From Pediatrics to Geriatrics: Reviewing Family-Centered Care Interventions and Their Influence on Intensive Care Unit Patient Outcomes.

There is growing interest in centralised patient flow centres (PFCs) designed to optimise hospital patient flow and improve resource efficiency. However, the specific impact of such centres on intensive care unit (ICU) patient flow and patient outcomes is unknown. The objective of this study was to evaluate the effects of ICU discharge efficiency and patient outcomes before and after implementation of a PFC. A retrospective cohort study was conducted at a tertiary ICU in Australia, including patients admitted to the ICU between January 1st, 2018, and December 31st, 2023. Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. Primary outcomes were ICU discharge delay, after-hours discharge, and readmission to the ICU within 48 h of discharge. Secondary outcomes included ICU and hospital length of stay (LOS) and hospital mortality. A total of 8 383 patients were included. Post implementation, a higher proportion of patients experienced ICU discharge delays (16.1%, n = 656, p = 0.05) and after-hours discharges (15.6%, n = 636, p < 0.001), without a significant change in the ICU readmission rate. After adjusting for confounders, patients in the post-PFC group had a higher risk for after-hours discharge than those in the pre-PFC group (odds ratio: 1.62, confidence interval: 1.41-1.87, p < 0.001). The implementation of the PFC was associated with lower hospital mortality (odds ratio: 0.72, confidence interval: 0.55-0.94, p < 0.05) and shorter hospital LOS (p = 0.05). An increase in the proportion of ICU discharge delays and after-hours discharges was observed following the PFC implementation, without an increase in ICU readmissions. Centralised coordination and improved visibility of patient flow through the hospital system could have contributed to reduced hospital LOS and mortality. Future studies must explore factors influencing the effectiveness of the PFC on ICU patient flow and evaluate the observed benefits by incorporating ICU access block measures.

BackgroundPatient and Family-Centered Care (PFCC) interventions are increasingly recognized as a viable approach to address various mental health issues among patients in Intensive Care Units (ICUs). Therefore, this review aims to estimate the effect of Patient and Family-Centered Care Interventions on specific outcomes in adult patients admitted to Intensive Care Units (ICUs). MethodsWe systematically searched four major databases for parallel arm Randomized Controlled Trials (RCTs). The PRISMA framework was used to report our review. We included studies involving adult patients (> 18-years) admitted to ICUs and examined the effects of any type of Patient and Family-Centered Care intervention (PFCC) on outcomes such as depression, anxiety, delirium, and length of hospital stay. Data extraction was performed independently by two authors in Medline, Google Scholar, and ScienceDirect, from inception to July 2024. Random effects model was used to pool the data. ResultsA total of 11 studies were included in our systematic review and meta-analysis, with a combined sample size of 3352 patients (PFCC group, n = 1681; usual care group, n = 1671). A random-effects model revealed a significant reduction in delirium prevalence in the PFCC group, with a pooled Risk Ratio (RR) of 0.54 (95% CI 0.36 to 0.81). However, no statistical significance was found for other outcomes such as depression, length of ICU stay, and anxiety. It is important to note that all the included studies were assessed to have either a high or unclear risk of bias. ConclusionPFCC interventions may significantly reduce delirium rates among ICU patients; however, their effects on other outcomes, such as depression, anxiety, and length of stay, were not statistically significant.

Preterm birth is the leading cause of under-five mortality. Family-centred care (FCC) interventions may improve outcomes related to prematurity and may be used to address this issue to achieve the Sustainable Development Goals. We aimed to consolidate the scope of evidence and components of FCC interventions for preterm infants globally and see its relevance for low-resource settings. We conducted an umbrella review informed by the Joanna Briggs Institute (JBI) guidelines. Systematic literature reviews evaluating FCC in the preterm or high-risk infant population and their families were identified from six databases. Keywords included “family-centred care”, “premature infants”, “neonatal intensive care unit”, and their relevant synonyms. Quality appraisal was conducted using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and data extraction performed to an agreed table. Thematic analysis was carried out to categorise the components of FCC interventions. Forty-four reviews were included in the umbrella review. Outcomes were observed on the parents in 40 studies, the infant in 19, the health care provider in 13, and the health system in 7. Most studies focused on inpatient settings (79.6%) and were conducted primarily in high-income countries (92.3%). The components identified were general FCC, health system design, parent support, partnership in care, and information and communication. Overall, FCC interventions have a positive impact on parental, infant, and health system outcomes, with consistent reporting of FCC impact on parental well-being and satisfaction, infant length of stay, feeding and growth, and hospital readmission rates. FCC interventions have the potential to improve preterm infant health system outcomes. To maximise impact, FCC interventions need to be further explored in low-resource and post-discharge settings, where the burden of premature infant morbidity and mortality is highest. Evidence in both these settings is scarce. Future research efforts should aim to close these evidence gaps.

Family-Centered Critical Care: A Practical Approach to Making It Happen

Families are reporting loss of interactions and communication in response to restrict isolation measures. Other tangible losses include income, access to resources, engagement, involvement in decision-making process and other planned activities. Listening to families' needs, concerns and say has been identified as one of the most important and least accomplished health care providers' roles in the intensive care units (ICUs). (1) To explore the experiences and concerns of Arab family members and health care professionals facing the challenges during ICU isolation, and (2) to develop recommendations for enhancing family support and improving effective communication to better address the needs of families during ICU isolation. This study utilizes a qualitative descriptive phenomenological design. We analysed data gained from 32 family members' concerns during their ICU patients' stay in isolated room settings and 21 health care providers' reflections through 2 focused groups recruited from Emirati and Egyptian ICUs. Thematic analysis revealed two main themes. The first theme, Family Members' Perspectives, highlights families' emotional and logistical challenges, including fears about infection, frustration over delayed updates and barriers to advocating for their loved ones. Subthemes include (a) family experiences and emotional challenges and (b) family-derived recommendations, such as implementing regular video calls, providing detailed patient updates and allowing occasional controlled visits to the ICU. The second theme, Health Care Providers' Perspectives, reflects HCPs' professional challenges in balancing family engagement with clinical demands. Subthemes include (a) challenges faced by HCPs, such as time constraints and communication difficulties, and (b) HCP-derived suggestions, including the integration of liaison nurses, social workers and revised visitation policies to enhance family-centred care. Families expressed concerns regarding the post-ICU discharge plan, prognosis and treatment quality. They proposed regular calls and video conferences as key methods for expressing preferences, emphasizing the importance of their active involvement during isolation. In response, health care providers acknowledged the imbalance in family-centred care and recommended expanding the ICU team to include social workers, psychologists and liaison nurses to better address the holistic needs of patients and families in isolation. This study underscores the critical role of family support and involvement in ICU care, specifically highlighting the responsibilities of ICU nurses. It calls for targeted policy modifications, the implementation of structured communication strategies and the establishment of a supportive environment to enhance family engagement. By equipping ICU nurses with the necessary resources, training and tools, these strategies aim to optimize family-centred care, improve the quality of communication and ultimately contribute to better patient outcomes in intensive care settings.

The need and values of patient- and family-centred care (PFCC) have been globally increasing in the health care landscape. However, the concept of PFCC and the components in adult intensive care units (ICUs) remain wide-ranging. To elucidate the core concepts of PFCC interventions and evaluate the effects of the interventions in adult ICUs. We searched electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, PsycINFO, RISS, KMbase and KoreaMed) from inception to 20 June 2022, for all studies on PFCC interventions. Three authors independently conducted data screening and extraction. The core concepts and the effects of PFCC interventions in adult ICUs were examined. The effects of patient- and family-centred care interventions in adult ICUs were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. Overall, 3507 records were identified, and 14 full-text articles were assessed. Participants in the included studies were patients and/or their family members in adult ICUs. The main concepts of the studies were participation and information-sharing. Only two studies used collaboration as the main concept of intervention. PFCC interventions have shown positive outcomes for patients, including increased satisfaction, improvement of patient health status and reduced incidence of complications. They have also been beneficial for families, leading to higher satisfaction levels and decreased anxiety. Additionally, these interventions have positively impacted health care providers by enhancing satisfaction and improving rounding efficiency. Moreover, they have influenced health care utilization by decreasing hospital costs and length of stay. This review highlights the advantages of PFCC interventions for patients, families and health care providers in adult ICUs. Future research should focus on developing strategies to incorporate collaboration more comprehensively as a core concept in the implementation of PFCC interventions. Future research endeavours must prioritize collaborative efforts involving health care providers, patients and their families by deploying an array of strategies within the intensive care unit setting.

The intensive care unit (ICU) setting represents a hostile environment for mechanically ventilated patients. Although considerable efforts have been undertaken to continuously improve the outcomes of ICU patients) overall morbidity and mortality have not been dramatically reduced during the past 20 years. The role of factors that have previously been considered as having a negligible impact on outcome needs to be revisited. Several lines of evidence suggest that sleep is qualitatively and quantitatively severely disturbed in ICU mechanically ventilated patients. Hence) sleep disturbances, as estimated using sleep-quality questionnaires) affect a very high percentage of patients) and persist for many days) even for several weeks or months in some cases) after anesthesia and intensive care. Sleep disorders may play an unexpectedly important role in decreasing host defenses and in worsening patient outcome. The importance of sleep disorders in the ICU has been recently emphasized in elegant reviews on the topic [1, 2]. In the present chapter) we will focus on the possible impact of these disorders on outcomes in ICU patients) and suggest possible ways to improve sleep quality in the ICU.

IntroductionThe Family-Centered Care (FCC) model has been linked to improved clinical outcomes and family satisfaction. However, implementing this model can be challenging, especially in neonatal and pediatric critical care units. This review aims to map the literature on FCC in neonatal and pediatric critical care units, identify barriers and facilitators of effective interventions, and suggest a practical step-by-step approach for implementing FCC interventions.MethodsThis scoping review was guided by the PRISMA-ScR guidelines and followed the Arksey and O'Malley 5-step scoping review framework. We accessed the databases on the 28 th of April, 2024, and included all prospective and randomized controlled trials (RCT) implementing FCC interventions from PubMed and Web of Science databases. Data were organized, tabulated, and described narratively.ResultsOut of 1,577 potentially relevant citations after duplicate removal, 17 articles met our eligibility criteria (4 RCTs and 13 prospective studies). Nine of these studies were conducted in neonatal intensive care units (NICU) and eight in pediatric intensive care units (PICU). Three NICU interventions were single-type interventions, while six were part of comprehensive programs; in the PICU, seven were single-type interventions and one was part of a comprehensive program. All interventions incorporated elements of FCC principles (respect, information sharing, collaboration, and participation). Barriers included institutional factors, provider attitudes, cultural issues, communication challenges, environmental constraints, training needs, and emotional stress. FCC facilitators included enhanced environment, empowerment and training, supportive Infrastructure, collaborative communication, parental Involvement, adaptive interventions, and continuous feedback.ConclusionEffective implementation of FCC interventions requires careful planning and needs assessment. It ensures management support, regular staff training, family orientation, and a continuous feedback loop. Incorporating FCC principles and delivering culturally acceptable interventions is key while acknowledging possible barriers and utilizing available facilitators. FCC interventions can help foster a healthcare culture that values partnerships with families and can transform the neonatal and pediatric critical care experience for patients, families, and providers alike.

Route, early or energy? \u2026 Protein improves protein balance in critically ill patients

Delirium in the general intensive care unit (ICU) population is common, associated with adverse outcomes and well studied. However, knowledge on delirium in the increasing number of ICU patients with malignancy is scarce. The aim was to assess the frequency of delirium and its impact on resource utilizations and outcomes in ICU patients with malignancy. This retrospective, single-center longitudinal cohort study included all patients with malignancy admitted to ICUs of a University Hospital during one year. Delirium was diagnosed by an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. Of 488 ICU patients with malignancy, 176/488 (36%) developed delirium. Delirious patients were older (66 [55–72] vs. 61 [51–69] years, p = 0.001), had higher SAPS II (41 [27–68] vs. 24 [17–32], p < 0.001) and more frequently sepsis (26/176 [15%] vs. 6/312 [1.9%], p < 0.001) and/or shock (30/176 [6.1%] vs. 6/312 [1.9%], p < 0.001). In multivariate analysis, delirium was independently associated with lower discharge home (OR [95% CI] 0.37 [0.24–0.57], p < 0.001), longer ICU (HR [95% CI] 0.30 [0.23–0.37], p < 0.001) and hospital length of stay (HR [95% CI] 0.62 [0.50–0.77], p < 0.001), longer mechanical ventilation (HR [95% CI] 0.40 [0.28–0.57], p < 0.001), higher ICU nursing workload (B [95% CI] 1.92 [1.67–2.21], p < 0.001) and ICU (B [95% CI] 2.08 [1.81–2.38], p < 0.001) and total costs (B [95% CI] 1.44 [1.30–1.60], p < 0.001). However, delirium was not independently associated with in-hospital mortality (OR [95% CI] 2.26 [0.93–5.54], p = 0.074). In conclusion, delirium was a frequent complication in ICU patients with malignancy independently associated with high resource utilizations, however, it was not independently associated with in-hospital mortality.

The intensive care unit (ICU) setting represents a hostile environment for mechanically ventilated patients. Although considerable efforts have been undertaken to continuously improve the outcomes of ICU patients, overall morbidity and mortality have not been dramatically reduced during the past 20 years. The role of factors that have previously been considered as having a negligible impact on outcome needs to be revisited. Several lines of evidence suggest that sleep is qualitatively and quantitatively severely disturbed in ICU mechanically ventilated patients. Hence, sleep disturbances, as estimated using sleep-quality questionnaires, affect a very high percentage of patients, and persist for many days, even for several weeks or months in some cases, after anesthesia and intensive care. Sleep disorders may play an unexpectedly important role in decreasing host defenses and in worsening patient outcome. The importance of sleep disorders in the ICU has been recently emphasized in elegant reviews on the topic [1, 2]. In the present chapter, we will focus on the possible impact of these disorders on outcomes in ICU patients, and suggest possible ways to improve sleep quality in the ICU. KeywordsSleep DisturbanceSleep QualitySleep DisorderIntensive Care Unit PatientSleep DeprivationThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

BackgroundThe mobilization quantification score (MQS) provides an opportunity to quantify the duration and intensity of mobilization therapy in the intensive care unit (ICU) and predict functional outcomes in ICU patients after surgery and stroke. MQS is a numerical measurement of early mobilization dose in the ICU, and its relationship with activities of daily living (ADL) dependence has been shown. We created and validated the Japanese version of the MQS using the endpoint ADL in a mixed population of patients in the ICU.Materials and methodsIn this prospective study, consecutive patients who were admitted to one of three ICUs of a tertiary care hospital in Japan, aged ≥18 years, and who received mechanical ventilation for >48 hours were enrolled. The Japanese version of the MQS was applied twice daily by an ICU physiotherapist and data recorded for analysis. The primary outcome was ADL dependence at hospital discharge, defined as a Barthel index (BI) of <70 or in-hospital death. The reliability among assessors was verified by calculating the interclass correlation coefficient (ICC) (2.1) for the average daily MQS. We performed a multiple logistic regression analysis to examine and identify a binary cutoff point for high-/low-dose rehabilitation.ResultsOf the 340 target patients, eight were aged <18 years, 109 had neurological complications, 11 had a BI <70 before admission, 79 had a lack of communication skills, 16 were terminally ill, eight did not complete the assessment during their ICU stay, 18 died in the ICU, and 53 denied consent. After 302 patients were excluded, 38 were included in the study. Six assessors, two at each hospital, measured the MQS in 38 patients. The ICC (2.1) for the MQS mean value was 0.98 (0.96-0.99) during the ICU stay. Logistic regression analysis using the mean MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at discharge (odds ratio (OR): 0.76, confidence interval (CI): 0.61-0.96, adjusted p = 0.009). Logistic regression analysis using a high MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at hospital discharge (OR: 0.14, CI: 0.03-0.66, adjusted p = 0.013).ConclusionsWe present a validated version of the Japanese MQS with a high inter-rater reliability that predicts ADL dependence at hospital discharge. The instrument can be used in future clinical trials in the ICU to control for the mobilization level in the ICU. The increased utilization of mobilization acutely in the ICU setting as quantified by the MQS may improve patient outcomes.

Family-centred care interventions in paediatric intensive care units: a scoping review.

Patient, family-centred care interventions within the adult ICU setting: An integrative review

Introduction: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly in managing critically ill patients in intensive care units (ICUs). Among these patients, acute kidney injury has emerged as a common complication, with severe implications for patient outcomes. This study aims to investigate the impact of renal function on the prognosis of COVID-19 ICU patients in Saudi Arabia. Methods: This was a retrospective cohort study, carried out in tertiary hospitals of Saudi Arabia from 22 June 2020 to 22 October 2020. Medical records of adult COVID-19 patients admitted to ICUs were reviewed. Patients with incomplete data or hospital stay &lt;48 h were excluded. Demographics, laboratory/radiological parameters, treatments and outcomes were retrieved. The first study endpoint to be assessed was in-hospital mortality (INH) all-cause in-hospital mortality. The secondary objectives were microbiological cure which is two negative SARS-CoV-2 polymerase chain reaction in a row; ICU/hospital stay duration; and WAS days on mechanical ventilation (MV). The patients were grouped according to their diabetes mellitus (DM) diagnosis result. The relationship between DM and outcomes was determined using Chi-square and Mann–Whitney tests. Binary logistic regression for mortality and extended ICU stay determined independent predictor variables; covariates included. Ethical clearance from the local Institutional Review Board was sought before carrying out the study. Variables were reported using frequencies, percentages, means and standard deviation or medians and interquartile range based on the type of data. P &lt; 0.05 indicated statistical significance. Results: An investigation was done on the 1102 severely ill mechanically ventilated, and invasively monitored, adult COVID-19 patients in ICUs. The mean age was 56 ± 15 years, with males accounting for 74.6% of patients. 51.2% had a documented history of DM. The overall mean hospital length of stay (LOS) was 22 ± 19 days, while the mean ICU LOS was 15 ± 14 days. MV was required by 13.84 ± 14.14 days on average. Diabetes was significantly associated with prolonged ICU stay, but not other clinical outcomes. After adjusting for covariates, DM remained a significant predictor. Among patients still requiring MV support at 28 days of ICU admission, diabetics comprised a significantly higher proportion of 70.4% compared to 29.6% without diabetes. These findings suggest that DM may influence the clinical course and recovery timelines in critically ill COVID-19 patients. Conclusion: In severely sick COVID-19 patients, this study showed that DM had a minor effect on recovery time in the ICU, rather than only having an impact on survival. Diabetes patients accounted for the majority of those remaining in need of ventilator after 28 days. For this high-risk population, targeted treatment approaches that take concomitant DM into consideration may improve patient management and resource use.