Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries. A randomised controlled trial.

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.

Virtual visiting in the intensive care unit: implementation, utilisation and provider acceptance in an Australian metropolitan health service.

We describe the design and implementation of an intensive care unit (ICU) virtual visiting program in a metropolitan ICU in Melbourne, Victoria, Australia, to examine patterns of use, and describe clinician acceptance of this technology. This was a mixed-methods study, comprising a retrospective analysis of virtual visits from 18 August to 30 September 2020. Patterns of utilisation included duration and time of visits, as well as bandwidth used. A post-implementation survey on a Virtual Visiting program based on the technology acceptance model was sent to clinicians; results were reported on separate scales for usefulness and usability. Publicly available telecommunication solutions were unsuitable for virtual visiting, whereas dedicated telehealth solutions needed modification to improve accessibility by patients and families. During the study period, 69 virtual visits were made with a median length of 10 min (range 1-80 min). A total of 72.5% of calls were made during office hours (09:00-17:00 h), with the latest occurring at approximately 21:30 h. Virtual visits required a mean bandwidth of 1224 kbps (download) and 940 kbps (upload), and consumed 0.7 GB (range 0.0-7.0 GB) and 0.5 GB (range 0.0-6.7 GB) of download and upload data. Clinicians reported a mean score of 2 (range 1-4) for perceived usefulness and 3 (range 1-6) for the perceived ease of use. Virtual visiting is a feasible alternative in the ICU, with good acceptance by clinicians. Challenges include safety and usability of videoconferencing platforms, as well as bandwidth requirements. Future health service design should consider support for dedicated virtual visiting solutions, as well as ensuring adequate bandwidth capabilities for this service. Further studies are needed to assess patient and family acceptability of this technology.

Impact of lockdowns on critical care service demand in a metropolitan hospital in Melbourne, Australia.

OBJECTIVE: There is a growing recognition of the impact of lockdowns on non-COVID-19 demand for critical care services. While a reduction in demand has been postulated, there remains a paucity of quantitative data on the extent and nature of this reduction. The present study aims to quantify the impact of lockdown on critical care services, namely ED, intensive care unit (ICU), medical emergency team (MET) and emergency theatre (ET) demand, during the lockdown in Victoria, Australia. METHODS: This is a single-centred, retrospective observational study on critical service demand, comparing activity levels during the lockdown (31 March to 27 October 2020) with the matched time period from 1 year prior. RESULTS: There was a reduction in presentations to ED (27.2%), MET calls (27.4%), ICU patient episodes (14.5%) and ET bookings (5.8%). There was an unexpected increase in ICU admissions for metabolic diagnoses, comprising drug overdoses and diabetic ketoacidosis, and a reduction in respiratory ICU admissions. There was a reduction across all ED triage categories, which included triage 1 and 2 patients, indicating a reduction even in life-threatening and emergency presentations. CONCLUSION: Lockdowns lead to a significant reduction in ICU, MET call and ED demand, and to a lesser extent ET demand. This pattern should be considered in surge capacity and workforce redeployment planning. There are also impacts on public health epidemiology, with potential adverse consequences on mental health and chronic disease management. Further research on the impact of lockdowns on long-term disease outcomes is needed.