Journal ArticleDOI
The critical care cascade: a systems approach.
Rishi Ghosh,Paul E. Pepe +1 more
TLDR
The basis and rationale for the ‘critical care cascade’ concept, which contends that the optimal management of critically ill patients should be a continuum of care through the healthcare system, are discussed.Abstract:
Purpose of review To emphasize the evolving body of evidence that supports the need for a more seamless and interconnected continuum of patient care for a growing compendium of critical care conditions, starting in the prehospital and emergency department (ED) phases of management and continuing through ICU and rehabilitation services. Recent findings The care of critically ill and injured patients has become increasingly complex. It now has been demonstrated that, for a number of such critical care conditions, optimal management not only relies heavily on the talents of highly coordinated, multidisciplinary teams, but it also may require shared responsibilities across a continuum of longitudinal care involving numerous specialties and departments. This continuum usually needs to begin in the prehospital and ED settings with management extending through specialized in-hospital diagnostic and interventional suites to traditional ICU and rehabilitation programs. In recent years, examples of these conditions have included the development of systems of care for trauma, cardiac arrest, myocardial infarction, stroke, sepsis syndromes, toxicology and other critical illnesses. Although the widespread implementation of such multidisciplinary, multispecialty critical care cascades of care has been achieved most commonly in trauma care, current healthcare delivery systems generally tend to employ compartmentalized organization for the majority of other critical care patients. Accordingly, optimal systematic care often breaks down in the management of these complex patients due to barriers such as lack of interoperable communication between teams, disjointed transfers between services, unnecessary time-consuming, re-evaluations and transitional pauses in time-dependent circumstances, deficiencies in cross-disciplinary education and quality assurance loops, and significant variability in patient care practices. Such barriers can lead to adverse outcomes in this fragile patient population. Summary This article discusses the basis and rationale for the 'critical care cascade' concept, which contends that the optimal management of critically ill patients should be a continuum of care through the healthcare system. In the critical care cascade, each patient is enrolled on a 'pathway' of management based on their working diagnosis and each and every healthcare provider engaged along that continuum acts as part of a interconnected coordinated team that ensures a specific endpoint for these patients in a bundled manner that seamlessly extends from the prehospital and ED phases to the ICU and rehabilitation services.read more
Citations
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Journal ArticleDOI
A consensus-based template for documenting and reporting in physician-staffed pre-hospital services
Andreas J. Krüger,David Lockey,Jouni Kurola,Stefano Di Bartolomeo,Maaret Castrén,Søren Mikkelsen,Hans Morten Lossius,Hans Morten Lossius +7 more
TL;DR: A core data set for documenting and reporting in physician-staffed pre-hospital services in Europe is established and it is believed that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre- hospital care.
Journal ArticleDOI
Combining quick Sequential Organ Failure Assessment with plasma lactate concentration is comparable to standard Sequential Organ Failure Assessment score in predicting mortality of patients with and without suspected infection
TL;DR: TheqSOFA score had a modest ability to predict mortality of both septic and nonseptic patients; combining qSOFA with plasma lactate had a predictive ability comparable to the standard SOFA score.
Journal ArticleDOI
Emergency Department Length of Stay for Critical Care Admissions. A Population-based Study.
Louise Rose,Damon C. Scales,Clare L. Atzema,Karen E. A. Burns,Sara Gray,Christina Doing,Alex Kiss,Gordon D. Rubenfeld,Jacques S. Lee +8 more
TL;DR: In this population-based study, less than half of adult ED patients were admitted to an ICU 6 hours or less after arrival to an ED, an internationally recognized performance indicator for ED care quality.
Journal ArticleDOI
Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients.
Don K. Nakayama,Sally S. Lester,Darla R. Rich,Bryan C. Weidner,Joshua B. Glenn,Issam J. Shaker +5 more
TL;DR: A multidisciplinary team developed a checklist that documented patient data and handoffs for all intrahospital transfers involving pediatric surgical inpatients and found that patient care issues were most common, followed by documentation and process problems.
Journal ArticleDOI
Emergency department length of stay for patients requiring mechanical ventilation: a prospective observational study
Louise Rose,Sara Gray,Karen E. A. Burns,Clare L. Atzema,Alex Kiss,Andrew Worster,Damon C. Scales,Gordon D. Rubenfeld,Jacques S. Lee +8 more
TL;DR: While patients requiring mechanical ventilation represent a small proportion of overall ED visits these critically ill patients frequently experienced prolonged ED stay especially those treated with NIV, assigned lower priority triage scores at ED presentation, and non-trauma patients.
References
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Journal ArticleDOI
Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Emanuel P. Rivers,Bryant Nguyen,Suzanne Havstad,Julie Ressler,Alexandria Muzzin,Bernhard P. Knoblich,Edward L. Peterson,Michael C. Tomlanovich +7 more
TL;DR: This study randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit.
Journal ArticleDOI
Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association.
Journal ArticleDOI
Guidelines for the Early Management of Patients With Ischemic Stroke A Scientific Statement From the Stroke Council of the American Stroke Association
Harold P. Adams,Robert J. Adams,Thomas G. Brott,Gregory J. del Zoppo,Anthony J. Furlan,Larry B. Goldstein,Robert L. Grubb,Randall T. Higashida,Chelsea S. Kidwell,Thomas Kwiatkowski,John R. Marler,George J. Hademenos +11 more
TL;DR: In this article, the authors provide updated recommendations that can be used by primary care physicians, emergency medicine physicians, neurologists, and other physicians who provide acute stroke care from admission to an emergency department through the first 24 to 48 hours of hospitalization by addressing the diagnosis and emergent treatment of the acute ischemic stroke in addition to the management of its acute and subacute neurological and medical complications.
Journal ArticleDOI
The golden hour: scientific fact or medical "urban legend"?
E. Brooke Lerner,Ronald Moscati +1 more
TL;DR: A detailed literature and historical record search for support of the "golden hour" concept is discussed, finding none is identified.
Journal ArticleDOI
Pilot Randomized Clinical Trial of Prehospital Induction of Mild Hypothermia in Out-of-Hospital Cardiac Arrest Patients With a Rapid Infusion of 4°C Normal Saline
Francis Kim,Michele Olsufka,W. T. Longstreth,Charles Maynard,David Carlbom,Steven Deem,Peter J. Kudenchuk,Michael K. Copass,Leonard A. Cobb +8 more
TL;DR: These pilot data suggest that infusion of up to 2 L of 4°C normal saline in the field is feasible, safe, and effective in lowering temperature, and it is proposed that the effect of this cooling method on neurological outcome after cardiac arrest be studied in larger numbers of patients, especially those whose initial rhythm is ventricular fibrillation.