Articles: intensive-care-units.
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Bed chest X-rays carried out in an Intensive Care Unit (ICU) are an important means of patient monitoring. To get the starting points for standardization of the documentation of X-ray findings, we examined course and contents of the daily X-ray conference in an ICU. We video-taped the conferences and registered its vocabulary. ⋯ Sorting and viewing the X-rays took 60 s. Main disruptions were related to non-availability of X-rays and clinical patient data. Clinical information reported during the discussion is rarely mentioned in the dictated findings.
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Critical care clinics · Jan 1994
Multicenter Study Comparative StudyThe case against using the APACHE system to predict intensive care unit outcome in trauma patients.
The use of outcome indices as a means of evaluating institutional performance for delivery of medical care is at the forefront of federal health policy reforms. Because an enormous number of clinical and financial data are generated by ICU patients, it is inevitable that integrated bedside computers will be necessary to supply the type of information that is being sought by governmental and private insurance agencies involved in assessment of hospital performance. The Health Care Financing Administration already has adopted the APACHE data collection protocols and predictive models for the severity of illness adjustments that were used in assessing the 1986 hospital-specific death rate for acute myocardial infarction, congestive heart failure, stroke, and pneumonia. ⋯ The inequities for certain subgroups of patients, including trauma patients, could create situations in which care is rationed rather than allocated according to a plan that distributes resources efficiently. The APACHE system has several shortcomings and adds little, if anything, to the potential solutions for trauma quality assurance and resource allocation. Nor has the APACHE system established procedures for documenting institutional review of unexpected trauma deaths that would be equivalent, for example, to the type of audit filters applied by the American College of Surgeons in conjunction with the TRISS methodology.(ABSTRACT TRUNCATED AT 400 WORDS)
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Meeting the challenges of allocating critical care resources in the fairest way possible depends upon the development of a standardized strategy for apportioning ICU services in times of limited supply. Two main approaches are emerging to handle these challenges. ⋯ The second approach involves improving the efficiencies of the care giving system itself. Either approach requires the establishment of a standard of care that reduces the potential for personal biases into the decision making process.
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The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed. ⋯ The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.