Critical care clinics
-
Critical care clinics · Jul 2015
ReviewSeizures in Sleep: Clinical Spectrum, Diagnostic Features, and Management.
Sleep is disrupted in most patients hospitalized in the intensive care unit and the disturbances are even more profound in patients impacted by epilepsy. Nocturnal seizures must be differentiated from other common nocturnal events, such as delirium, parasomnias, and sedation. Many antiepileptic drugs produce undesirable side effects on sleep architecture that may further predispose patients to insomnia during the night and excessive sedation and hypersomnolence during the day. Failure to recognize, correctly diagnose, and adequately manage these disturbances may lead to more prolonged hospitalization, increased risk for nosocomial infections, poorer health-related qualify of life, and greater health care financial burden.
-
Sleep-disordered breathing in the perioperative setting poses an increase in both perceived and demonstrated challenges for health care providers. Some of these challenges relate to identifying patients at high risk for obstructive sleep apnea prior to surgery. Other management challenges include identifying the proper monitoring techniques, using the correct mix of pharmacologic and nonpharmacologic strategies to manage these patients, and identifying the proper and safe disposition strategy after surgery. Additional populations, such as pediatrics and the morbidly obese, are also highlighted, which may help address questions in populations that are frequently managed in the critical care setting postoperatively.
-
Critical care medicine is at a crossroads in which limited numbers of staff care for increasing numbers of patients as the population ages and use of ICUs increases. Also at this time health care spending must be curbed. ⋯ When implemented correctly and in the right populations this technology has improved outcomes. Future studies regarding implementation, organization, staffing, and innovation are needed to determine the optimal use of this critical care professional enhanced technology.
-
For more than 20 years, a 100-year-old state-based system for medical licensure has not progressed commensurate with the level of 21st century technology development. Despite government and nongovernment organizational attempts, each state maintains a process of variable and time-consuming requirements with lack of reciprocity. Lack of available reimbursement for Tele-ICU physician services is thought to be a long-standing and significant barrier to the rapid adoption of Tele-ICU programs. By reviewing the reimbursement guidelines for telehealth services across all major patient financial classes, a model is discussed for developing financial projections to determine exactly what reimbursement is available for Tele-ICU programs.
-
Critical care clinics · Apr 2015
ReviewOutcomes Related to Telemedicine in the Intensive Care Unit: What We Know and Would Like to Know.
Telemedicine has been increasingly used in the intensive care unit setting (Tele-ICU) for providing care. Given the shortage of qualified intensivists and critical care nurses in the United States and the ever-increasing demand for intensive care services, Tele-ICU has been proposed as a strategy to bridge this supply/demand gap. The Tele-ICU staffing model provides for many important outcome benefits that have been evaluated over the years by several studies. In this review, the authors summarize the existing evidence and identify areas where further evaluation is warranted.