Telemedicine coverage for post-operative ICU patients.

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47-69) versus 58 (IQR 44-70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7-14) versus 15 (IQR 11-21), p \u3c 0.001). The average amount of time patients spent in the VICU was 13.7 + /-9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation

The emergency observation and assessment ward

A recent development to reduce ED crowding and increase urgent patient admissions is the opening of an Emergency Observation and Assessment Ward (EOA Ward). At these wards urgent patients are temporarily hospitalized until they can be transferred to an inpatient bed. In this paper we present an overflow model to evaluate the effect of employing an EOA Ward on elective and urgent patient admissions

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Medical treatment of ascites in cirrhosis

Medical treatment of cirrhotic ascites is essentially supportive, dictated by the patient's discomfort, impaired cardiovascular or respiratory function and potential for infection. Treatment of ‘simple’ ascites (moderate fluid accumulation, serum albumin > 3.5 g/dl, serum creatinine < 1.5 mg/dl, no electrolyte disturbance) is implemented sequentially. Only 10% of patients respond to dietary sodium restriction and bed rest; most require pharmacotherapy consisting of spironolactone, which increases the proportion of responding patients to 65% and loop diuretics, which may produce clinical improvement in an additional 20% (85% in all); in the remaining 15% of refractory patients, use of novel adjunctive therapies may be attempted. Patients with tense ascites, impaired renal function and electrolyte disturbances merit special consideration before diuretics are introduced. Spironolactone has long been a standard for the treatment of cirrhotic ascites because it directly antagonizes aldosterone. The loop diuretic most frequently added to spironolactone has been furosemide. However, there is preliminary evidence that torasemide may be more effective in some patients. Other investigational agents that may play a role in treatment of patients resistant to conventional drugs include ornipressin (a vasopressin analogue) and atrial natriuretic factor

Bed Assignment: A Nurse\u27s Call

The purpose of this Integrated Thesis Project is to develop a nursing unit based bed assignment procedural guideline. Currently general care patients admitted to the hospital are assigned to a bed through a centralized bed assignment process that does not involve nursing input. The nursing unit based bed assignment process is developed using the assumption that nurses will select the right bed for the right patient the first time with consideration given to patient\u27s individual needs and staffing on the unit. A nursing unit based bed assignment process is anticipated to increase satisfaction for patient, family and nurse. Jean Watson\u27s Theory of Human Caring and the Mayo Nursing Model of Care are used as the theoretical foundation for the procedure

Low back pain : a comparative study on the value of core training versus traditional strengthening exercises

This randomised controlled trial (RCT) employed a pre-test/post-test design to compare the effects of core training (Pilates method) and traditional back exercises on a population with low back pain (LBP). Therapeutic intervention related to the Pilates method has recently become popular, but there is little evidence to prove it works. In this study, 120 individuals with LBP were allocated to three different groups. Group A was the control group, Group B was given modified Pilates intervention and Group C received traditional back exercises. All three groups were given a posture re-education session and back-care advice. After the initial session, the control group had individual sessions on posture re-education. The other groups undertook a six-week course of either modified Pilates or general back exercise classes. The modified Pilates group was taught how to use the core muscles, incorporating stabilisation with increasing functional movements. The back exercise group did similar exercises without learning to specifically stabilise. The Oswestry Low Back Pain Disability Questionnaire (ODQ) and the Visual Analogue Scale (VAS) were used as measures for pain and functional disability. Post-test ODQ readings showed no significant difference for pain-related function whilst VAS readings revealed a significant improvement in pain levels in all three groups, with the control group showing the best scores. However, the six-month follow-up scores showed that only the modified Pilates group continued to improve. At this stage, the control group was beginning to regress and the back exercise group was almost back to baseline measures. It was therefore concluded that core stability exercises have better long-term effects than traditional back exercisespeer-reviewe