mdlinx mdlinx
Latest (358) Full Text Articles (5583) Article Summary

Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit
The Journal of Trauma and Acute Care Surgery,

McMillen MA et al. – Annual mortality immediately improved at a busy nontrauma hospital with rapid, structured consultation by the surgical intensive care unit (SICU) team, comprehensive daily rounds guided by critical care best practices, and daytime in–unit surgical intensivists. Low mortality was maintained over 9years as surgery volume nearly doubled but did not improve further with 24/7 in–unit coverage by surgical intensivists and cardiac surgeons. The process of care in an SICU may be more important than 24hour a day, 7days a week intensivists.

Methods
  • In 2001, a new surgical critical care service was created for an 800-bed urban teaching hospital with a 12-bed surgical intensive care unit (SICU).
  • Consults, daily rounds, daily notes, and adherence to best practices were standardized over the next 9years for a team of postgraduate year-1 and -2 surgical residents, physician assistants and surgical intensivists.
  • The Fundamentals of Critical Care Support course was given as basic introduction, and published guidelines for ventilators, hemodynamics, cardiac, infections, and nutrition management were implemented.
  • A "beyond FCCS" curriculum was repeated every resident rotation.
  • A 12-bed stepdown unit was developed for the more stable patients, mostly run by SICU physician assistants with SICU attending coverage.
  • The first 5years, night coverage was by the daytime intensivist from home.
  • The last 4years, night coverage was in-unit surgical intensivists or cardiac surgeons.

Results
  • Data for 13,020 patients drawn from 152,154 operations over 9years is reported.
  • Surgery grew 89% to 24,000cases/year in 2010.
  • Half the patients were general, gastrointestinal oncology, or vascular surgery.
  • Ninety-two percent were perioperative.
  • The 8% nonoperative patients were mostly gastrointestinal bleeding, abdominal pain, or pancreatitis.
  • In the first year, annual SICU mortality decreased from an average of 4.5% the 5 previous years to 1.96% (2002) and remained 1.75% (2003), 2.1% (2004), 1.9% (2005), 1.5% (2006), 1.5% (2007), 2.2% (2008), 2.4% (2009), and 2.1% (2010).

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Nursing

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Nursing Articles

Last month's top read Top Articles of 2013

1 Ticks may cause double trouble, Stanford scientists find Full Text EurekAlert!, February 21, 2014    Free full text

2 'Putting the next generation of brains in danger' Full Text CNN Health, February 18, 2014    Free full text

3 How grazing affects your digestive function U.S. News & World Report - Health, January 30, 2014

4 A meta-analysis of coffee intake and risk of urolithiasis Urologia Internationalis, February 7, 2014    Clinical Article

5 Personal health: tackling menopauses side effects The New York Times, February 12, 2014

6 Yogurt consumption and impact on health: focus on children and cardiometabolic risk American Journal of Clinical Nutrition, March 21, 2014    Review Article

7 Long-term coffee consumption and risk of cardiovascular disease Circulation, February 11, 2014    Evidence Based Medicine    Review Article    Clinical Article

8 Tea consumption and leukemia risk: A meta-analysis Tumor Biology, February 12, 2014    Evidence Based Medicine    Clinical Article

9 Coffee intake and gastric cancer risk Cancer Epidemiology, Biomarkers & Prevention, March 19, 2014    Clinical Article

10 Effects of pomegranate juice consumption on inflammatory markers in patients with type 2 diabetes: A randomized, placebo-controlled trial Journal of Research in Medical Sciences, March 20, 2014    Clinical Article

11 Egg consumption and cardiovascular disease among diabetic individuals: A systematic review of the literature Full Text Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, March 28, 2014    Free full text    Review Article

12 Could you relationship with your mom increase your childs chances of obesity? Full Text EurekAlert!, February 3, 2014    Free full text

13 Coffee consumption and prostate cancer risk: An updated meta-analysis Cancer Causes and Control, March 3, 2014    Evidence Based Medicine    Clinical Article

14 Heated vegetable oils and cardiovascular disease risk factors Vascular Pharmacology, March 20, 2014    Review Article

15 Animal protein intake is associated with higher-level functional capacity in elderly adults: The Ohasama study Journal of the American Geriatrics Society, March 5, 2014    Clinical Article

16 Coffee consumption and risk of prostate cancer: A meta-analysis of prospective cohort studies Carcinogenesis, January 17, 2014    Evidence Based Medicine    Review Article

17 Vascular dysfunction and chronic obstructive pulmonary disease Hypertension, February 26, 2014    Clinical Article

18 Egg consumption and risk of GI neoplasms: dose–response meta-analysis and systematic review European Journal of Nutrition, February 6, 2014    Evidence Based Medicine    Review Article

19 Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis International Journal of Cardiology, March 17, 2014    Evidence Based Medicine    Review Article    Clinical Article

20 Is ginger effective for the treatment of irritable bowel syndrome? A double blind randomized controlled pilot trial Complementary Therapies in Medicine, March 4, 2014    Clinical Article

Indexed Journals in Nursing: Journal of Advanced Nursing, Journal of Clinical Nursing, Nurse Education In Practicemore

Other Topics in Nursing

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Stay current - Media Tool

Newsletter
RSS
Follow
Like

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close