Understanding Staff Needs for Improving End-Of-Life Care in Critical Care Units: A Qualitative Focus Group Analysis and Service Evaluation.

Critical care workforce in crisis: A path forward

Trauma, Critical Care, and Emergency Care Anesthesiology: A New Paradigm for the "Acute Care" Anesthesiologist?

Critical care, defined as the diagnosis and management of life-threatening conditions that require close or constant attention by a group of specially trained health professionals, is inherent to the practice of cardiovascular medicine. The demand for cardiovascular critical care is increasing with the aging of the population and is reflected by trends in the use of critical care in general.1 Between 2000 and 2005, although the total number of hospital beds in the United States declined by 4.2%, the number of critical care beds increased by 6.5% and the annual costs attributed to critical care increased by 44%, representing 13.4% of hospital costs.2 Projections for the next 15 years suggest that the need for critical care will increase markedly in the United States and globally.1,3–5 For example, in Canada, a 57% increase in the need for critical care beds is anticipated during that period.5 Concurrent with increases in demand, the medical demographics of general and cardiac critical care have evolved toward a patient population with an increasing number of comorbid medical conditions who require more prolonged and more technologically sophisticated invasive support. As a result, the delivery of critical care is advancing substantially in its complexity. Moreover, accumulating evidence has indicated that outcomes are better when critical care is provided by specially trained providers in a dedicated intensive care unit (ICU).6–9 In the context of this evolution, provision of optimal care in the contemporary cardiac ICU (CICU) presents a different set of challenges and requires an expanded set of skills compared with 10 years ago. Cardiovascular medicine has lagged behind other medical disciplines that have met the “critical care crisis”4 with ICU-focused innovations in organization, training, and quality improvement. Therefore, the American Heart Association Council on Cardiopulmonary, Critical …

First, Do No Harm: Less Training ≠ Quality Care

What does the increasing prevalence of critical care research mean for critical care nurses?

What is in this issue.

Regionalisation of critical care: can we sustain an intensive care unit in every hospital?

An ever-thorny issue: Defining key elements of critical care nursing and its relation to staffing.

Japan has the highest proportion of older adults worldwide but has fewer critical care beds than most high-income countries. Although the COVID-19 infection rate in Japan is low compared with Europe and the United States, by the end of 2020, several infected people died in ambulances because they could not find hospitals to accept them. Our study aimed to examine the Japanese healthcare system's capacity to accommodate critically ill COVID-19 patients during the pandemic. We created a model to estimate bed and staff capacity at 3 levels of pandemic response (conventional, contingency, and crisis), as defined by the US National Academy of Medicine, and the function of Japan's healthcare system at each level. We then compared our estimates of the number of COVID-19 patients requiring intensive care at peak times with the national health system capacity using expert panel data. Our findings suggest that Japan's healthcare system currently can accommodate only a limited number of critically ill COVID-19 patients. It could accommodate the surge of pandemic demands by converting nonintensive care unit beds to critical care beds and using nonintensive care unit staff for critical care. However, bed and staff capacity should not be expanded uniformly, so that the limited number of physicians and nurses are allocated efficiently and so staffing does not become the bottleneck of the expansion. Training and deploying physicians and nurses to provide immediate intensive care is essential. The key is to introduce and implement the concept and mechanism of tiered staffing in the Japanese healthcare system. More importantly, most intensive care facilities in Japanese hospitals are small-scaled and thinly distributed in each region. The government needs to introduce an efficient system for smooth dispatching of medical personnel among hospitals regardless of their founding institutions.

As of April 2020, more than 2 million people worldwide had tested positive for COVID-19, and more than 200,000 deaths are attributed to this virus. It is estimated that around 15% of patients diagnosed with COVID-19 will develop severe health complications, and around 5- 10% will require intensive level care due to the seriousness of the symptoms and the high mortality risk (3-5%)( Baud et al., 2020; Murthy, Gomersall, & Fowler, 2020). At the time of writing, COVID-19 has caused the need for hospitalisation of thousands of people due to the serious pneumonia type symptoms that result in extreme breathing difficulty.

Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020).

Optimal Recovery from Cardiac Arrest: Implementation of a Therapeutic Hypothermia Program

Dying and death in critical care settings can have particularly negative implications for the bereavement experience of family members, family interaction and the wellbeing of critical care staff. This study explored critical care staff perspectives of dying, death and bereavement in this context, and their role related to patients and their families, adopting a multidisciplinary perspective. This study employed a descriptive exploratory qualitative design, using reflexive thematic analysis to interpret the data. Semi-structured interviews were conducted with 15 critical care staff from hospitals in the Republic of Ireland. Most participants were female (n = 11), with four male participants. Professional disciplines included nursing, dietetics, physiotherapy, anaesthesiology and medicine. Key findings included supporting a 'nice death' for patients and their families, the challenges critical care staff experience, the need for better supports in critical care, and the need for change in current bereavement support provision given the diversity evident in the modern Irish population. This study suggests that the unique challenges faced by staff and families throughout the dying process may benefit from the development of additional psychological, educational, and infrastructural supports. Inconsistencies in supports across critical care units in Ireland were also identified. Future research should complement the current study and examine family members' experience of the dying process in critical care and their perspectives on supports provided.

Critical care is an expensive and limited resource in the United States. Estimates from more than a decade ago suggest that over $100 billion a year is spent on critical care services.1 Over the past two decades, the number of patients presenting to the Emergency Department (ED) requiring critical care services has increased at a much higher rate than the growth in overall ED volume.2,3 The proportion of ED patients requiring Intensive Care Unit (ICU) admission has increased 75% over the first decade of the twenty-first century. In addition to the increase in the absolute number of patients requiring critical care admission, the ED length of stay for critically ill patients increased by 60 minutes. This resulted in a total nationwide increase in critical care provided in the ED by more than threefold. This disproportionate increase in critical care time reflects both the increase in critical care volume and the increase in ED boarding of critically ill patients. Data from 2008 reported the median boarding time for a patient waiting in the ED for an ICU bed was more than 5 hours, and 30% of patients waited more than 6 hours for an ICU bed.2,3 This article is protected by copyright. All rights reserved.

Alternative cardiac intensive care unit locations during the COVID-19 pandemic at an academic medical center