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Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study

OBJECTIVE: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. DESIGN: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapp...

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Autores principales: Clay-Williams, Robyn, Blakely, Brette, Lane, Paul, Senthuran, Siva, Johnson, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429927/
https://www.ncbi.nlm.nih.gov/pubmed/30852541
http://dx.doi.org/10.1136/bmjopen-2018-025041
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author Clay-Williams, Robyn
Blakely, Brette
Lane, Paul
Senthuran, Siva
Johnson, Andrew
author_facet Clay-Williams, Robyn
Blakely, Brette
Lane, Paul
Senthuran, Siva
Johnson, Andrew
author_sort Clay-Williams, Robyn
collection PubMed
description OBJECTIVE: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. DESIGN: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data. SETTING: ICU in a 700-bed regional tertiary care hospital in Australia. PARTICIPANTS: 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments. INTERVENTION: Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan. MAIN OUTCOME MEASURES: Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds. RESULTS: Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ(2) (1)=24.9, p<0.0001. CONCLUSIONS: By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.
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spelling pubmed-64299272019-04-05 Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study Clay-Williams, Robyn Blakely, Brette Lane, Paul Senthuran, Siva Johnson, Andrew BMJ Open Intensive Care OBJECTIVE: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. DESIGN: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data. SETTING: ICU in a 700-bed regional tertiary care hospital in Australia. PARTICIPANTS: 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments. INTERVENTION: Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan. MAIN OUTCOME MEASURES: Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds. RESULTS: Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ(2) (1)=24.9, p<0.0001. CONCLUSIONS: By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled. BMJ Publishing Group 2019-03-09 /pmc/articles/PMC6429927/ /pubmed/30852541 http://dx.doi.org/10.1136/bmjopen-2018-025041 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Intensive Care
Clay-Williams, Robyn
Blakely, Brette
Lane, Paul
Senthuran, Siva
Johnson, Andrew
Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
title Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
title_full Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
title_fullStr Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
title_full_unstemmed Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
title_short Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
title_sort improving decision making in acute healthcare through implementation of an intensive care unit (icu) intervention in australia: a multimethod study
topic Intensive Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429927/
https://www.ncbi.nlm.nih.gov/pubmed/30852541
http://dx.doi.org/10.1136/bmjopen-2018-025041
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