Clinical Pearls

Abstract

Burnout results from chronic workplace stress that has not been successfully managed. Excellent teamwork lessens negative outcomes for patients and providers, but little work has examined factors that contribute to burnout across disciplines working in the intensive care unit (ICU).Colbenson and colleagues interviewed ICU pharmacists, physicians, registered nurses, and respiratory therapists to understand their experiences. They identified 2 themes related to factors contributing to burnout: interdisciplinary dynamics (eg, providers feeling their opinion was not valued, inattention given to their contributions, and shared decision-making that was deficient) and work stressors: Many nonphysician team members did not feel heard or respected during multidisciplinary rounds. Although more work is needed, the authors suggest team-based care include well-defined roles and respect to provide a culture of safety for both staff and patients.See Article, pp 391-396Many children hospitalized in the pediatric intensive care unit (PICU) require mechanical ventilation, a necessary therapy that can cause stress, anxiety, and even pain. Researchers have used music therapy as a nonpharmacological pain-reducing intervention in adults receiving mechanical ventilation; however, there are few studies with children and those done used recorded music with contradictory findings.Bush and colleagues compared the use of live music, with a trained board-certified music therapist who adapted the music to the patient’s needs, versus recorded music in children <2 years of age who are sedated and receiving mechanical ventilation. They found Although further research is needed with larger samples, the findings suggest use of live music with a trained therapist may be effective in reducing anxiety in children receiving mechanical ventilation in the PICU.See Article, pp 343-349The Glasgow Coma Scale (GCS) has been used for more than 4 decades as a prediction tool in the care of patients with traumatic brain injury (TBI). The GCS has been used successfully to predict outcomes, including mortality, for TBI patients, but it has not been validated for use in non-TBI patients.Li et al compared admission GCS scores with scores on the modified Rankin Scale (mRS), a tool used for evaluating functional outcomes in stroke patients. In a sample of >3000 patients with a non-TBI neurological diagnosis, they found Although further work is needed, the authors caution against use of GCS scores to predict outcomes in non-TBI patients and instead recommend further exploration of alternative tools designed for non-TBI conditions.See Article, pp 350-355The Society of Critical Care Medicine guidelines indicate that patients with lower-level care needs can be admitted to an intermediate-care unit (IMCU). However, unplanned admissions of patients with potentially unstable conditions to the IMCU have been associated with worse outcomes owing to difficulty with predicting deterioration.Ramos and colleagues evaluated 3 patterns of urgent admissions to the IMCU and the intensive care unit (ICU): admission directly to ICU; admission to IMCU with no transfer to ICU; admission to IMCU and subsequent transfer to ICU (“step-up”). They found Although study findings show greater negative outcomes with step-up patients, the authors suggest further research on objective criteria for identifying patients with potentially unstable conditions that may quickly deteriorate.See Article, pp 397-400