Articles: intensive-care-units.
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Critical care medicine · Apr 1996
Comparative StudyAssociation of pre mortem diagnosis and autopsy findings in pediatric intensive care unit versus emergency department versus ward patients.
As part of the overall quality assurance program for the Department of Pediatrics, we determined whether there were differences in the rates of unexpected autopsy findings between pediatric intensive care unit (ICU), emergency department, and ward patients. ⋯ Autopsies were performed more frequently in emergency department patients. Class I through IV unexpected findings occurred more frequently in pediatric ICU patients compared with emergency department or ward patients. Autopsy examinations are an especially valuable diagnostic tool for pediatric ICU patients and physicians.
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To evaluate the training of clinical staff in the use of interhospital transfer guidelines and to examine the underlying decision-making behavior in organizing patient transfers between hospitals. ⋯ Clinical staff can make informed and appropriate decisions by using standardized guidelines when organizing interhospital transfers.
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To determine whether APACHE III and multiple organ dysfunction syndrome scores can predict a prolonged length of stay for critically ill surgical patients in the intensive care unit. ⋯ The development of multiple organ dysfunction syndrome is a powerful predictor of a prolonged ICU course in critical surgical illness, even in survivors. Increased risk of a prolonged stay in the ICU plateaued at 21 days, making 21 days an appropriate definition of prolonged care for future studies. Predictive models should account for organ dysfunction and very long stays in future estimations. The combined use of APACHE III and the multiple organ dysfunction score may provide improved prediction of a prolonged stay in the ICU, but further enhancements are needed before prediction of outcome in individual patients is reliable.
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Thorac Cardiovasc Surg · Apr 1996
Multicenter StudyImplications of the introduction of fixed reimbursement rates in Germany.
The introduction of fixed reimbursement rates in Germany for cardiac surgery of adults, mainly coronary artery bypass grafting (CABG) and valve surgery, has shifted the financial risk from insurers to providers of medical care, namely hospitals. Costs in turn are closely related to the preoperative condition of a patient, implicating that surgery in high-risk patients may result in financial losses for the operating institution. Furthermore, reports from the Society of Thoracic Surgeons national database indicate a trend over time towards a higher proportion of patients with adverse risk factors for the United States. ⋯ Postoperatively, high-risk patients suffer more often from morbidity with subsequent prolonged intensive care and are, therefore, a financial burden for the operating institution in a reimbursement system with fixed rates. This is aggravated by the fact that a trend towards adverse risk profiles among patients undergoing cardiac surgery can be observed. Both factors combined may result in a scenario where those who would benefit most are denied surgical treatment.
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Intensive Crit Care Nurs · Apr 1996
Patients' experience of confusion in the intensive care unit following cardiac surgery.
This article reports a study of postoperative intensive care as experienced by coronary artery by-pass patients. The purpose is to describe and reflect upon the patients' experience of confusion in the intensive care unit (ICU). The study was performed according to the phenomenological-hermeneutic research tradition, with ten patients participating. ⋯ Patients' comments concerning their confusion verified the challenge this phenomenon poses in nursing care. A research methodology which highlights the individuality of the patients can uncover other hidden or unquestioned issues in nursing. Accordingly, further areas for study are suggested here.