Critical Care Leadership Research Articles

Creating an Escape Room for Continuous Renal Replacement Therapy Validation

Creating an Escape Room for Continuous Renal Replacement Therapy Validation

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Self-confidence and knowledge in leadership in critical care: simulation with the “blindfolded” technique

RESUMO Objetivo: Verificar as contribuições do uso da técnica de “olhos vendados” na autoconfiança e conhecimento de estudantes de enfermagem no atendimento ao paciente crítico em cenários clínicos simulados. Método: Estudo quase-experimental com 25 estudantes do curso de enfermagem de uma Universidade Federal do interior de São Paulo entre novembro e dezembro de 2021. Os participantes responderam à Escala Self-confidence Scale e ao Checklist de Conhecimento, Habilidades e Atitudes em Reanimação Cardiorrespiratória, pré e pós-intervenção. Realizou-se a análise descritiva do checklist e o teste de Wilcoxon para avaliar o checklist e Self-confidence Scale. Resultados: Média de 4,04 acertos adicionais na amostra analisada, através da diferença de acertos entre os dois momentos. Um total de 80% da amostra demonstrou um aumento no conhecimento. Conclusão: Os estudantes em papéis de liderança após a simulação clínica com a técnica “olhos vendados”, apresentaram um aumento de conhecimento e autoconfiança durante a assistência nos cenários críticos.

Critical care leadership during the COVID-19 pandemic.

The COVID-19 pandemic taxed critical care and its leaders in unprecedented ways. Medical directors, nursing directors, division chiefs and department chairs were forced to lead their staff through a pandemic wrought with personal and professional safety concerns, uncertainty, and more death than most critical care practitioners had ever seen. No leader was fully prepared for the COVID-19 pandemic. Herein, we describe what we believe are the three most important qualities of a leader in times of crisis: presence, transparency, and empathy.

Mobilizing PACU Nurses to Provide Critical Care during the Covid-19 Pandemic

Background InformationIn March 2020, a New York State mandate required our institution place a moratorium on elective surgery for an unknown period of time to ensure adequate Covid-19 surge hospital bed availability. This resulted in extremely low patient volumes for perioperative services. Conversely, critical care was experiencing an influx of patient volume and acuity, necessitating additional nursing support.Objectives of ProjectOur aim was to bolster the hospital's critical care service line by pooling available nursing resources. The perioperative and critical care leadership teams further identified this initiative as an opportunity to strengthen relationships between nurses that share a common skill set.Process of ImplementationHospital command center meetings to address surge bed capacity reinforced the partnership between perioperative and critical care services. Team nursing models were reviewed collaboratively. The PACU nurse manager requested volunteers to staff critical care based on a team model. Five highly experienced PACU RNs and five newer PACU RNs without prior ICU assignments volunteered, with goals to expand knowledge, improve critical assessment skills, and help a service in need. The ten PACU nurse volunteers were assigned into five pairs, consisting of one experienced RN and one newer RN. The five teams of two were consistently matched with their partner, and worked every shift in the ICU as a pair.Statement of Successful PracticeThis collaborative effort between the perioperative and critical care nursing services achieved the goal of providing safe and competent care to a population in dire need during the height of the Covid-19 pandemic. This initiative also strengthened relationships between the services, thereby promoting improved communication and increased efficiency.Implications for Advancing the Practice of Perianesthesia NursingThe future implications of Covid-19 are largely unknown, and this initiative mobilized nursing resources in a systematic fashion to provide necessary specialized care. A framework was established that could be easily replicated, thereby strengthening our ability to collaboratively approach emergency preparedness moving forward.

Exploring Unsupervised Query Paraphrasing to Identify Relevant Search Phrases for a Literature Review.

Literature databases have multifaceted search options, but emerging research areas do not have an established terminology and therefore it is difficult to find relevant literature when conducting a review. This study aimed to explore if an unsupervised paraphrasing approach is useful in identifying relevant search phrases for a literature review on an emerging research topic - situational leadership in critical care. Using an initial set of 12 search phrases, the system was used to propose additional phrases, which were manually classified and further used in an expanded PubMed database search. Finally, we assessed the papers found with the expanded search and compared this to the initial search results. As a result, the expanded search more than tripled the search results, from 182 to 673 papers. The expanded search also more than tripled the number of relevant papers, from 12 in the original search to 39 in the expanded search.

Improving gender equity in critical care medicine: a protocol to establish priorities and strategies for implementation

IntroductionWhile the number of women entering medical school now equals or surpasses the number of men, gender equity in medicine has not been achieved. Women continue to be under-represented in...

The approachable team leader: Front line perspectives on leadership in critical care

Good leadership in critical care is essential for patient safety, staff moral and system performance. The approachability of a leader is a core skill enabling appropriate challenge, sharing of ment...

A "Fundamentals" Train-the-Trainer Approach to Building Pediatric Critical Care Expertise in the Developing World.

Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-intensivists, nurses, and critical care practitioners in diverse health-care settings to deal with the acute deterioration of pediatric patients. Our objective was to evaluate the PFCCS course as a tool for developing a uniform, reproducible, and sustainable model for educating local health-care workers in the optimal management of critically ill children in the Republic of Georgia. Over a period of 18 months and four visits to the country, we worked with Georgian pediatric critical care leadership to complete the following tasks: (1) survey health-care needs within the Republic of Georgia, (2) present representative PFCCS lectures and simulation scenarios to evaluate interest and obtain “buy-in” from key stakeholders throughout the Georgian educational infrastructure, and (3) identify PFCCS instructor candidates. Georgian PFCCS instructor training included the following steps: (1) US PFCCS consultant and content experts presented PFCCS course to Georgian instructor candidates. (2) Simulation learning principles were taught and basic equipment was acquired. (3) Instructor candidates presented PFCCS to Georgian learners, mentored by PFCCS course consultants. Objective evaluation and debriefing with instructor candidates concluded each visit. Between training visits Georgian instructors translated PFCCS slides to the Georgian language. Six candidates were identified and completed PFCCS instructor training. These Georgian instructors independently presented the PFCCS course to 15 Georgian medical students. Student test scores improved significantly from pretest results (n = 14) (pretest: 38.7 ± 7 vs. posttest 62.7 ± 6, p < 0.05). A Likert-type scale of 1 to 5 (1 = not useful or effective, 5 = extremely useful or effective) was used to evaluate each student’s perception regarding (1) relevance of course content to clinical work students rated as median (IQR): (a) relevance of PFCCS content to clinical work, 5 (4–5); (b) effectiveness of lecture delivery, 4 (3–4); and (c) value of skill stations for clinical practice, 5 (4–5). Additionally, the mean (±SD) responses were 4.6 (±0.5), 3.7 (±0.6), and 4.5 (±0.6), respectively. Training local PFCCS instructors within an international environment is an effective method for establishing a uniform, reproducible, and sustainable approach to educating health-care providers in the fundamentals of pediatric critical care. Future collaborations will evaluate the clinical impact of PFCCS throughout the Georgian health-care system.

What are the priorities for future success in critical care research in the UK? Report from a national stakeholder meeting.

Critical care in the United Kingdom is now well-established in terms of professional status, standards of clinical practice and training, and national audit through professional bodies and government representation. Research is fundamental to the further development and maturation of the specialty, to develop new therapies and technologies, more efficient and effective service organisation, and to improve patient and family experience and outcomes. Critical care research has expanded rapidly in the UK, and now has established organisations and infrastructure to share and develop ideas, through the UK Critical Care Research Forum and similar meetings. In September 2014, the Intensive Care Foundation and Critical Care Leadership Forum hosted a research colloquium to reflect, in part, on achievements, but more importantly plan for the future. With an invited list of participants the meeting explored firstly - the practical delivery of clinical research and secondly - the future financing landscape, from both academic funders' and commercial developers' perspectives. The following article summarises the important 'take home' messages from this meeting and suggests key issues for future strategy.

Reducing waste in the critical care setting.

The ICU at London Health Sciences Centre-University Hospital (LHSC-UH) is a 40-bed critical care unit that contains two separate supply rooms that carry all the essential materials necessary for patient care. However, considering the patient acuity in critical care, it is vital that this equipment is made more accessible for practitioners at the bedside. Therefore, nurse servers or bedside supply cabinets are present in each of the patient rooms. While these servers provide timely access to the supplies essential for nursing care, they are also a huge source of waste. When patients who are identified as having antibiotic-resistant organisms (AROs) are discharged, numerous unused items are discarded for infection control purposes. Project objectives were to curtail waste by minimizing stocked supplies at the bedside, exploring alternative stocking options and increasing awareness of this issue with practitioners. An interprofessional team was formed consisting of registered nurses, support service workers, environmental service workers, infection control practitioners and critical care leadership. A cost analysis of discarded supplies was undertaken, and results were communicated to all staff. Infection control practitioners developed guidelines specific to use of the nurse servers and linen supply areas. The stocking process and contents of the servers were reviewed; surplus was removed and relocated to a close central area outside patient rooms. Following agreement on new server contents, lists and photos were created and posted in each supply room. New stocking guidelines were phased in gradually and were adapted according to user feedback. Over a two-week period, a pilot cost analysis identified that supplies valued at $2,327.25 had been discarded from five bedsides. Future long-term cost savings will enable management to redirect such resources and therefore improve other essential care services in the ICU. Increasing awareness of wasteful stocking practices facilitated the engagement of this CQI project. New stocking practices have greatly reduced waste and increased service efficiencies while maintaining the integrity of optimal patient care.

Use of a protocolized approach to the management of sepsis can improve time to first dose of antibiotics

PurposeThe Surviving Sepsis Guidelines established recommendations for early recognition and rapid treatment of patients with sepsis. Recognizing systemic difficulties that delayed the application of early goal-directed therapy, the Emergency Department and Critical Care leadership instituted a sepsis protocol to identify patients with sepsis and expedite antibiotic delivery. We aimed to determine if the sepsis protocol improved the time to first dose of antibiotics in patients diagnosed with sepsis. Materials and methodsWe performed a retrospective chart review of patients with sepsis comparing the time from antibiotic order placement to the first dose of antibiotic therapy over a 3-year period. Patients who received vancomycin and ciprofloxacin underwent additional subgroup analysis, as these antibiotics were made available by protocol for use without infectious disease consultation. ResultsThe average time to first dose of antibiotics for the presepsis protocol group was 160 minutes, and the average time for the sepsis protocol group was 99 minutes. Fifty-eight patients received vancomycin, and 30 received ciprofloxacin, with a decrease in time of 65 minutes and 41 minutes, respectively. ConclusionsInitiation of a sepsis protocol, which emphasizes early goal-directed therapy, can improve time to administration of first dose of antibiotics.

Substitutes for leadership in anaesthesia teams and their impact on leadership effectiveness

In this study we aim to increase our understanding of leadership in anaesthesia teams by investigating the relationship between substitutes for leadership, leadership behaviour, and team performance in situations with varying levels of routine and standardization. The present study relied on video recordings of 12 anaesthesia teams in a simulated setting with the occurrence of a nonroutine event. Clinical team performance was measured by the speed of adequate team reaction to this event. The leadership behaviours observed were coded either as content oriented (e.g., information transmission) or structuring (e.g., assigning tasks). Results showed that leadership behaviour changed depending upon the level of routine of a situation, the degree of standardization, and, to some extent, on the experience of team members. Leadership tends to be positively related to team performance during nonroutine and low standardized situations but negatively related to team performance in routine and highly standardized situations. Furthermore, leadership is only slightly related to team member experience. This study improves our understanding of influences of substitutes for leadership on successful leadership behaviour in anaesthesia teams. The findings also lead to suggestions for both further research and the enhancement of team leadership in critical care.

Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge

Critical care leaders frequently must face challenging situations requiring specific leadership and management skills for which they are, not uncommonly, poorly prepared. Such a fictitious scenario was discussed at a Canadian interdisciplinary critical care leadership meeting, whereby increasing intensive care unit (ICU) staff turnover had led to problems with staff recruitment. Participants discussed and proposed solutions to the scenario in a structured format. The results of the discussion are presented. In situations such as this, the ICU leader should first define the core problem, its complexity, its duration and its potential for reversibility. These factors often reside within workload and staff support issues. Some examples of core problems discussed that are frequently associated with poor retention and recruitment are a lack of a positive team culture, a lack of a favorable ICU image, a lack of good working relationships between staff and disciplines, and a lack of specific supportive resources. Several tools or individuals (typically outside the ICU environment) are available to help determine the core problem. Once the core problem is identified, specific solutions can be developed. Such solutions often require originality and flexibility, and must be planned, with specific short-term, medium-term and long-term goals. The ICU leader will need to develop an implementation strategy for these solutions, in which partners who can assist are identified from within the ICU and from outside the ICU. It is important that the leader communicates to all stakeholders frequently as the process moves forward.

Critical Care Leadership Course

This article describes how to implement a baccalaureate level course in critical care leadership and management and emphasizes the value of this course in recruiting and developing critical care nurses with leadership abilities.