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A patient daily goals checkoff form used twice daily during rounds has helped the surgical intensive care unit (SICU) team at Hartford (CT) Hospital achieve a 25% drop in its mortality rate, while cutting lengths of stay and ventilator days.
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The universal consent form described eight commonly performed procedures: placement of an arterial catheter, a central venous catheter, a pulmonary artery catheter, a peripherally inserted central catheter, lumbar puncture, thoracentesis (surgical puncture through the chest wall with drainage of fluid from the thoracic cavity), paracentesis (surgical puncture through the abdominal wall with drainage or aspiration of fluid from the abdominal cavity), and intubation/mechanical ventilation.
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Using a universal consent form for multiple procedures anticipated for a patient can nearly double the consent rate for most of the invasive procedures performed in an intensive care unit, according to researchers in Chicago. But observers say the tactic may violate the spirit of the informed consent process.
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New rules put forth by the bush administration that took effect on Nov. 10 significantly relax strictures in the 1986 Emergency Medical Treatment and Labor Act (EMTALA) that required hospitals and some hospital-owned clinics to examine and treat people who need emergency medical care even when those patients cant pay.
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Measuring the quality of a complex service like critical care that combines the highest technology with the most intimate caring is a challenge. Recently, consumers, clinicians, and payers have requested more formal assessments and comparisons of the quality and costs of medical care.
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In this randomized control trial, Schneiderman and Associates evaluated the effect of an intervention, namely, an ethics consultation, on several variables associated with the care of patients eventually dying in the ICU.
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Advancing technology continues to reshape the way care management is practiced in the ICU and elsewhere, but early experience shows that technology is no guarantee for physician buy-in at the front end, much less patient compliance at the back end.
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Good ED/ICU networks are becoming more important as more rural hospitals close due to lack of funding, says Janet Williams, MD, FACEP, director of the Center for Rural Emergency Medicine and Professor of Emergency Medicine at West Virginia University in Morgantown.
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The randomized, controlled trial (RCT) is believed to provide the strongest evidence for verifying both effectiveness and ineffectiveness of a given treatment. Once the RCT judges the proposed treatment as ineffective, it is rare that the treatment is ever evaluated again.