ABSTRACT
Hospital cost containment and nursing shortages have diminished resources available in surgical intensive care units (SICU). To provide a more quantitative approach to management of these resources, the nursing intervention scoring system (NISS) devised by Greenburg et al was instituted in the SICU at the VA Medical Center, Gainesville, Fla. The NISS scores for patients in the SICU were calculated without computer support. During a four-month study period, 725 NISS evaluations on 70 patients were collected. Characteristic curves of NISS scores versus postoperative days were generated from the data and were predictive of workloads in the unit. In addition, NISS patient scores provided a basis for day-to-day bed control and provided an effective tool for management of nursing service staffing. The hospital administrators responded positively to quantitative documentation of SICU resource requirements by providing additional personnel, equipment, and intermediate care facilities. We have concluded that the NISS is an effective means of providing optimal day-to-day use of SICU beds. In addition, the NISS also provides the data needed to quantitate unit needs for nursing service and administration.
Subject(s)
Intensive Care Units , Nursing Care/standards , Nursing Staff, Hospital/standards , Aorta, Abdominal/surgery , Aortic Aneurysm/surgery , Coronary Artery Bypass/nursing , Cost-Benefit Analysis , Craniotomy/nursing , Evaluation Studies as Topic , Florida , Hemodynamics , Hospital Bed Capacity, 300 to 499 , Humans , Neck Dissection/nursing , Postoperative Care/standards , WorkforceABSTRACT
We obtained angiograms on 61 consecutive patients being evaluated for elective aneurysmorrhaphy at the Gainesville VA Medical Center, Gainesville, Florida. Renal artery stenosis was documented in 33% of cases, aberrant or multiple renal arteries in 26%, and other aneurysmal disease, most commonly in the iliac system, was present in 51%. Occlusive disease was common (30%). In 72% of patients, the preoperative angiogram affected the operative plan. Only one complication was recorded, a retroperitoneal hematoma from catheter perforation. The results correlate well with previously published reports. We conclude that a significant majority of patients having abdominal aortic aneurysm have angiographic abnormalities. In a majority of these patients, the angiogram altered operative therapy.
