This issue of Critical Care Nursing Quarterly is devoted to technology and its many applications to caring for the patient in the intensive care environment. Both direct and indirect applications will be discussed, with emphasis on best practices and emerging science.
Rufo begins the issue with Part 1 of her article, "Using the Tele-ICU Care Delivery Model to Drive Organizational Performance." She endorses the positions of the Institute of Medicine and the Leapfrog Group, both which supports the proposition that redesigned systems and an intensivist-based model of care can reduce medical errors and improve overall care quality. Mobile technology used in the tele-ICU is an excellent illustration of leveraging scarce critical clinical resources to produce improved outcomes for patients across several systems within the hospital. Rufo takes the reader to a new level in Part 2, "Tele-ICUs: Adding Value to the Health Care Equation." She explains value-based purchasing and illustrates how one hospital's investment in an eICU(R) program has reaped both operational and financial benefits.
"An Innovative Approach to Meeting Early Goal-Directed Therapy Using Telemedicine" by Loyola, Wilhelm, and Fornos, emphasizes that a key component in the treatment of severe sepsis and septic shock is optimization of the septic patient's abnormal physiology. She shares how a five-hospital system in San Antonio uses telemedicine to help achieve compliance with the sepsis bundles. Using a multidisciplinary team to review data and assess compliance is the key to their practice improvements. Loyola demonstrates key processes and tools that are utilized within the multi-hospital system to improve the care of septic and septic shock patients including the Adult Rapid Response Team Protocol, Sepsis 24-Hour Management Bundle, Sepsis 6-Hour Bundle Checklist, Sepsis Screening Tool, Severe Management Pathway and Sepsis-eICU Management of Sepsis Prompt.
Clinical technology takes many forms, but ventricular-assist devices are among the most sophisticated life-support systems utilized within the critical care arena. Litton compares and contrasts various mechanical approaches to pumping support in her article, "Demystifying Ventricular Assist Devices." Carefully selected illustrations used throughout the text will assist readers in understanding the basics of these vital adjuncts to caring for patients with life-threatening heart failure.
Noah's article, "Implementing Electronic Documentation" considers the challenges associated with introducing new technology which either supports or replaces long-established practices used to maintain the patient's medical record. She states that when there is a major strategic objective to introduce electronic documentation, organizations must meet "meaningful use" criteria and secure expert leadership support for the project. Noah contends that communication, accountability and clinical champions are the vital elements for successful implementation of an Electronic Medical Record (EMR).
"Reiki Therapy: A Nursing Intervention for Critical Care" by Toms, explores one of the newer tools among the practices of complementary and alternative medicine (CAM). The author mentions that CAM is not generally associated with the complexity and intensity of critical care. However, research findings suggest that certain therapies such as Reiki, relieve pain and anxiety and reduce symptoms of stress. Tom notes that CAM therapies are cost effective, noninvasive and can easily be incorporated into patient care.
Warren and Ruppert present an engaging paper, "Ischemic Middle Cerebral Artery Stroke: A Case Study." Stroke, the third leading cause of death, ranks lower only to cardiac disease and cancer. Patients with stroke involving large vessels, including the middle cerebral artery (MCA), account for almost half of all patients with ischemic strokes. These victims have a high risk for poor outcomes and mortality. Despite the availability and use of published guidelines for the early management of ischemic stroke, evidence to support treatment modalities for cerebral edema is still lacking. This case presentation includes the pathophysiology of an ischemic stroke and outlines the established management guidelines.
Young, Derr, Cichillo and Bressler have contributed a project report "Compassion Satisfaction, Burnout, and Secondary Traumatic Stress in Heart and Vascular Nurses." Their objectives were to compare the impact of these stressors on intensive care and intermediate care nurses. Results of their study suggest that leadership must possess an increased awareness of the impacts of secondary traumatic stress on nurse performance, and should develop specific strategies to prevent its adverse effects.
Vreeland, Rea and Montgomery present "A Review of the Literature on Heart Failure Discharge Education." The Centers for Medicare and Medicaid Services (CMS) propose decreases in reimbursement for patients diagnosed with heart failure (HF) if they are readmitted to a hospital within 30 days of their discharge. The Joint Commission (TJC) has identified six key education topics for HF patients with their families that can result in decreased readmissions. The authors emphasize that although the patient may be too ill for discharge education, critical care nurses can begin the process immediately with family members or post-hospital caregivers. This article summarizes the evidence for discharge education by answering six questions that address the "who and when" as well as the "what" of discharge education.
Finally, Attin and Davidson illustrate how new diagnostic tools and other technologies can be used to reduce risks for certain cardiac patients. Their article, "Using QRS Morphology and QTC Interval to Prevent Complications and Cardiac Death" explains the value of these selected electrocardiographic predictors in preventing catastrophic events in this vulnerable patient population. They further examine some of the barriers to widespread use of such technological advancements, including limitations in bedside monitoring systems and inadequate staff preparation.
This issue illustrates the versatility of technological approaches to solving major problems in the intensive care environment. Sophisticated documentation, medical devices, specialized therapies and emerging best practices that are research-based contribute to improvements in care processes for the critically ill patient.
-Janet M. Barber, MSN, RN, FAAFS
Editor