Crit Care Resusc
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Multicenter Study Comparative Study Observational Study
What do ICU doctors do? A multisite time and motion study of the clinical work patterns of registrars.
To quantify the time that intensive care unit registrars spend on different work tasks with other health professionals and patients and using information resources, and to compare them with those of clinicians in general wards and the emergency department (ED). ⋯ Face-to-face communication and information seeking consume a vast proportion of ICU registrars' time. Multitasking and handling frequent interruptions characterise their work, and such behaviours may create an increased risk of task errors. Electronic clinical information systems may be particularly beneficial in this information-rich environment.
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To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. ⋯ About one in five patients reached CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.
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High-flow nasal cannula (HFNC) therapy is increasingly used in paediatric intensive care unit (PICU) patients, despite a paucity of studies. We describe its use over the 3 years since its implementation in our tertiary intensive care unit. ⋯ HFNC therapy was successful in most patients. Most failures occurred within 8.25 hours. Use of HFNC for heart disease was associated with a high therapy failure rate (50%).
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ICU registrars frequency encounter RRT calls associated with EOLC during their training. Interventions involving EOLC appear to be some of the commonest interventions performed during RRT review. Therefore, training about the assessment an management of such calls should be provided to registrars who participate in RRT calls. The approach outlined here provides a framework for such training.