Articles: intensive-care-units.
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Review of 2219 admissions to an intensive care unit at a large urban hospital from 1983 to 1985 revealed an epidemic of cardiac arrests during the evening shift from January 1984 to March 1985. Of the 88 evening-shift cardiac arrests during this time, one specific nurse (Nurse 14) was the care giver for 57 (65%). Eight of ten epidemic-period patients who experienced shift-specific circadian recurrences of cardiac arrests were patients of Nurse 14. ⋯ An expert determined that, compared with other nurses, the cardiac arrests among Nurse 14's patients were more likely to be consistent with unexplained hyperkalemia, to be unexpected in timing, and to be inconsistent with the clinical course. The epidemic ceased when Nurse 14 left employment at the intensive care unit in March 1985. Epidemiologic surveillance of adverse outcomes in health care settings is recommended.
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Intensive care medicine · Jan 1988
Mortality and quality of life after intensive care for critical illness.
Early and late mortality of 313 ICU patients and the quality of life of 118 long term ICU survivors was studied to assess the effectiveness of intensive care for critically ill patients. The survival rate at discharge from the ICU was 76%, falling to 61% at 6 months and to 58% at 1 year. A simplified acute physiology score (SAPS) was recorded on ICU admission, as well as age, length of ICU-stay and the number of complications during intensive care. ⋯ In 21% of the patients a deteriorated physical condition was found, 77% remained unchanged and 2% were improved 2 years after ICU discharge, compared to their condition prior to the acute illness. Major functional impairment was found in 38% of the patients. Although the longterm physical condition and functional status correlated with SAPS and age on ICU admission, the best indicator for quality of life after intensive care proved to be the health status prior to the acute illness.
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Research on stress experienced by staff in critical care units has predominantly focused on the nurses; however, a small number of investigations have centred on intensivist neonatologists and paediatricians. Australian studies which have highlighted the major stressors encountered by critical care staff are reviewed. Research is reported which suggests that job satisfaction is diminished for staff working within highly stressful critical care units. Implications are discussed in order to focus attention upon the effects of high dependency stressful work environments.
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Critical care medicine · Jan 1988
Improving the outcome and efficiency of intensive care: the impact of an intensivist.
Data from two 3-month time periods before and after the arrival of a pediatric intensivist were collected prospectively and compared to determine the intensivist's impact on ICU mortality, use of monitoring and therapeutic modalities, and efficiency of ICU bed utilization. Severity of illness and care modalities were determined daily for all patients with the Physiologic Stability Index and the Therapeutic Intervention Scoring System. The only major organizational change in the postintensivist period was the organization and implementation of a daytime ICU team. ⋯ The severity of the illness-adjusted ICU mortality rate was significantly higher in the pre-intensivist period than in the postintensivist period (weighted mean mortality difference 5.3 +/- 2.6%; p less than .05). The incidence of both therapeutic and monitoring modalities increased in the postintensivist period. These results indicate that a pediatric intensivist can improve mortality rates and efficiency of bed utilization in the pediatric ICU.