Clinical Pearls

Abstract

Health care and professional organizations have made much effort to standardize and improve critical care through evidence-based protocols and guidelines. However, intensive care unit (ICU) survivors are at risk for various cognitive, functional, and mental health impairments that can persist during their hospitalization.To characterize the early intensive care unit aftercare period, Kim and colleagues conducted a retrospective study of patients who transferred from a medical ICU to an acute medical unit. They found that the following practices and syndromes (with percentage affected) continued after transfer from the ICU: Findings show that the complexity of ICU care continues after transfer to the acute medical unit. The authors emphasize the urgent need for engagement of non–critical care providers to improve the quality of patient care during early ICU aftercare.See Article, pp 193-200Survivors of acute respiratory distress syndrome (ARDS) can experience long-term problems such as physical limitations, cognitive impairment, and emotional difficulties. Although patients and their family members have reported these problems, there are no specific proven treatments that prevent or treat such problems.Hauschildt and colleagues interviewed adult ARDS survivors 9 to 16 months after their illness to explore how they adapted. They found Although these findings contribute to the knowledge base of ongoing support needed by patients and families in the immediate postdischarge period, the authors recommend future research to assess the effectiveness of various strategies.See Article, pp 221-229About 14% to 16% of all hospitalized patients with COVID-19 require intensive care. Although uncertainties persist about the disease and treatment, some clinical patterns of care have emerged, including difficulties in weaning off mechanical ventilation, challenges in sedation, and use of off-label therapeutics.Bose and colleagues surveyed intensivists’ interest in use of a disease-focused checklist embedded in the electronic medical record to streamline rounds. They found Although overall efficiency and utility of the tool need further examination, the authors suggest that institutions modify the checklist to focus on their own priorities and needs.See Article, pp 238-241Medical errors are the third leading cause of death in the United States. A recent national study indicated that poor physical and mental health of nurses was related to increased medical errors; however, that study included nurses from all specialties.Melnyk and colleagues surveyed critical care nurses (CCNs) to examine the relationship between their health, professional quality of life, perception of wellness support, and self-reported medical errors. They found Nurses who perceived high workplace wellness support reported better health on all measures. Health care system leaders are encouraged to create and sustain cultures of wellness to improve the quality of patient care.See Article, pp 176-184