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McNeill G.,University of Nottingham | Bryden D.,Critical Care Unit

Background: For critical care to be effective it must have a system in place to achieve optimal care for the deteriorating ward patient. Objectives: To systematically review the available literature to assess whether either early warning systems or emergency response teams improve hospital survival. In the event of there being a lack of evidence regarding hospital survival, secondary outcome measures were considered (unplanned ICU admissions, ICU mortality, length of ICU stay, length of hospital stay, cardiac arrest rates). Methods: The Ovid Medline, EMBASE, CINAHL, Web of Science, Cochrane library and NHS databases were searched in September 2012 along with non-catalogued resources for papers examining the effect of early warning systems or emergency response teams on hospital survival. Inclusion criteria were original clinical trials and comparative studies in adult inpatients that assessed either an early warning system or emergency response team against any of the predefined outcome measures. Exclusion criteria were previous systematic reviews, non-English abstracts and studies incorporating paediatric data. Studies were arranged in to sections focusing on the following interventions:. Early warning systems-Single parameter systems-Aggregate weighted scoring systems (AWSS)Emergency response teams-Medical emergency teams-Multidisciplinary outreach servicesIn each section an appraisal of the level of evidence and a recommendation has been made using the SIGN grading system. Results: 43 studies meeting the review criteria were identified and included for analysis. 2 studies assessed single parameter scoring systems and 4 addressed aggregate weighted scoring systems. A total of 20 studies examined medical emergency teams and 22 studies examined multidisciplinary outreach teams. Limitations: The exclusion of non English studies and those including paediatric patients does limit the applicability of this review. Conclusions: Much of the available evidence is of poor quality. It is clear that a 'whole system' approach should be adopted and that AWSS appear to be more effective than single parameter systems. The response to deterioration appears most effective when a clinician with critical care skills leads it. The need for service improvement differs between health care systems. © 2013 Elsevier Ireland Ltd. Source

Patel J.,University of Manchester | Baldwin J.,Critical Care Unit | Bunting P.,Royal Preston Hospital Lancashire Teaching Hospitals NHS Trust | Laha S.,Royal Preston Hospital Lancashire Teaching Hospitals NHS Trust

Sleep deprivation is common among intensive care patients and may be associated with delirium. We investigated whether the implementation of a bundle of non-pharmacological interventions, consisting of environmental noise and light reduction designed to reduce disturbing patients during the night, was associated with improved sleep and a reduced incidence of delirium. The study was divided into two parts, before and after changing our practice. One hundred and sixty-seven and 171 patients were screened for delirium pre- and post-intervention, respectively. Compliance with the interventions was > 90%. The bundle of interventions led to an increased mean (SD) sleep efficiency index (60.8 (3.5) before vs 75.9 (2.2) after, p = 0.031); reduced mean sound (68.8 (4.2) dB before vs 61.8 (9.1) dB after, p = 0.002) and light levels (594 (88.2) lux before vs 301 (53.5) lux after, p = 0.003); and reduced number of awakenings caused by care activities overnight (11.0 (1.1) before vs 9.0 (1.2) after, p = 0.003). In addition, the introduction of the care bundle led to a reduced incidence of delirium (55/167 (33%) before vs 24/171 (14%) after, p < 0.001), and less time spent in delirium (3.4 (1.4) days before vs 1.2 (0.9) days after, p = 0.021). Increases in sleep efficiency index were associated with a lower odds ratio of developing delirium (OR 0.90, 95% CI 0.84-0.97). The introduction of an environmental noise and light reduction programme as a bundle of non-pharmacological interventions in the intensive care unit was effective in reducing sleep deprivation and delirium, and we propose a similar programme should be implemented more widely. © 2014 The Association of Anaesthetists of Great Britain and Ireland. Source

Brown C.R.,Critical Care Unit
Journal for nurses in staff development : JNSD : official journal of the National Nursing Staff Development Organization

Developing and implementing a program to introduce clinical nurses to research and evidence-based practice (EBP) should spark interest and participation. In this article, the authors describe and evaluate a staff development initiative not only to introduce the principles of EBP and research but also to give nurses the opportunity to participate in the research process and development of EBP questions. Source

Anderson A.,Critical Care Unit
Nursing standard (Royal College of Nursing (Great Britain) : 1987)

The Liverpool Care Pathway (LCP) is an integrated care pathway used to manage terminally ill patients in their final days or hours of life. It was developed by the Marie Curie Palliative Care Institute Liverpool to incorporate 'gold standard' care associated with the hospice setting into mainstream healthcare. The LCP has been advocated by the National Institute for Health and Clinical Excellence and the Department of Health for use in the care of dying patients. A literature review was undertaken to determine whether there is sufficient evidence that the LCP represents best practice in end of life care and whether patients cared for using the LCP receive better end of life care. Eight research articles were selected for inclusion in the review. The key themes of symptom management, communication and documentation were identified, and the research surrounding these themes was analysed. The analysis showed that use of the LCP promotes better care for patients in the terminal stage of illness; however, some weaknesses in the research were identified and recommendations have been made for further research and future practice. Source

Fontes D.,Critical Care Unit | Generoso S.D.V.,Federal University of Minas Gerais | Toulson Davisson Correia M.I.,Federal University of Minas Gerais
Clinical Nutrition

Background & aims: Nutritional assessment of critically ill patients has created controversy. However, it is well established that malnourished patients who are severely ill have worse outcomes than well-nourished patients. Therefore, assessing patients' nutritional status may be useful in predicting which patients may experience increased morbidity and mortality. Method: One hundred eighty-five consecutively admitted patients were followed until discharge or death, and their nutritional status was evaluated using Subjective Global Assessment (SGA) as well as anthropometric and laboratory methods. Agreement between the methods was measured using the Kappa coefficient. Results: Malnutrition was highly prevalent (54%), according to SGA. Malnourished patients had significantly higher rates of readmission to the intensive care unit (ICU) (OR 2.27; CI 1.08-4.80) and mortality (OR 8.12; CI 2.94-22.42). The comparison of SGA with other tests used to assess nutritional status showed that the correlation between the methods ranged from poor to superficial. Conclusion: SGA, an inexpensive and quick nutritional assessment method conducted at the bedside, is a reliable tool for predicting outcomes in critically ill patients. © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source

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