Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Dec 2014
ReviewTransitional care models: preventing readmissions for high-risk patient populations.
Transition from hospital to home is a vulnerable period for older adults with multiple chronic conditions. A pilot of the Transitional Care Model at a community hospital reduced readmission rates for patients with heart failure by 48%. This article shares the experience of a large metropolitan health care system in expanding transitional care across facilities to decrease readmission rates.
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Crit Care Nurs Clin North Am · Dec 2014
ReviewDriving sepsis mortality down: emergency department and critical care partnerships.
This article describes the Baylor Health Care System (BHCS) approach to decreasing sepsis-related mortality within a large complex adaptive health care system. BHCS implemented sepsis care improvement initiatives based on the Surviving Sepsis Campaign early goal directed therapy guidelines. By adhering to rigorous process improvement and evidence-based practice principles, BHCS has demonstrated improvements in sepsis care processes and a significant reduction in sepsis mortality.
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Crit Care Nurs Clin North Am · Dec 2014
ReviewTherapeutic hypothermia after cardiac arrest and return of spontaneous circulation: it's complicated.
Providing evidence-based care to patients with return of spontaneous circulation after a cardiac arrest is a recent complex innovation. Once resuscitated patients must be assessed for appropriateness for therapeutic hypothermia, be cooled in a timely manner, maintained while hypothermic, rewarmed within a specified time frame, and then assessed for whether hypothermia was successful for the patient through neuroprognostication. Nurses caring for therapeutic hypothermia patients must be knowledgeable and prepared to provide care to the patient and family. This article provides an overview of the complexity of therapeutic hypothermia for patients with return of spontaneous circulation in the form of a case study.
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Crit Care Nurs Clin North Am · Dec 2014
ReviewOverview of extracorporeal membrane oxygenation in cardiogenic shock.
In recent years, the use of extracorporeal membrane oxygenators (ECMO) has proliferated in cardiovascular intensive care units (ICUs) partially due to advances in technology with the development of smaller, more portable machines, and the increasing numbers of patients with end-stage heart failure and cardiogenic shock. The use of ECMO has been found to improve survival rates in this deadly situation. Due to higher volumes of patients requiring ECMO, additional qualified resources for providing ECMO services may be necessary. The purpose of this article was to review cardiogenic shock etiologies, the role of ECMO, and to discuss the transition process of implementing a nurse-run ECMO program.
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Crit Care Nurs Clin North Am · Dec 2014
ReviewIncidence and prevention of delirium in critical care patients.
Delirium in the intensive care unit is prevalent and a topic of high interest. Although it has been studied a great deal, screening, prevention, and management remain difficult. There are many causes of delirium and equally as many approaches to prevention and treatment. Two case studies sharing the challenges and successes of education, prevention, and treatment of delirium are presented in the context of complex adaptive systems.