Critical care clinics
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The goal of this article is to introduce the elements of the Electronic Medical Record as they pertain to critical care medicine including order communications and decision support.
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Critical care has become an important part of the health care system; however, it still is provided in a heterogeneous, and likely suboptimal, fashion. Future challenges will include providing an adequate workforce; ensuring critical care is delivered to the right patients at the right time; converting advances in our understanding of the biology of critical illness into improved care and outcomes; and partnering successfully with patients, families, and society in forging the critical care of the future.
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Critical care clinics · Jan 2005
ReviewManagement of the critically ill patient in the emergency department: focus on safety issues.
The management of the critically ill patient in the emergency department (ED) is an evolving process. Currently there is sufficient evidence substantiating the central role of the ED in the management of critically ill patients. ⋯ With the continuous increment of critically ill patients presenting to EDs throughout the country, the nationwide shortage of critical care physicians, and the limited availability of intensive care unit eds throughout hospital systems, there will be an increased focus on managing these patients in the ED. As the field of emergency medicine continues to mature, the ED physician must take notice of the potential risk areas within the management of the critically ill patient to continue to improve these patients' short- and long-term survival.
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The organizational structure of critical care services likely affects the quality of patient care, and ultimately, patient outcomes. Based on the available data, the ideal intensive care unit would be a closed-unit staffed by dedicated intensivists. Whether or not around-the-clock intensivist staffing is necessary, however, is debatable. Because financial realities preclude all units from being ideal, alternative strategies for organization must be explored.
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Critical care clinics · Jan 2005
ReviewFailure mode and effects analysis application to critical care medicine.
In July 2001, the United States Joint Commission on Accreditation of Health care Organizations adopted a new leadership standard that requires department heads in health care organizations to perform at least one Failure Mode and Effects Analysis (FMEA) every year. This proactive approach to error prevention has proven to be highly effective in other industries, notably aerospace, but remains untested in acute care hospitals. For several reasons, the intensive care unit (ICU) potentially is an attractive setting for early adoption of FMEA; however, successful implementation of FMEA in ICUs is likely to require strong, effective leadership and a sustained commitment to prevent errors that may have occurred rarely or never before in the local setting. This article describes FMEA in relation to critical care medicine and reviews some of the attractive features together with several potential pitfalls that are associated with this approach to error prevention in ICUs.