Critical care medicine
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Critical care medicine · Jun 2012
Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program.
The frequency of bedside percutaneous tracheostomies is increasing in intensive care medicine, and both safety and efficiency of care are critical elements in continuing success of this procedure. Prioritizing patient safety, a tracheostomy team was created at our institution to provide bedside expertise in surgery, anesthesiology, respiratory, and technical support. This study was performed to evaluate the metrics of patient outcome, efficiency of care, and cost-benefit analysis of the multidisciplinary Johns Hopkins Percutaneous Tracheostomy Program. ⋯ An institutionally subsidized, multi-disciplinary percutaneous tracheostomy program can improve the quality of care in a cost-effective manner by decreasing the incidence of tracheostomy complications and improving both the time to tracheostomy, duration of procedure, and postprocedural intensive care unit stay.
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Critical care medicine · Jun 2012
Review Meta AnalysisDelirium screening in critically ill patients: a systematic review and meta-analysis.
Despite its frequency and impact, delirium in critically ill patients is poorly recognized. Our aim was to systematically review the accuracy of delirium screening instruments in critically ill patients. ⋯ The Confusion Assessment Method for the Intensive Care Unit was the most specific bedside tool for the assessment of delirium in critically ill patients. However, there was significant heterogeneity of the results. These findings were largely obtained in research settings, and the low sensitivity of the Confusion Assessment Method for the Intensive Care Unit in routine, daily practice may limit its use as a screening test.
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Critical care medicine · Jun 2012
Editorial CommentControl charts: from widgets to critically ill patients.