Intensive Care Unit Rounds Research Articles

An Approach to Intensive Care Unit Rounds Utilizing 5, 10, and 15-Minute Strategies.

Teaching medical rounds in intensive care units (ICUs) are essential for resident education. However, the ICU's high workload can hinder these rounds. We propose a new approach that is based on the constructivist theory of learning communities. This approach emphasizes active, collaborative learning through interaction. In the ICU, it encourages active learning, peer interaction, and shared responsibility among residents. Our model involves structured teaching rounds that promote active learning, collaboration, and reflection, all integrated into the ICU workflow. This new approach aims to enhance the learning experience; improve teaching round effectiveness; and, ultimately, contribute to better patient care.

Impact of a Novel Virtual Rounding Queue Software on Nurse and Family Presence for Rounds in the Neonatal Intensive Care Unit: A Pilot Study

ObjectiveCoordinating getting everyone in the room at the same time for family-centered rounds (FCR) is challenging. The objective of this study was to determine if using a virtual queue that notifies nurses and families in real time when to expect the rounding team could impact their presence on rounds. MethodsWe observed rounds on two NICU teams for six weeks before and after implementation of a novel rounding software, Q-rounds™, that shares real-time updates on when the team will arrive and allows families to RSVP to join remotely when they can’t be there in person. Observers collected metrics pertinent to FCR including nurse and family presence (in-person or remotely) and duration of rounds and used chi-squared and two group t-tests for analysis. ResultsRounds were observed for 165 patient encounters pre-implementation and 179 patient encounters post-implementation, with an average rounding duration of 10.3 minutes (SD 6.5) and 10.4 minutes (SD 6.3) per patient respectively (P =0.91). The proportion of nurses who were present for the entirety of the rounding discussion increased from 18.8% to 58.2% (P < 0.001). Family presence on rounds increased from 20.0% (95% CI, 13.9-26.1) to 43.0% (95% CI, 35.8-50.3; P < 0.001). The percentage of families that participated in rounds remotely increased from 15.2% to 55.8% (P < 0.001). ConclusionsThis observational study showed that the use of a novel rounding software was associated with a significant increase in family presence for rounds and nurse presence for the entirety of rounds without increasing rounding duration.

Differential Impact of Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit by Social Factors: A Post Hoc Subgroup Analysis.

Background: Barriers to attending family-centered rounds (FCR) exist for socially disadvantaged families. Using telehealth to conduct virtual FCR could potentially promote equitable parent/guardian FCR access. The objective of this work was to assess whether the effects of a virtual FCR intervention on parent FCR attendance varied by subgroups defined by social factors. Methods: We conducted a post hoc analysis of a randomized controlled trial of virtual FCR in the neonatal intensive care unit. Parents of intervention arm infants were invited to participate in virtual FCR plus usual care; control arm infants received usual care. Participants were analyzed according to the assigned group and by race/ethnicity, insurance, mother's education, and neighborhood health conditions. We used Poisson regression to estimate and compare FCR parent attendance rates. Heterogeneity of intervention effects was assessed using interaction terms to evaluate the relative benefit of the intervention in increasing parent FCR attendance. Results: We included all enrolled trial subjects (74 intervention, 36 control). Intervention arm infants had 3.36 (95% confidence interval [CI]: 2.66-4.23) times the FCR parent attendance rate of subjects in the control arm. Compared with the corresponding reference subgroup, intervention benefits were 2.15 times (95% CI: 1.30-3.56) better for racial/ethnic minorities, 3.08 times (95% CI: 1.59-5.95) better for those with private insurance, 2.68 times (95% CI: 1.12-6.40) better for those whose mother reported no college education, and 4.14 times (95% CI: 2.07-8.25) better for those from a neighborhood with worse health conditions. Conclusions: Virtual FCR improved parent FCR attendance overall, with even greater benefits for certain subgroups. Further research is needed to mitigate the differential benefit demonstrated for privately insured subjects.

Integrating Social Determinants of Health in Critical Care

BackgroundSocial determinants of health (SDOH) mediate outcomes of critical illness. Increasingly, professional organizations recommend screening for social risks. Yet, how clinicians should identify and then incorporate SDOH into acute care practice is poorly defined. Research QuestionHow do medical intensive care unit (ICU) clinicians currently operationalize SDOH within patient care, given that SDOH are known to mediate outcomes of critical illness? Study Design and MethodsUsing ethnographic methods, we observed clinical work rounds in three urban ICUs within a single academic health system to capture use of SDOH during clinical care. Adults admitted to the medical ICU with respiratory failure were prospectively sequentially enrolled. Observers wrote field notes and narrative excerpts from rounding observations. We also reviewed electronic medical record (EMR) documentation for up to 90 days following ICU admission. We then qualitatively coded and triangulated data using a constructivist grounded theory approach and the Centers for Disease Control Healthy People SDOH framework. ResultsSixty-six patients were enrolled and over 200 observation hours of clinical work rounds were included in the analysis. ICU clinicians infrequently integrated social structures of patients’ lives into their discussions. Social structures were most frequently invoked when related to: 1) etiologies of acute respiratory failure, 2) decisions on life sustaining therapies, and 3) transitions of care. There was no systematic way in which data about common SDOH were collected (e.g., food and housing insecurity) and some SDOH were rarely or never discussed (e.g., access to education, discrimination, incarceration). InterpretationClinicians do not incorporate many areas of known SDOH into ICU rounds. Improvements in integration of SDOH should leverage the multidisciplinary team, identifying who is best suited to collect information of SDOH during different timepoints in critical illness. Next steps include clinician, patient-, and caregiver-focused assessments of feasibility and acceptability of an ICU-based SDOH assessment.

Family Perceptions of Virtual Family-Centered Rounds in a Quaternary Cardiac Intensive Care Unit.

Background: Family-centered rounds (FCR) reduce the risk of psychological comorbidities of family members and improve the quality of communication between providers and families. Materials and methods: We conducted a pilot quality improvement study analyzing family perceptions of virtual FCR. Family members of previously admitted cardiac ICU patients who participated in at least one session of virtual FCR between April 2020 and June 2021 at Massachusetts General Hospital were surveyed post-ICU discharge. Results: During the study, 82 family members enrolled and participated in virtual FCR with 29 completing the post-admission telephone survey. Many cardiac ICU patients were male (n = 53), and a majority were discharged home (43%) with the patient's wives being the most common respondents to the questionnaire (n = 18). Across all questions in the survey, more than 75% of the respondents perceived the highest level of care in trust, communication, relationship, and compassion with their provider. Participants perceived the highest level of care in trust (96%), explanation (88%), as well as care and understanding (89%). Conclusions: Family members of cardiac ICU patients positively rated the quality of communication and perceived a high level of trust and communication between their providers on the virtual format.

A Novel Continuous Real-Time Vital Signs Viewer for Intensive Care Units: Design and Evaluation Study.

Clinicians working in intensive care units (ICUs) are immersed in a cacophony of alarms and a relentless onslaught of data. Within this frenetic environment, clinicians make high-stakes decisions using many data sources and are often oversaturated with information of varying quality. Traditional bedside monitors only depict static vital signs data, and these data are not easily viewable remotely. Clinicians must rely on separate nursing charts-handwritten or electric-to review physiological patterns, including signs of potential clinical deterioration. An automated physiological data viewer has been developed to provide at-a-glance summaries and to assist with prioritizing care for multiple patients who are critically ill. This study aims to evaluate a novel vital signs viewer system in a level 1 trauma center by subjectively assessing the viewer's utility in a high-volume ICU setting. ICU attendings were surveyed during morning rounds. Physicians were asked to conduct rounds normally, using data reported from nurse charts and briefs from fellows to inform their clinical decisions. After the physician finished their assessment and plan for the patient, they were asked to complete a questionnaire. Following completion of the questionnaire, the viewer was presented to ICU physicians on a tablet personal computer that displayed the patient's physiologic data (ie, shock index, blood pressure, heart rate, temperature, respiratory rate, and pulse oximetry), summarized for up to 72 hours. After examining the viewer, ICU physicians completed a postview questionnaire. In both questionnaires, the physicians were asked questions regarding the patient's stability, status, and need for a higher or lower level of care. A hierarchical clustering analysis was used to group participating ICU physicians and assess their general reception of the viewer. A total of 908 anonymous surveys were collected from 28 ICU physicians from February 2015 to June 2017. Regarding physicians' perception of whether the viewer enhanced the ability to assess multiple patients in the ICU, 5% (45/908) strongly agreed, 56.6% (514/908) agreed, 35.3% (321/908) were neutral, 2.9% (26/908) disagreed, and 0.2% (2/908) strongly disagreed. Morning rounds in a trauma center ICU are conducted in a busy environment with many data sources. This study demonstrates that organized physiologic data and visual assessment can improve situation awareness, assist clinicians with recognizing changes in patient status, and prioritize care.

Extraneous Load, Patient Census, and Patient Acuity Correlate With Cognitive Load During ICU Rounds

BackgroundCognitive Load Theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of intensive care unit (ICU) rounds, when multidisciplinary providers integrate complex decision-making and teaching in a noisy, high-stress environment prone to cognitive distractions. Research QuestionWhat features of ICU rounds correlate with high provider cognitive load? Study Design and MethodsThis was an observational, multisite study of multidisciplinary providers during ICU rounds. Investigators recorded rounding characteristics and hourly extraneous cognitive load events during rounds (defined as distractions, episodes of split-attention or repetition, and deviations from standard communication format). Following rounds, investigators measured each provider’s cognitive load using the Provider Task Load (PTL), an instrument derived from the NASA Task Load Index survey that assesses perceived workload associated with complex tasks. Relationships between rounding characteristics, extraneous load, and PTL score were evaluated using mixed-effects modeling. Results76 providers were observed during 32 rounds from December 2020 – May 2021. The mean (±standard deviation) rounding census was 12.5±2.9 patients. The mean rounding time was 2h17m±49m. The mean extraneous load was 20.5±4.5 events per hour, or one event every 2m51sec. This included 8.6±3.4 distractions, 8.2±4.2 communication deviations, 1.9±1.4 repetitions, and 1.8±1.3 episodes of split-attention per hour. Controlling for covariates, the hourly extraneous load events, number of new patients, and number of higher acuity patients were each associated with increased PTL score (slope: 2.40 and 95% CI: 0.76 – 4.04, slope: 5.23 and 95% CI: 2.02 – 8.43, slope: 3.35 and 95% CI: 1.34 – 5.35, respectively). InterpretationIncreased extraneous load, new patients, and patient acuity were associated with higher cognitive load during ICU rounds. These results can help direct how the ICU rounding structure may be modified to reduce workload and optimize provider learning and performance.

A voice-based digital assistant for intelligent prompting of evidence-based practices during ICU rounds

ObjectiveTo evaluate the technical feasibility and potential value of a digital assistant that prompts intensive care unit (ICU) rounding teams to use evidence-based practices based on analysis of their real-time discussions. MethodsWe evaluated a novel voice-based digital assistant which audio records and processes the ICU care team’s rounding discussions to determine which evidence-based practices are applicable to the patient but have yet to be addressed by the team. The system would then prompt the team to consider indicated but not yet delivered practices, thereby reducing cognitive burden compared to traditional rigid rounding checklists. In a retrospective analysis, we applied automatic transcription, natural language processing, and a rule-based expert system to generate personalized prompts for each patient in 106 audio-recorded ICU rounding discussions. To assess technical feasibility, we compared the system’s prompts to those created by experienced critical care nurses who directly observed rounds. To assess potential value, we also compared the system’s prompts to a hypothetical paper checklist containing all evidence-based practices. ResultsThe positive predictive value, negative predictive value, true positive rate, and true negative rate of the system’s prompts were 0.45 ± 0.06, 0.83 ± 0.04, 0.68 ± 0.07, and 0.66 ± 0.04, respectively. If implemented in lieu of a paper checklist, the system would generate 56% fewer prompts per patient, with 50%±17% greater precision. ConclusionA voice-based digital assistant can reduce prompts per patient compared to traditional approaches for improving evidence uptake on ICU rounds. Additional work is needed to evaluate field performance and team acceptance.

Who Is Teaching Residents in the Intensive Care Unit? Perceptions of Interprofessional Teaching at an Academic Medical Center.

Teamwork is essential for high-quality care in the intensive care unit (ICU). Interprofessional education has been widely endorsed as a way of promoting collaborative practice. Interprofessional providers (IPPs), including nurses, pharmacists, and respiratory therapists (RTs), routinely participate in multidisciplinary rounds in the ICU, but their role in teaching residents at academic medical centers has yet to be characterized. To characterize perceptions of interprofessional teaching during and outside of rounds in the ICU. The authors conducted a cross-sectional survey of critical care physicians, internal medicine residents, nurses, pharmacists, and RTs across three ICUs at a tertiary academic medical center from September 2019 to March 2020. The frequency of different types of rounds contributions was rated on a Likert scale. Means and medians were compared across groups. A total of 221 of 285 participants completed the survey (78% response rate). All IPPs described that they report data, provide clinical observations, and make recommendations frequently during ICU rounds, but teaching occurred infrequently (mean values, nurses = 2.9; pharmacists = 3.5; RTs = 3.7; 1 = not at all; 5 = always). Nurses were least likely to report teaching (P = 0.0017). From residents' and attendings' perspectives, pharmacists taught most frequently (mean values, 3.7 and 3.4, respectively). RTs self-report of teaching was higher than physicians' reports of RT teaching (P < 0.0001). Outside of rounds, residents reported a low frequency of teaching by nurses and RTs (means, nurses = 3.1; RTs = 3.1), but they reported a high rate of teaching by pharmacists (mean, 4.4). Nonphysician IPPs routinely participate in ICU rounds but teach medical trainees infrequently. Physicians' perception of IPP teaching frequency was generally lower than self-reports by IPPs. Exploring modifiers of interprofessional teaching may enhance education and collaboration.

A qualitative study of how team characteristics and leadership are associated with information sharing in multidisciplinary intensive care units

BackgroundBetter information sharing in intensive care units has been associated with lower risk-adjusted mortality. This study explored how team characteristics and leadership are associated with information sharing in 4 intensive care units in a single large urban, academic medical center. MethodsA qualitative study was conducted to understand how team characteristics and leadership are associated with information sharing. Qualitative data were conducted through ethnographic observations. One postdoctoral research fellow and one PhD qualitative researcher conducted nonparticipant observations of a Medical, Surgical, Neurological, and Cardiothoracic intensive care unit morning and afternoon rounds, as well as nurse and resident handoffs from May to September 2021. Field notes of observations were thematically analyzed using deductive reasoning anchored to the Edmondson Team Learning Model. This study included nurses, physicians (ie, intensivists, surgeons, fellows, and residents), medical students, pharmacists, respiratory therapists, dieticians, physical therapists, physician assistants, and nurse practitioners. ResultsWe conducted 50 person-hours of observations involving 148 providers. Three themes emerged from the qualitative analysis: (1) team leaders used variable leadership techniques to involve team members in discussions for information sharing related to patient care, (2) predefined tasks for team members allowed them to prepare for effective information sharing during intensive care unit rounds, and (3) a psychologically safe environment allowed team members to participate in discussions for information sharing related to patient care. ConclusionInclusive team leadership is foundational in creating a psychologically safe environment for effective information sharing.

Family Participation in Cardiovascular Intensive Care Unit Rounds: A Pilot Randomized Controlled Trial

BackgroundObservational studies have shown an association between family participation in intensive care unit (ICU) rounds and better family-centred outcomes. However, evidence from randomized studies on the impact of family participation in ICU rounds is lacking. The objective of this pilot study was to evaluate the feasibility of a randomized trial for family participation in ICU rounds and obtain preliminary estimates of effect to inform a future effectiveness trial. MethodsFamily members of patients in the cardiovascular ICU at an academic tertiary-care hospital were randomized to the intervention (participation in rounds) or usual-care group. Following ICU discharge, family member participants completed the family satisfaction (Family Satisfaction in the Intensive Care Unit Survey [FS-ICU]). Feasibility metrics were recruitment (≥ 10 participants per month), uptake (≥ 80%), and follow-up (≥ 80%). Effectiveness was measured by between-group differences in survey score at follow-up. ResultsA total of 27 participants were recruited over 8 weeks. A total of 44% of family members (27 of 61) who were approached agreed to participate. Nonparticipation was due most commonly to lack of interest (N = 20; 64%). All family members randomized to the intervention (N = 16) were present for rounds (100% uptake). Follow-up data were available for 23 participants (85%). Family members who participated in rounds had a higher level of satisfaction with care, compared to the usual-care group (87.3 vs 74.7, P = 0.03, respectively). ConclusionsFamily participation in cardiovascular ICU rounds is feasible and effective at improving family satisfaction. Our findings will inform the design of a planned, larger, multicentre study to evaluate the effectiveness of family participation in ICU rounds to improve family-centred outcomes. Trial registration number: NCT05528185.

Virtual family-centered hospital rounds in the neonatal intensive care unit: protocol for a cluster randomized controlled trial

BackgroundFamily-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child’s bedside during hospital rounds is a promising solution. We aim to evaluate the impact of virtual family-centered hospital rounds in the neonatal intensive care unit on parental and neonatal outcomes.MethodsThis two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual hospital rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in hospital rounds in-person or to not participate in hospital rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.DiscussionThe findings from this trial will increase our understanding about virtual family-centered hospital rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention.Trial registrationClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First posted: March 10, 2023; last update posted: March 10, 2023.

Perception versus reality: analysis of time spent on bedside rounds in an academic ICU (Intensive Care Unit)

BackgroundDespite its importance, teaching at the bedside is declining over time. This purported decline has not been quantified. Quantifying bedside teaching is challenging, and we found only one study quantifying bedside teaching on a hospitalist service.ObjectiveWe conducted a study to understand the prevalence of bedside teaching in our medical intensive care unit.MethodsWe conducted a single-center single-unit study in the medical intensive care unit of an academic tertiary care institution. We used a survey tool to assess perceived time spent on bedside teaching, quality of teaching, and total rounding time. In parallel, independent observers objectively measured time spent on rounds and on bedside teaching. Residents were asked to complete the survey once a week. Independent observers collected data daily and weekly averages were obtained.Results43 responses were collected over a 4-month period. Most respondents (73%) reported a total rounding time of either 90–120 min or greater than 120 min. Median reported bedside teaching time was 16–20 min with 16 respondents (37%) reporting less than 15 min and 27 respondents (63%) reporting 16 min or more. The amount of time spent on bedside teaching was reported as adequate or more than adequate by 77% (33) of respondents with 58% (25) reporting that bedside teaching was very or extremely effective in helping them learn. Mean census reported by the independent observers was 12.75 patients per team. Bedside teaching represented an average of 12% of total rounding time, 16.85 min per day. While total rounding time increased with increasing census, there was no decline in bedside teaching time.ConclusionIt is reported that bedside teaching has decreased over time. Our study has demonstrated that bedside teaching occurs in our Medical ICU, and though it represents a minority of the time spent on rounds, residents still reported teaching in the ICU to be adequate.

Provision of Microbiology, Infection Services and Antimicrobial Stewardship in Intensive Care: A Survey across the Critical Care Networks in England and Wales.

Infection rounds in Intensive Care Units (ICU) can impact antimicrobial stewardship (AMS). The aim of this survey was to assess the availability of microbiology, infection, AMS services, and antimicrobial prescribing practices in the UK ICUs. An online questionnaire was sent to clinical leads for ICUs in each region listed in the Critical Care Network for the UK. Out of 217 ICUs, 87 deduplicated responses from England and Wales were analyzed. Three-quarters of those who responded had a dedicated microbiologist, and 50% had a dedicated infection control prevention nurse. Infection rounds varied in their frequency, with 10% providing phone advice only. Antibiotic guidance was available in 99% of the units; only 8% of those were ICU-specific. There were variations in the availability of biomarkers & the duration of antibiotics prescribed for pneumonia (community, hospital, or ventilator), urinary, intra-abdominal, and line infections/sepsis. Antibiotic consumption data were not routinely discussed in a multi-disciplinary meeting. The electronic prescription was available in ~60% and local antibiotic surveillance data in only 47% of ICUs. The survey highlights variations in practice and AMS services and may offer the opportunity to further collaborations and share learnings to support the safe use of antimicrobials in the ICU.

Clinical Pearls

Extubating patients as soon as possible is recommended to prevent adverse physical and cognitive outcomes. Hemodynamic stability is often listed as a criterion for extubation; however, the evidence is conflicting regarding the safety of extubation while the patient is receiving vasopressor medications. In addition, little is known about actual bedside practice in such situations.Costa and colleagues surveyed clinicians to examine their reported practice of extubation with patients receiving vasopressor therapy. They found One-third of respondents stated that they would extubate a patient receiving a continuous infusion of vasopressors.About one-quarter reported that it would depend on the type of medication being used.Almost 58% stated that their unit did not have a protocol or that they did not know if there was a protocol for this practice.Clinicians working in a surgical intensive care unit (ICU) and those who provide direct patient care at least 50% of the time more often said they would extubate patients receiving vasopressors.Extubation of patients receiving a vasopressor varied significantly by unit type and provider role. The authors recommend further research to explore the safety of this practice and examine existing protocols in ICUs.See Article, pp 127-130Parents with children in the pediatric intensive care unit (PICU) rely on the health care team to discuss their child’s possible morbidities and risk of mortality. These are called prognostic conversations. However, very little research has addressed the impact of prognostic conversations on post–intensive care syndrome in families in the PICU.Rissman and colleagues surveyed parents and health care providers at discharge from the PICU. They found Findings support the need for prognostic conversations to occur multiple times and using multiple formats throughout the PICU hospitalization, in order to appropriately prepare families for possible post-PICU morbidities.See Article, pp 118-126Although a necessary therapy, mechanical ventilation can cause significant stress and anxiety in patients. Management of these responses continues to be via medications such as antipsychotics, analgesics, and sedatives. However, these may produce adverse effects that could increase length of stay and cost of care and could contribute to long-term adverse outcomes.Golino and colleagues evaluated the impact of live music therapy as a nonpharmacologic intervention to reduce anxiety, pain, and agitation in adult patients receiving mechanical ventilation. They found Findings show music therapy reduces pain and agitation in adults receiving mechanical ventilation. Further research is needed, but nonpharmacologic interventions such as music therapy may reduce the need for pain and anxiety medications.See Article, pp 109-115The implementation of checklists during intensive care unit (ICU) rounds helps facilitate evidence-based practice and improve patient outcomes. However, checklists are sometimes not used as intended, and customization of the checklist may affect reliability and quality of care.King and colleagues created a paper-based assessment tool that one critical care nurse could use to reliably assess ABCDEF bundle care checklist items during rounds. They evaluated the tool with 2 independent nurses during rounds on 53 patients and found that Although tool item improvements are needed, findings support having one critical care nurse serve as checklist prompter to reliably assess ABCDEF bundle care during ICU rounds.See Article, pp 92-99

Measuring Performance on the ABCDEF Bundle During Interprofessional Rounds via a Nurse-Based Assessment Tool

Nurse-led rounding checklists are a common strategy for facilitating evidence-based practice in the intensive care unit (ICU). To streamline checklist workflow, some ICUs have the nurse or another individual listen to the conversation and customize the checklist for each patient. Such customizations assume that individuals can reliably assess whether checklist items have been addressed. To evaluate whether 1 critical care nurse can reliably assess checklist items on rounds. Two nurses performed in-person observation of multidisciplinary ICU rounds. Using a standardized paper-based assessment tool, each nurse indicated whether 17 items related to the ABCDEF bundle were discussed during rounds. For each item, generalizability coefficients were used as a measure of reliability, with a single-rater value of 0.70 or greater considered sufficient to support its assessment by 1 nurse. The nurse observers assessed 118 patient discussions across 15 observation days. For 11 of 17 items (65%), the generalizability coefficient for a single rater met or exceeded the 0.70 threshold. The generalizability coefficients (95% CIs) of a single rater for key items were as follows: pain, 0.86 (0.74-0.97); delirium score, 0.74 (0.64-0.83); agitation score, 0.72 (0.33-1.00); spontaneous awakening trial, 0.67 (0.49-0.83); spontaneous breathing trial, 0.80 (0.70-0.89); mobility, 0.79 (0.69-0.87); and family (future/past) engagement, 0.82 (0.73-0.90). Using a paper-based assessment tool, a single trained critical care nurse can reliably assess the discussion of elements of the ABCDEF bundle during multidisciplinary rounds.

The impact of rounds with a psychiatry team in the intensive care unit: A prospective observational pilot study evaluating the effects on delirium incidence and outcomes

BackgroundDelirium in the intensive care unit (ICU) is a common but serious condition that has been associated with in-hospital mortality and post-discharge psychological dysfunction. The aim of this before and after study is to determine the effect of a multidisciplinary care model entailing daily ICU rounds with a psychiatrist on the incidence of delirium and clinical outcomes. ObjectiveTo assess the impact of a proactive psychiatry consultation model in the surgical ICU on the incidence and duration of delirium. MethodsThis was a prospective, single institution, observational controlled cohort pilot study of adult patients admitted to a surgical ICU. A control group that received standard of care (SOC) with daily delirium prevention care bundles in the pre-intervention period was compared to an intervention group, which had a psychiatrist participate in daily ICU rounds (post-intervention period). The primary outcome was delirium incidence. The secondary outcomes were: delirium duration, ventilator days, hospital and ICU length of stay, and in-hospital mortality. ResultsA total of 104 patients were enrolled and equally split between SOC and intervention groups; 95 contributed to analysis. The overall incidence of ICU delirium was 19%. SOC and intervention groups had similar rates of delirium (21% vs 18%, p = 0.72). None of the secondary outcomes statistically significantly differed between the two groups. ConclusionDelirium in ICU patients is a potentially preventable condition with serious sequelae. There was no difference in delirium incidence or duration between patients receiving SOC or patients who had multidisciplinary rounds with a psychiatrist.

Reducing unnecessary diagnostic phlebotomy in intensive care: a prospective quality improvement intervention

BackgroundCritically ill patients receive frequent routine and recurring blood tests, some of which are unnecessary.AimTo reduce unnecessary routine phlebotomy in a 30-bed tertiary medical-surgical intensive care unit (ICU) in Toronto,...

A study on post intervention impact assessment of antibiotic prescribing practices in the neurosurgery ICU, under antimicrobial stewardship program

Introduction: Antimicrobial Stewardship is a coordinated program that ensures the optimal selection, dose, and duration of an antimicrobial therapy that leads to the best clinical outcome for the treatment or prevention of an infection.Objectives: Objectives of the study are, (1) to describe antibiotic stewardship program implementation by critically evaluating antibiotic prescribing practices; (2) to design an appropriate intervention for subsequent implementation; and (3) to discern the impact of intervention.Methodology: An interventional and cross-sectional study was carried out for 19 months in a neurosurgery intensive care unit (ICU) of a tertiary-care hospital, consisting of three phases: baseline, intervention, and postintervention. First phase involved the evaluation of antibiotic utilization and prescribing practices and appropriateness for the same without provision of any recommendations. In second phase, a 3-component intervention was introduced, i.e. active ICU rounds, postprescription review with feedback and teaching programs. Third phase involved evaluation of antibiotic utilization and prescribing practices and appropriateness for the same with provision of recommendations. The study tool was an antibiotic prescription chart (pre and post-intervention phase) and postprescription review and feedback form (only postintervention phase) that was used for data collection. The primary outcome of the study was days of therapy (DOT) per 1000 In-patient days (PD) for antimicrobials. Data analysis was done by SPSS 23.Results: Overall decrease in the DOT per 1000 In-patient days from baseline to postintervention phase was 17.8% (P = 0.35). The reduction in cost of antibiotic usage per patient day from preintervention phase to postintervention phase was INR 78.1.Conclusion: Antibiotic stewardship ward rounds and dedicated prescription chart can achieve reduction in antibiotic consumption.

Implementation and Modification of Developmental Care Rounds in the Cardiac Intensive Care Unit.

In 2019, an interprofessional team at Texas Children's Hospital designed and instituted developmental care rounds to better coordinate developmentally appropriate care within the cardiac intensive care unit. During the first 2 years, we conducted 230 developmental care rounds on 169 patients; for these rounds, family participation was greater than 85%. Since their inception, these rounds have undergone several modifications, including changes to the patient selection criteria and team role delegation. Importantly, the structure of these rounds has evolved to prominently integrate family members' perspectives and experiences. Lessons learned through developmental care rounds have formed a foundation for implementing other developmentally appropriate practices and initiatives throughout the hospital's Heart Center.