Critical care nursing clinics of North America
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With the expansion of higher acuity patients in noncritical care areas, the perceived need for arrhythmia monitoring has also escalated. For institutions pursuing this expansion, many factors must be kept in mind, including patient criteria for telemetry initiation and discontinuation, staff competency of ECG interpretation, safety, technology required, usability, and cost effectiveness. All of these issues must be addressed according to the individual institution's needs and the needs of the patient populations they serve.
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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.