Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Mar 1999
Review Case ReportsContinuous mixed venous (SvO2) monitoring. Too expensive or indispensible?
Based on theoretic principles and clear literature support, SvO2 (mixed venous oxyhemoglobin) monitoring offers an important advantage over traditional hemodynamic parameters. SvO2 allows more precise understanding of the adequacy of cardiac and pulmonary function than traditional parameters. SvO2 values do not replace the need to measure individual parameters of oxygen delivery or consumption but serves as the standard for assessing the impact of each parameter on tissue oxygenation. ⋯ The cost-effectiveness of the catheter, like any technology, is predicated on the clinician. Clinicians++ must be educated to use SvO2 as a primary end point for treatment decisions regarding hemodynamic therapy and patient stability. If used properly, every PAC should use fiberoptic SvO2 capabilities.
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Hemodynamic monitoring is one of the most exciting and potentially useful technologies in critical care. Hemodynamic monitoring, particularly the PAC, is the technology most often associated with the critical care unit. However, it is a difficult technology to master and is associated with clear (although infrequent) serious complications. ⋯ Appropriate implementation is not easy with this technology. This type of technology should only be employed in hospitals willing to invest the education and quality monitoring to ensure its appropriate application. As a part of this infrastructure, physicians and nurses need frequent communication in terms of what is expected from this technology for each patient.
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Crit Care Nurs Clin North Am · Mar 1999
ReviewOutlier management. Influencing the highest resource-consuming areas in acute and critical care.
Outliers account for a large amount of technology utilization and resources consumed in acute care, despite accounting for only a small portion of the total patient population. Most current efforts to reduce costs, such as re-engineering and downsizing, are nonspecific methods of controlling costs. Focusing efforts in high-cost areas, such as outlier management, is much more likely to improve patient care and improve the use of technology while achieving real advances in cost control. ⋯ These processes will take time and careful planning, but they are essential for the effective management of technology utilization and outliers. The failure to employ focused efforts like outlier management will result in the superficial treatment of high costs in acute care. The benefit to employing these methods leads to the best use of technology and the improved management of a difficult patient population.
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POCT is rapidly expanding in today's critical care areas. Nurses need to be involved in the implementation and evaluation process of POCT at every step. Each institution must determine which bedside tests are indicated based on an in-depth analysis of test accuracy, positive clinical impact, and cost-benefit ratio. ⋯ In addition, clinicians should examine the cost to patients regarding comfort and quicker discharge. These are quality indicators from the patient's perspective. POCT offers many advantages, but surrounding the implementation of this technology is a multitude of questions that each institution must answer prior to undertaking a POCT program.