ABSTRACT
BACKGROUND: The pediatric intensive care unit (PICU) is an environment where seriously ill children receive complex care, delivered mostly by specialty-trained nurses (registered nurses [RNs]) who must perform multiple high-level tasks. With stressors on healthcare systems at an all-time high, design that optimizes RN workflow has taken on a renewed imperative. OBJECTIVES: To employ a multimodal approach (1) to identify environmental factors in the PICU patient room that contribute to caregiver workflow inefficiencies, (2) to optimize safety by identifying high-touch surfaces that cause hospital-acquired infections, (3) to develop human-centered design recommendations. METHODS: This mixed-method case study was conducted in a 23-bed urban hospital PICU. The activities, movements, and workflows of 13 RNs were recorded using spatial movement mapping, behavioral mapping, and clinical activity mapping. Frequency of RN contact with surfaces was documented to assess relative infection transmission risk. Face-to-face interviews were conducted with RNs to elicit their views on care delivery and their physical work environment. RESULTS: Direct patient care occupied 50% of RNs' time. Of the direct patient care workflow activities recorded, 26% were to prepare for care around the bedside, while 27% were for random travel between clean and soiled areas. The surfaces most frequently touched were (1) patient bedrails, (2) intravenous pumps and poles, (3) tubing and medical equipment, and (4) vital sign monitors. CONCLUSION: Value-added tasks account for only about 20% of nurses' work. Combining technology and strategic interior design to streamline workflow and enhance infection prevention optimizes efficiency and empowers frontline providers to maximize their time at the bedside performing value-added tasks.
Subject(s)
Intensive Care Units, Pediatric , Patients' Rooms , Attitude of Health Personnel , Child , Humans , Workflow , WorkplaceABSTRACT
The impact of gestational age on perioperative morbidity was examined using a novel construct, the resource utilization index (RUI). The medical records of subjects from birth to 1 year of age entered into a pediatric cardiothoracic surgery database from a major academic medical center between 2007 and 2011 were reviewed. The hypothesis tested was that infants born at 37-38 weeks (early-term infants) experience greater resource utilization after open heart surgery than those born at 39 completed weeks and that this association can be observed until 1 year of age. The results support the premise that resource utilization increases linearly with declining gestational age among infants at 0-12 months who undergo cardiac surgery. Five of the six variables comprising the RUI showed statistically significant linear associations with gestational age in the predicted direction. Multivariate linear regression analysis showed that gestational age was a significant predictor of an increased RUI composite. Further investigation is needed to test the concept and to expand on these findings.
Subject(s)
Cardiac Surgical Procedures/methods , Gestational Age , Health Resources/statistics & numerical data , Heart Defects, Congenital/mortality , Heart Defects, Congenital/surgery , Infant, Premature , Age Factors , Analysis of Variance , Cardiac Surgical Procedures/adverse effects , Child, Preschool , Databases, Factual , Female , Follow-Up Studies , Health Resources/economics , Heart Defects, Congenital/diagnosis , Humans , Infant , Infant, Newborn , Linear Models , Male , Monitoring, Physiologic/economics , Monitoring, Physiologic/methods , Multivariate Analysis , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Postoperative Complications/therapy , Pregnancy , Retrospective Studies , Risk Assessment , Survival Analysis , Time FactorsABSTRACT
Alveolar capillary dysplasia with misalignment of the pulmonary veins (ACD/MPV) is a rare, fatal developmental lung disorder of neonates and infants. This review aims to address recent findings in the etiology and genetics of ACD/MPV and to raise awareness of this poorly known disease, which may also present as milder, unclassified forms. Successively discussed are what is known about the epidemiology, pathogenesis, pathophysiology, diagnostic indicators and approaches, genetic testing, treatment, and cases of delayed onset. The review concludes with suggestions for future directions to answer the many unknowns about this disorder.
Subject(s)
Persistent Fetal Circulation Syndrome/genetics , Persistent Fetal Circulation Syndrome/therapy , Animals , Humans , Infant , Infant, Newborn , Mice , Persistent Fetal Circulation Syndrome/physiopathology , Pulmonary Alveoli/abnormalities , Pulmonary Alveoli/physiopathologySubject(s)
Brain Injuries , Craniocerebral Trauma/etiology , Practice Guidelines as Topic , Primary Health Care/methods , Adolescent , Adult , Brain Injuries/diagnosis , Brain Injuries/physiopathology , Brain Injuries/therapy , Child , Child, Preschool , Craniocerebral Trauma/classification , Female , Glasgow Coma Scale , Humans , Infant , Infant, Newborn , Male , Primary Health Care/trends , PrognosisABSTRACT
The treatment of complex parapneumonic effusions in children remains controversial, with some advocating less invasive, strictly medical management and others supporting a more aggressive approach of thoracotomy with or without decortication. Recent advances, including video-assisted thoracoscopic surgery and intrapleural fibrinolytic therapy, offer new options for effective treatment. We report the first case of successful resolution of a complex parapneumonic effusion in a 16-month-old girl with the use of tissue plasminogen activator (alteplase), infused via a catheter in the pleural space.
