2.50
Hdl Handle:
http://hdl.handle.net/10755/162566
Type:
Presentation
Title:
Too Cool: Transitioning from ED to ICU Post Cardiac Arrest
Abstract:
Too Cool: Transitioning from ED to ICU Post Cardiac Arrest
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Foskett, Sharon, RN, BA
P.I. Institution Name:University Health Network
Title:Educator
Contact Address:399 Bathurst Street, Emerency Department, Toronto, Ontario, M5T 2S8, Canada
Contact Telephone:416-603-5029
Co-Authors:Sharon McGonigle, RN, MScN
Leadership Conference - Evidence-Based Practice Abstract: Too Cool: Transitioning from ED to ICU Post Cardiac Arrest

Purpose: New treatment paradigms, such as therapeutic hypothermia (TH) post cardiac arrest, offer the promise of improving patient outcomes. Despite the growing body of evidence of TH as an effective neuroprotective treatment option, our major Canadian Academic Health Science Centre did not have a protocol that ensured patientsÆ consistent access to this intervention.

Design: As a result of increasing volumes and changes to Government funding, Emergency Departments (ED) are challenged to improve patient flow and system efficiency by improving transfer of care times and decreasing wait times. Our Health Science Center, as part of a collaborative network of hospitals, was invited to participate in an initiative designed to standardize, monitor, and improve the care of patients resuscitated from out-of-hospital cardiac arrest. Over a one-year period prior to this initiative, out of 29 cardiac arrest patients, only 4 were discharged alive. We needed a strategy to improve outcomes.

Setting: The 37 bed ED is an urban, academic, level II facility. The 21 bed Intensive Care Unit (ICU) manages medical, surgical and neurosurgical populations. Staffing ratios vary depending on shift and patient acuity.

Participants/Subjects: Whilst TH should be considered with all unresponsive adults patients post cardiac arrest, it is not suitable in every situation. Inclusion criteria included: primary cardiac arrest; Advanced Cardiac Life Support started within 15 minutes from collapse; return of spontaneous circulation within 60 minutes of collapse; Glasgow Coma Scale 9 or less; 18 years of age or older. Exclusion criteria were also explored.

Methods: With a goal of seamless integration of care and improved patient flow, a collaboration approach between ED and ICU was developed; a working group formed and a treatment strategy developed. Champions were identified in both areas. Further coordination with the independent TH Group took place to utilized their existing expertise and ensure an evidence based approach to protocol implementation.

Preprinted orders to enhance clinical decision-making at the point of care and influence adoption of TH were implemented. Clinical outcomes data including patient eligibility: protocol implementation; time to reaching target TH; and survival rates are collected generating a Cooling Report by the Independent Initiative Group. System outcome evaluation included clinician satisfaction surveys and .improvements in patient flow.

Results/Outcomes: TH protocol has contributed to change in four main areas:
i. Coordinating care û improved patient flow between departments by addressing continuity of care and improving cost efficiency.
ii. Integrated treatment protocols and pre-printed orders enhanced clinical decision making and improved consistency in adoption of TH post cardiac arrest.
iii. Realization of patient centered care by improving accessibility to standardized treatment regimes.
iv. Clinicians reported high satisfaction, including feeling greater confidence in point of care decision making, greater understanding of processes and improved communication. .

Implications: The success of this project highlights the limitations of current system fragmentation and the organizational benefits when strategies are integrated, coordinated and streamlined.

This presentation highlights development and implementation of a TH protocol from ED triage to ICU. Lessons learned and successful strategies for improved utilization of TH will be shared.

Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleToo Cool: Transitioning from ED to ICU Post Cardiac Arresten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162566-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Too Cool: Transitioning from ED to ICU Post Cardiac Arrest</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Foskett, Sharon, RN, BA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University Health Network</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">399 Bathurst Street, Emerency Department, Toronto, Ontario, M5T 2S8, Canada</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">416-603-5029</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">sharon.foskett@uhn.on.ca</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Sharon McGonigle, RN, MScN</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Evidence-Based Practice Abstract: Too Cool: Transitioning from ED to ICU Post Cardiac Arrest<br/><br/>Purpose: New treatment paradigms, such as therapeutic hypothermia (TH) post cardiac arrest, offer the promise of improving patient outcomes. Despite the growing body of evidence of TH as an effective neuroprotective treatment option, our major Canadian Academic Health Science Centre did not have a protocol that ensured patients&AElig; consistent access to this intervention.<br/><br/>Design: As a result of increasing volumes and changes to Government funding, Emergency Departments (ED) are challenged to improve patient flow and system efficiency by improving transfer of care times and decreasing wait times. Our Health Science Center, as part of a collaborative network of hospitals, was invited to participate in an initiative designed to standardize, monitor, and improve the care of patients resuscitated from out-of-hospital cardiac arrest. Over a one-year period prior to this initiative, out of 29 cardiac arrest patients, only 4 were discharged alive. We needed a strategy to improve outcomes. <br/><br/>Setting: The 37 bed ED is an urban, academic, level II facility. The 21 bed Intensive Care Unit (ICU) manages medical, surgical and neurosurgical populations. Staffing ratios vary depending on shift and patient acuity.<br/><br/>Participants/Subjects: Whilst TH should be considered with all unresponsive adults patients post cardiac arrest, it is not suitable in every situation. Inclusion criteria included: primary cardiac arrest; Advanced Cardiac Life Support started within 15 minutes from collapse; return of spontaneous circulation within 60 minutes of collapse; Glasgow Coma Scale 9 or less; 18 years of age or older. Exclusion criteria were also explored.<br/><br/>Methods: With a goal of seamless integration of care and improved patient flow, a collaboration approach between ED and ICU was developed; a working group formed and a treatment strategy developed. Champions were identified in both areas. Further coordination with the independent TH Group took place to utilized their existing expertise and ensure an evidence based approach to protocol implementation.<br/><br/>Preprinted orders to enhance clinical decision-making at the point of care and influence adoption of TH were implemented. Clinical outcomes data including patient eligibility: protocol implementation; time to reaching target TH; and survival rates are collected generating a Cooling Report by the Independent Initiative Group. System outcome evaluation included clinician satisfaction surveys and .improvements in patient flow. <br/><br/>Results/Outcomes: TH protocol has contributed to change in four main areas: <br/>i. Coordinating care &ucirc; improved patient flow between departments by addressing continuity of care and improving cost efficiency.<br/>ii. Integrated treatment protocols and pre-printed orders enhanced clinical decision making and improved consistency in adoption of TH post cardiac arrest.<br/>iii. Realization of patient centered care by improving accessibility to standardized treatment regimes. <br/>iv. Clinicians reported high satisfaction, including feeling greater confidence in point of care decision making, greater understanding of processes and improved communication. . <br/><br/>Implications: The success of this project highlights the limitations of current system fragmentation and the organizational benefits when strategies are integrated, coordinated and streamlined.<br/><br/>This presentation highlights development and implementation of a TH protocol from ED triage to ICU. Lessons learned and successful strategies for improved utilization of TH will be shared. <br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:21Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:21Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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