Care Units In Australia Research Articles

Quantifying variation of paediatric length of stay among intensive care units in Australia and New Zealand

ObjectiveTo quantify variation of mean paediatric length of stay (LoS) among intensive care units (ICUs) in Australia and New Zealand.MethodRetrospective data from Australian and New Zealand institutions that admitted children...

Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study

Objective To describe the epidemiology of 2009 A/H1N1 influenza in critically ill pregnant women.Design Population based cohort study.Setting All intensive care units in Australia and New Zealand.Participants All women with...

Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia

To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI). Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line-associated BSI. Six Victorian public hospitals with more than 100 beds. Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line-associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line-associated BSI were also assessed to see whether they met the definition of central line-associated BSI. Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (k = 0.31). Of the 46 reported central line-associated BSIs, 27 were confirmed to be central line-associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%-73%). Of the 62 cases of bacteremia reviewed that were not reported as central line-associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%-83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72. The agreement between the reporting of central line-associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line-associated BSIs may be missed in Victorian public hospitals.

The management of patent ductus arteriosus in Australia and New Zealand

This study aimed to establish current management practice for patent ductus arteriosus (PDA) among individual consultant neonatologists in Australia and New Zealand, to examine the influences that drives practice and highlight the importance of future randomised controlled trials in the region. Eligible subjects were identified from the Directory of Neonatal Intensive Care Units in Australia and New Zealand, 2007. A questionnaire was sent online to each consultant and was followed up with a letter and telephone call. Seven questions addressed management approach, the drug used and the treatment regimen, threshold for referral for surgical ligation and the literature influencing practice. Data were collected from 22 August 2007 to 22 November 2007. The overall response rate was 95%. For infants < or =28 weeks or < or =1000 g, all consultants treat PDA by one of four distinct management approaches. Expectant management was favoured by 35%, echocardiographic targeted prophylaxis 32%, presymptomatic treatment 16% and prophylaxis by 17%. There were marked regional variations in practice. Within individual units, more than one approach is used in 14 out of 24 units. Long courses of indomethacin are used to treat PDA by 86%. For 22% of consultants, management is not influenced by published literature. Differences of opinion in the literature are reflected by the heterogeneity in clinical practice across regions and within units. Crucial questions undergoing evaluation are whether data extrapolated from a previous area are relevant to PDA in modern neonatology and whether targeting treatment early can translate to improved clinical outcome.

Intranasal sufentanil for cancer-associated breakthrough pain

The objective of this study was to demonstrate the efficacy, safety and patient acceptability of the use of intranasal sufentanil for cancer-associated breakthrough pain. This was a prospective, open label, observational study of patients in three inpatient palliative care units in Australia. Patients on opioids with cancer-associated breakthrough pain and clinical evidence of opioid responsiveness to their breakthrough pain were given intranasal (IN) Sufentanil via a GO Medical™ patient controlled IN analgesia device. The main outcome measures were pain scores, need to revert to previous breakthrough opioid after 30 min, number of patients who chose to continue using IN sufentanil, and adverse effects. There were 64 episodes of use of IN sufentanil for breakthrough pain in 30 patients. There was a significant reduction in pain scores at 15 (P < 0.0001) and 30 min (P < 0.0001). In only 4/64 (6%) episodes of breakthrough pain did the participants choose to revert to their prestudy breakthrough medication. Twenty-three patients (77%) rated IN sufentanil as better than their prestudy breakthrough medication. The incidence of adverse effects was low and most were mild. Our study showed that IN sufentanil can provide relatively rapid onset, intense but relatively short lasting analgesia and in the palliative care setting it is an effective, practical, and safe option for breakthrough pain.

Parental presence during resuscitation in the PICU: the parents’ experience

To provide in-depth understanding of the meaning for parents who were present or absent during a resuscitation attempt on their child in the PICU. Family presence during resuscitation remains a topic of debate with both benefits and disadvantages identified, yet few studies have asked parents of children in PICU to describe their experiences of being present or absent during this resuscitation and what this means to their understanding and coping. Additionally, minimal research has investigated parental presence during a successful resuscitation. A qualitative design was used based upon van Manen's interpretative phenomenological approach. Fourteen parents of critically ill children from one paediatric intensive care unit in Australia, who had either survived or died following a resuscitation attempt were interviewed. Four main themes were identified: (1) being only for a child; (2) making sense of a living nightmare; (3) maintaining hope in the face of reality; (4) living in a relationship with staff. The findings underpin the inherent need for parents to choose to be present during resuscitation to make sense of the situation. Memories of the resuscitation were not long-lasting and distress was for the potential death of a child, rather than the resuscitation scene. Parents who did not witness their child's resuscitation were more distressed than those who did. Having the opportunity to make the decision to stay or leave was important for parents. Support during the resuscitation was best provided by experienced clinical nurses. Recognition of the parents' compelling need to stay will improve nurses' understanding of how witnessing this event may assist family coping and functioning. Ways in which parents may be better supported in making the decision to stay or leave during resuscitation are identified.

Survey of Cuff Management Practices in Intensive Care Units in Australia and New Zealand

Cuff management varies widely in Europe and North America. Little is known about current practice in Australia and New Zealand. To characterize important aspects of cuff management in intensive care units in Australia and New Zealand to compare with international reports. A questionnaire was sent to all nurse managers of adult intensive care units in Australia and New Zealand. Survey response was 53% (92/175). After intubation, most units (50/92, 54%) used both minimal occlusive volume technique and cuff pressure measurement; 5 (5.5%) used these methods along with pilot balloon palpation. Twenty units (22%) used cuff pressure measurement exclusively and 16 units (17.5%) used the minimal occlusive volume technique exclusively. Only 1 unit (1%) used the minimal leak technique after intubation. For ongoing management, cuff pressure measurement was the preferred method, used exclusively in 42 units (46%), with the minimal occlusive volume technique used in 40 units (43%; sole method in 6 units [7%]) and palpation in 4 units (4%). In most units (65/92, 71%), cuffs were monitored once per nursing shift. In units using the minimal occlusive volume technique, oropharyngeal suctioning (74%) and semirecumbent positioning (58%) were routinely incorporated; sigh breaths (6%), discontinuation of enteral feeding (10%), and nasogastric tube aspiration (26%) were uncommon. Cuff management protocols (37%) and subglottic suctioning (12%) were used infrequently. Cuff pressure measurement was the preferred method, used exclusively or in combination with other methods. The minimal occlusive volume technique was used more often after intubation than for ongoing management.

Reply: Admitting Term Infants to Neonatal Intensive Care Units in Australia

BirthVolume 35, Issue 3 p. 259-260 Reply: Admitting Term Infants to Neonatal Intensive Care Units in Australia Sally K. Tracy DMid, RM, Sally K. Tracy DMid, RM Professor of Women’s Health Nursing andMidwifery at the Royal Hospital for Women,Sydney, and theUniversity of Technology, Sydney, Australia Sally.tracy@sesiahs.health.nsw.gov.auSearch for more papers by this authorElizabeth A. Sullivan MBBS, MPH, MMed, Elizabeth A. Sullivan MBBS, MPH, MMed Associate Professor and DirectorAIHW National Perinatal Statistics UnitSchool Women’s and Children’s HealthUniversity of New South Wales, Sydney, Australia Search for more papers by this authorMark B. Tracy MBBS, FRACP, MScEpi, Mark B. Tracy MBBS, FRACP, MScEpi Director, Neonatal Intensive Care Unit,Nepean HospitalUniversity of Sydney,Sydney, Australia Search for more papers by this author Sally K. Tracy DMid, RM, Sally K. Tracy DMid, RM Professor of Women’s Health Nursing andMidwifery at the Royal Hospital for Women,Sydney, and theUniversity of Technology, Sydney, Australia Sally.tracy@sesiahs.health.nsw.gov.auSearch for more papers by this authorElizabeth A. Sullivan MBBS, MPH, MMed, Elizabeth A. Sullivan MBBS, MPH, MMed Associate Professor and DirectorAIHW National Perinatal Statistics UnitSchool Women’s and Children’s HealthUniversity of New South Wales, Sydney, Australia Search for more papers by this authorMark B. Tracy MBBS, FRACP, MScEpi, Mark B. Tracy MBBS, FRACP, MScEpi Director, Neonatal Intensive Care Unit,Nepean HospitalUniversity of Sydney,Sydney, Australia Search for more papers by this author First published: 20 August 2008 https://doi.org/10.1111/j.1523-536X.2008.00250_4.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume35, Issue3September 2008Pages 259-260 RelatedInformation

Admitting Term Infants to Neonatal Intensive Care Units in Australia

[Extract] Tracy et al reported an overall rate of admission to neonatal intensive care units (NICUs) across Australia of babies born at term (37-41 weeks) to low-risk mothers in the period 1999 to 2002, of 8.9 percent for primiparas, and of 6.3 percent for multiparas (Birth 2007;34 (4):301-301). It would be alarming if this were, in fact, the case and that such a high percentage of babies required the ventilatory support and invasive diagnostic workup described in this study. Tracy et al's study also reported considerably increased risks of admission to NICU for babies born by elective cesarean section at 37 to 39 weeks in lowrisk women.

Funding regimes and the implications for delivering quality palliative care nursing within residential aged care units in Australia

Funding to Australian residential aged care units has undergone recent reforms. Parallel with these fiscal developments, the Australian Government commissioned the Guidelines for a Palliative Approach in Residential Aged Care that addressed the inequities of service associated with dying in residential aged care. This literature review describes the variances in funding between Australian residential aged care facilities (RACFs), and multi-purpose services (MPSs) and, in doing so, exposes the impact that funding variances have on the delivery of end-of-life and palliative care to residents in aged care units. Government funding policy allowed RACFs an opportunity to adopt and implement the guidelines and standards, through funding individual resident identified healthcare needs. By comparison, MPSs are funded through an agreed (government and organisation) number of beds to provide nursing care to residents. This funding allocation forms MPSs' general consolidated revenue for service delivery. RACFs identify nursing care needs of residents through a residential classification scale, while management of MPSs allocates funding to service provision. The significant factor of funding beds (MPS) not the delivery of nursing care required by residents (RACFs) does impact on the implementation of a palliative approach for residents and, hence, the delivery of quality nursing care. Nursing management should consider funding implications when allocating resources to services in MPSs.

Management of central venous catheters in adult intensive care units in Australia: policies and practices

The aim of this study was to describe current practice for insertion and care of central venous catheters (CVCs) in intensive care units (ICUs) in Australia and to compare current practice with international guidelines. A prospective telephone survey was conducted to gather data that describe existing practices. A multivariate analysis of the data was conducted using clustering techniques. In the context of this study, cluster analysis was used to find groups with similar approaches to CVC practices. Forty Australian hospitals with level 2 or 3 ICUs as defined by ANZICS were randomly selected and four ICU nurses from each were randomly selected for interview. A total of 34 ICUs and 133 ICU nurses agreed to participate. All states and territories were represented. The majority of CVC management practices in Australian ICUs are consistent with the latest Centers for Disease Control and Prevention (CDC) guidelines. However, practices that did not comply with the recommendations included maximal sterile barrier precautions such as use of cap and mask, choice of dressing, catheter insertion site, cleansing of CVC port before CVC access, replacement of administration sets and CVCs, removal of CVCs and the choice of liquid soap over antiseptic containing soap. The heterogeneity of practice observed and the divergence from the CDC guidelines suggests that practices for insertion and care of CVCs in ICUs in Australia can be improved. Improved practice may result in lower rates of catheter-related bloodstream infection, save costs and improve health outcomes.

Observational study of patients admitted to intensive care units in Australia and New Zealand after interhospital transfer

Observational study of patients admitted to intensive care units in Australia and New Zealand after interhospital transfer

Implications for Australian practice of North American guidelines for the support of the family in patient-centred intensive care

Patient-centred care, in which health care professionals inform patients and families, maintain active involvement in decision making, coordinate care across disciplines, provide families with physical comfort and emotional support and ensure care is culturally sensitive, is recommended over clinician- or disease-centred care for better patient outcomes. Patients in intensive care are often too ill to participate in communication and decision making, so the patient's family should be involved in communication and decision making about the patient's care. The Society of Critical Care Medicine published clinical practice guidelines for the support of the family in the patient-centred intensive care unit. The purpose of this paper is to assess whether the 42 recommendations in the guidelines are valid and applicable in Australia. We used a recognised framework for evaluation of clinical practice guidelines. It was found that the guidelines were developed systematically using accepted methods of guideline development as much as possible. An extensive literature review was conducted and publications containing all levels of evidence were considered for inclusion. There were some weaknesses in the guideline development, especially lack of consultation with patients and families and a lack of high-level evidence, however the authors have provided comprehensive recommendations to guide all aspects of patient-centred care. We conclude that the recommendations are largely applicable to the patients and families receiving treatment and support within intensive care units in Australia. Where strong evidence is lacking, the recommendations should be a stimulus to conduct studies that test interventions that may benefit intensive care patients, their families, and intensive care staff.

Critically Ill Children in Non-Paediatric Intensive Care Units: A Survey, Review and Proposal for Practice

Despite strong arguments in favour of centralising care of critically ill children to paediatric intensive care units, around 2000 children per year are cared for in non-paediatric intensive care units in Australia and New Zealand. This paper reports a survey of consultants from 13 such units that admitted over 50 children in 2002 and 2003, to find out what factors affect the decision to keep critically ill children locally or transfer them to a paediatric intensive care unit and what infrastructure existed to support local care of these children. The results of this survey form the basis for a proposal to improve care of critically ill children in the non-paediatric intensive care units. The four key elements of this proposal are: the use of protocols, routine consultation with the regional paediatric intensive care unit, the use of telemedicine, and enhancing skills and experience of local staff Evidence supporting these measures as well as the evidence for centralising care of critically ill children is reviewed.

Relative Adrenal Insufficiency in Etomidate-Naïve Patients with Septic Shock

A recent study reported that 77% of patients with septic shock had relative adrenal insufficiency. However, all patients were mechanically ventilated and received high-dose inotropes. In addition, at least 24% had prior exposure to etomidate, a drug known to suppress adrenal function. We studied the incidence of relative adrenal insufficiency in etomidate-naïve patients with septic shock by analysing the adrenal response to high-dose short synacthen test in 113 consecutive patients from three university-affiliated intensive care units in Australia. Patients were allocated to three groups according to severity of illness and inclusion criteria of the trial of low dose hydrocortisone supplementation using information from patient records. Of the 113 patients, 98 had septic shock (Group A). The incidence of relative adrenal insufficiency in this subpopulation was 24.5%. Eighty-one per cent of patients with septic shock were mechanically ventilated (Group B). In this group, the incidence of relative adrenal insufficiency was 27.8%. Only 38 of the 98 patients with septic shock (39%) fulfilled inclusion criteria for the steroid supplementation trial (Group C). In this group, the incidence of relative adrenal insufficiency was only 34.2%. In all groups its presence was associated with a higher mortality. We conclude that the incidence of relative adrenal insufficiency in etomidate-naive septic shock patients was lower than observed in the steroid supplementation trial. Further, in those who fulfilled inclusion criteria for the trial, the incidence of relative adrenal insufficiency was half that reported by the trial. Our observations raise concerns about the generalizability of the findings of the above trial to etomidate-naïve patients.

Prenatal predictors of chronic lung disease in very preterm infants

Objective: To identify prenatal risk factors for chronic lung disease (CLD) at 36 weeks postmenstrual age in very preterm infants. Population: Data were collected prospectively as part of the ongoing...

Comparison of indirect methods of measuring intra-abdominal pressure in children

To determine the most accurate indirect method of measuring intra-abdominal pressure (IAP) in children. Single-centre, prospective, clinical study in a 23-bed specialist paediatric intensive care unit in Australia. 20 children admitted to paediatric intensive care with a peritoneal dialysis catheter in situ following congenital cardiac surgery. IAP was measured directly via the peritoneal dialysis catheter and by intragastric manometry via an indwelling nasogastric tube, and by intravesical manometry via an indwelling transurethral urinary catheter, using volumes of 0, 1, 3 and 5 ml/kg body weight of sterile saline instilled into the bladder. Across the range of IAPs of 1-8 mmHg the Bland-Altman method for assessing agreement between two methods of clinical measurement showed bladder pressure measured via the urinary catheter with 1 ml/kg body weight of saline instilled to be the most accurate indirect measurement technique, tending to give pressures between 0.07 and 1.23 mmHg higher than the direct measurement (95% CI for bias). Measuring bladder pressure with either no saline instilled or more saline per kilogram body weight instilled was less accurate over the same range of pressures, as was measuring the gastric pressure. The most accurate indirect method of measuring IAP in children over the normal range of IAPs involves measuring bladder pressure via a transurethral urinary catheter with 1 ml/kg body weight of sterile saline instilled into the bladder.

The Use of End-tidal Carbon Dioxide Monitoring to Confirm Endotracheal Tube Placement in Adult and Paediatric Intensive Care Units in Australia and New Zealand

The use of end-tidal carbon dioxide monitoring to assist in confirming endotracheal tube placement is currently not mandatory in intensive care units (ICUs) in Australia and New Zealand. Early detection of failed tracheal intubation is vital to optimize management and to prevent complications. Questionnaires were sent to the lead clinician/head of department of all 66 intensive care units approved for training purposes by the Joint Faculty of Intensive Care Medicine in Australia and New Zealand. The methods used to confirm correct endotracheal tube placement, the availability of end-tidal carbon dioxide monitoring and its role in confirming endotracheal tube placement in the intensive care unit were explored. Completed questionnaires were received from 61 of the 66 centres (92.4%). Wide variation in the method of confirmation of endotracheal tube position was demonstrated, with 23 (37.7%) of units using sub-optimal methods. Sixty (98.3%) of units had end-tidal carbon dioxide monitoring available. Thirty-eight (62%) units shared monitors between several beds; and 22 (36%) had one monitor per bed. End-tidal carbon dioxide monitoring was used routinely to confirm endotracheal tube placement in 42 (68.8%) units. Fifty-two respondents (83.3%) felt that end-tidal carbon dioxide monitoring was superior to other methods for confirming endotracheal tube placement in critically ill patients. Thirty-eight respondents (62.3%) thought that end-tidal carbon dioxide monitoring should be mandatory to confirm tracheal intubation in the intensive care unit. If it were available, 42 respondents (68.8%) would use end-tidal carbon dioxide monitoring for confirmation of every intubation. Mandatory end-tidal carbon dioxide confirmation of endotracheal tube placement was policy in 33 (54.1%) of the intensive care units.

Neonatal resuscitation: review of ventilation equipment and survey of practice in Australia and New Zealand.

The equipment used to provide positive pressure ventilation at neonatal resuscitation varies between institutions. Available devices were reviewed and their use surveyed in a geographically defined region. The aim of this study was to establish which resuscitation equipment is used at neonatal intensive care units in Australia and New Zealand. A questionnaire was sent to a neonatologist at each of the 29 neonatal intensive care units in Australia and New Zealand, asking which resuscitation equipment they used. If it was not returned, follow up was by email and telephone. Data was obtained from all units. Round face masks are used at all centres. Anatomically shaped masks are infrequently used at two of the three centres (10%) that have them. Straight endotracheal tubes are used exclusively at 23 (79%) centres. Shouldered tubes are used infrequently at three of the six centres that have them. The Laerdal Infant Resuscitator self-inflating bag is used at 22 (76%) centres. Flow-inflating bags are used at 12 (41%) centres. The Neopuff Infant Resuscitator is used at 14 (48%) centres. Varying oxygen concentrations are provided at delivery at 6/25 (24%) centres. There is a paucity of evidence for the efficacy of the equipment used currently to resuscitate newborn infants. This complete survey of the tertiary centres in a geographical region shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Further research is necessary to determine which devices are preferable for this most important and common intervention.

Neonatal respiratory therapy in the new millennium: Does clinical practice reflect scientific evidence?

Respiratory therapy has historically been considered the primary role of the physiotherapist in neonatal intensive care in Australia. In 2001 a survey was undertaken of all level three neonatal intensive care units in Australia to determine the role of the physiotherapist and of respiratory therapy in clinical practice. It appears that respiratory therapy is provided infrequently, with the number of infants treated per month ranging from 0 to 10 in 15 of the 20 units who provide respiratory therapy, regardless of therapist availability. The median number of respiratory treatments per month during the week was three, and on weekends it was one. Respiratory therapy was carried out by physiotherapists and nurses in 54.6% of units, by physiotherapists only in 36.4% of units, and by nurses only in the remaining 9% of units surveyed. There was also a diminution of the role of respiratory therapy in the extubation of premature infants. A review of the literature shows that overall the use of respiratory therapy reflects current evidence. The question remains whether it is possible to maintain the competency of staff and justify the cost of training in the current healthcare economic climate. It seems probable that the future role of physiotherapists in neonatal intensive care unit may be in the facilitation of optimal neurological development of surviving very low birth weight infants.