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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We hypothesise that there exists a substantial and growing group of "persistently critically ill" patients who appear to be intensive care unit-dependent because of a cascade of critical illnesses rather than their original ICU admitting diagnosis. These persistently critically ill patients are those who remain in the ICU because of ongoing complications of care that continue after their reason for admission has been treated and is no longer active. ⋯ We further believe that their primary problem is not simply failure to wean from mechanical ventilation due to muscle weakness and impaired gas exchange. We outline a program of clinician consultation, epidemiological research, consensus conference and validation to develop a useful definition of persistent critical illness, with the aim of supporting investigations in preventing persistence, and improving the care of patients so affected.