神经系统和心肺等方面的复杂问题 ,应采取针对性的对策 ,从其由ICU转归普通病房时的功能状况来看其结局是有利于重症患者的     

Opening the doors of the intensive care unit to cancer patients: A current perspective

The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival. In recent years, the classical intensive care unit(ICU) admission comorbidity criteria used for this group of patients have been discouraged since the risk factors for death that have been studied, mainly the number and severity of organic failures, allow us to understand the determinants of the prognosis inside the ICU. However, the availability of intensive care resources is dissimilar by country, and these differences are known to alter the indications for admission to critical care setting. Three to five days of ICU management is warranted before making a final decision(ICU trial) to consider keep down intensive management of critically ill cancer patients. Nowadays, taking into account only the diagnosis of cancer to consider ICU admission of patients who need full-supporting management is no longer justified.     

重症监护临床信息系统在急诊重症监护室中的应用

目的探讨重症监护临床信息系统(ICIS)在急诊重症监护室(EICU)中的应用效果。方法将本院急诊医学部重症监护室2014年8月—2015年1月收治的重症患者366例设为对照组,2015年2月—2015年7月收治的重症患者353例设为观察组。对照组患者应用"军卫一号",观察组应用重症监护临床信息系统,观察比较2组病情记录时间、观察项维护时间、出入量维护时间、核对确认医嘱时间及病情记录差错率、观察项维护差错率、出入量维护差错率和核对确认医嘱差错率。结果观察组护理记录时间、核对确认医嘱时间、护理工作记录差错率及核对确认医嘱差错率均显著低于对照组(P0.05)。结论 ICIS的应用提高了临床工作效率,节省了护理记录时间,降低了护理差错率,明显提高了临床护理质量和患者满意度。     

呼吸加强医疗病房患者预后因素研究

目的 探讨影响呼吸加强医疗病房患者预后的危险因素，为制定相应防治措施作参考。方法 回顾性分析216例呼吸加强医疗病房危重患者临床资料，采用Logistic回归分析，筛选和分析相关危险因素。结果急性生理和慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ，APACHEⅡ评分)、免疫抑制状态和氧合指数(PaO2／FiO2)对评价患者预后有重要作用；APACHEⅡ评分OR值为1．135，P值为0．00；氧合指数OR值为0．997，P值为0．092；免疫抑制OR值为6．583，P值为0．013。结论 升高的APACHEⅡ评分和降低的氧合指数以及合并免疫功能受损将使患者死亡风险升高，医务人员应高度重视。