Remote telemonitoring is associated with improved patient safety and decreased workload of nurses.

Objective: There is significant interest in exploring new technologies to improve efficiency and work-life quality for nurses. We aimed to evaluate the impact of a remote video monitoring (RVM) solution that provides continuous in-hospital patient audio-video (AV) monitoring by technicians. Methods: The RVM system that we developed, consisting of 2-way AV communication and a continuous O2 saturation monitoring device, has been deployed in all inpatient units within our hospital network, including 3 acute care hospitals and 2 rehabilitation facilities. Data were collected before and after implementation on safety measures including fall rates and adverse events, along with device utilization and number of escalation events requiring nursing intervention. Nurse job satisfaction was assessed with surveys. Results: Data were collected from April 2020 to May 2022. A total of 2087 patients were monitored at 5 hospital sites. The technicians identified 54,716 safety concerns that required them to intervene remotely and address with the patient. Of these, 46,289 required escalation of nursing staff, who were called to the bedside through the RVM alerting technology. Importantly, 8427 safety concerns were managed solely by the technicians without the need for nursing intervention, resulting in 8427 avoided nursing visits to the bedside. The surveyed nurses reported that the RVM technology provided reassurance that additional support was available to assist them in managing their patients. Patients and their families also expressed high degree of satisfaction. Since implementation, the rates of falls and other adverse events have been reduced, with the greatest impact in patients on high-flow oxygen. Code blue and mortality rates decreased from 7% to 1%. Conclusions: The use of RVM has proven to be a successful innovation at our hospital and has led to improved patient safety. RVM was able to reduce 8427 individual nurse visits to the bedside, allowing nurses to manage the care of patients more effectively while improving both patient and staff satisfaction.

Practice Patterns of Nurse Practitioners in a Multi-Site Academic Healthcare Setting.

OBJECTIVE: The objective of this paper is to describe the day-to-day activities, known as practice patterns, of nurse practitioners (NPs) across a four-site academic healthcare network in Ontario, which comprises acute, primary, rehabilitation and complex continuing care. BACKGROUND: Information regarding NP practice patterns is available from other jurisdictions and practice settings, but information specific to large, urban and multi-site organizations is available to a lesser extent. This information can inform and support leaders' decisions about NP roles and responsibilities. METHOD: A cross-sectional online survey was sent to the 125 NPs employed in this healthcare network. RESULTS: Respondents (n = 45) were primarily experienced, graduate-prepared NPs, who work with specialized populations and support the education of healthcare professional trainees. The majority of these NPs' activities focused on direct and indirect care, with fewer activities centred on leadership/administration, education, research and personal breaks. Clinical care activities varied among NPs and were contextual to the population and program. CONCLUSION: While direct and indirect care are vital components of NP practice, the overwhelming emphasis on these components indicates that the organization and the healthcare system are losing opportunities to capitalize on advanced nursing practice knowledge and skills in the domains of leadership, research and education.

Adjuvant lung resection in the management of nontuberculous mycobacterial lung infection: A retrospective matched cohort study.

BACKGROUND AND OBJECTIVES: Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is considered when medical therapy alone fails to provide long term control. Data regarding comparative and long-term outcomes are limited. We aimed to review indications and outcomes of adjuvant lung resection for NTM-PD compared with controls. METHODS: We retrospectively studied 27 surgically treated patients, matched 1:1 for age, sex, NTM species, and radiologic pattern of disease, with control patients treated exclusively with antibiotics. RESULTS: In the surgical group, the median (IQR) age was 55 (49-61) years and 74.1% were female. Eighteen patients had Mycobacterium avium complex, and 9 had M. xenopi. Operations included 8 pneumonectomies, 20 lobectomies, one segmentectomy and one lobectomy plus segmentectomy. Post-surgical complications occurred in 6 patients (20%), including 2 acute respiratory distress syndrome, 1 bronchopleural fistula, 1 pericardial tamponade, and 2 empyema. Complications were more common among patients operated upon for progressive disease despite medical therapy (OR 10, p = 0.025). Of 24 matched pairs followed for ≥1 year, sustained culture conversion was observed in 21 (87.5%) patients in the surgical group and in 11 (45.8%) patients in the non-surgical group (RR 2.36, 95%CI 1.37-4.03, p = 0.002). Median (IQR) percentage of follow-up time on antibiotics was 14% (0-100%) in the surgical group and 83% (10.8%-100%) in the non-surgical group (p = 0.195) during a median (IQR) follow-up of 16 (2-36) months. CONCLUSIONS: NTM-PD patients who underwent adjuvant lung resection experienced significant morbidity and more frequently achieved sputum culture conversion. Long term antibiotic requirements may have been reduced.

Anesthetic Considerations for Pneumonectomy With Left Atrial Resection on Cardiopulmonary Bypass in a Patient With Lung Cancer: A Case Report.

Cases of pneumonectomy plus atrial resection for lung cancer have been reported in the surgical literature, but not the anesthesia literature. To achieve curative resection, cardiopulmonary bypass (CPB) may be necessary. Although CPB may complicate the management of these high-risk patients, these cases should always be undertaken in a center where it is immediately available. Here, we discuss the anesthetic management of a 70-year-old man with left lower lobe lung cancer invading the left inferior pulmonary vein and left atrium.

A prospective study of patient-centred outcomes in the management of malignant pleural effusions.

BACKGROUND: In a patient population with a limited life expectancy, malignant pleural effusion can significantly impact quality of life (QoL). Different treatment options are available, each with its own effect on QoL. To date, satisfaction with treatment options has not been evaluated. PURPOSE: To evaluate QoL and satisfaction with treatment using patient-reported outcomes for four different treatment strategies. DESIGN: A prospective, cohort study that compared four treatment options: indwelling pleural catheter (IPC); video assisted thoracic surgery (VATS) and IPC; chest tube and talc slurry; and VATS talc poudrage. SETTING: A total of 104 participants were treated across four acute care teaching hospitals in a large Canadian city. MEASUREMENTS: Patient-reported outcomes were assessed using functional assessment of chronic illness therapy-palliative (FACIT-PAL), London Chest Activity of Daily Living scale and FACIT-treatment satisfaction questionnaires. RESULTS: No significant difference was identified between the four treatments based on patient-reported outcomes. VATS talc poudrage provided the most durable improvement. At the 6-week post-treatment time point, the highest patient satisfaction was noted in patients who received VATS and talc pleurodesis, lowest satisfaction in patients with chest tube and talc pleurodesis; however, the differences were not statistically significant (p=0.20). VATS and talc pleurodesis had the highest scores at 6 weeks for recommendation of treatment to others; however, the comparison with other treatment groups was not statistically significant (p=0.22). For FACIT-PAL, total scores when analysed as one group, there was a statistically significant increasing trend (indicating improvement) (p<0.0001). Breathlessness, measured using the London Chest Activity of Daily Living scale, indicated a statistically decreasing trend, suggesting an improvement (p=0.0003). There was no statistically significant difference in trends over time between the four treatment groups. CONCLUSIONS: While all treatment options addressed the patients' symptoms and relieved dyspnoea, an IPC offered effective treatment with minimal discomfort and time in hospital yet still high satisfaction.