Critical care nursing clinics of North America
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Pulse oximetry is one of the most commonly applied technologies in acute and critical care. It has the potential to continuously monitor pulmonary function, avoid unnecessary blood gases, and alert clinicians to hypoxemic events that are not readily apparent by physical assessment. Due to these advantages, pulse oximetry has a firm place in health care. ⋯ In addition, oximetry has the potential to be misused owing to its widespread application. In order to obtain the maximum benefits from this technology, clinicians must be educated about the strengths and limitations of oximetry. If this education effectively changes clinicians' behavior, pulse oximetry will provide an excellent clinical advantage in patient assessment as well as moderate cost benefits.
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Crit Care Nurs Clin North Am · Mar 1999
ReviewAdvances in continuous, noninvasive hemodynamic surveillance. Impedance cardiography.
In the current climate of shrinking health care reimbursement and increasing importance of patient centered care, impedance cardiography is one method of enhancing quality of patient care and appropriate use of resources. Hemodynamic and thoracic fluid status data may be obtained quickly, accurately, and without risk, providing a global clinical perspective. ⋯ Application of a technology assessment model to impedance cardiography illustrates the utility of this method of hemodynamic monitoring. Careful review and critique of the literature differentiates the available impedance technologies, supports use in areas not traditionally associated with hemodynamic monitoring, such as the home and emergency department, and validates the use of impedance cardiography in place of, or as an indication for, pulmonary artery catheterization.
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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.