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Biomedical subjects

Suzanne M Burns

Publications and source records attributed to Suzanne M Burns.

16 recordsLinked to original sources
PubMed2006

Detection of inadvertent airway intubation during gastric tube insertion: Capnography versus a colorimetric carbon dioxide detector.

BACKGROUND: In the medical intensive care unit at the University of Virginia Health System, capnography is used to detect end-tidal carbon dioxide to protect patients from inadvertent airway cannulation during placement of gastric tubes. OBJECTIVES: To compare the method in which capnography is used with a method in which a colorimetric carbon dioxide detector is used and to determine what variables affect accurate placement of gastric tubes. METHODS: A prospective convenience sample of 195 gastric tube insertions was studied in 130 adult patients in a medical intensive care unit. Standard insertions of gastric tubes (done with capnography) were simultaneously monitored by using a disposable colorimetric device, with a color change indicating the presence of carbon dioxide. RESULTS: Insertion variables included tube type (60% Salem sump tubes, 40% soft-bore feeding tubes), route of insertion (71% oral, 29% nasal), mechanical ventilation (81%), and decreased mental status (72%). Carbon dioxide was successfully detected with the colorimetric indicator (within seconds) in all insertions in which carbon dioxide was detected by capnography. When carbon dioxide was detected (27% of insertions), the tubes were withdrawn and reinserted. Carbon dioxide detection during tube placement was significantly associated with nasal insertions (P = .03) and spontaneously breathing/nonintubated status (P = .01) but not with mental status or tube type. CONCLUSIONS: A colorimetric device is as accurate as capnography for detecting carbon dioxide during placement of gastric tubes.

Adult↗
PubMed2005

A process improvement project: achieving quality outcomes.

The University of Virginia Health System designed a systematic approach to the care of the long-term, mechanically ventilated, adult patient population to improve patient outcomes and use institutional resources more efficiently. The authors discuss their process improvement strategies, barriers to implementation, and project outcomes.

Adult↗
PubMed2005

Development of the American association of critical-care nurses' sedation assessment scale for critically ill patients.

Clinicians commonly sedate critically ill patients. Sedatives should be administered to achieve predetermined end points. Most currently available scales used to assess sedation are inadequate because they focus on a single domain, such as consciousness. The development of the American Association of Critical-Care Nurses' Sedation Assessment Scale is described. This new scale consists of 5 domains: consciousness, agitation, anxiety, sleep, and patient-ventilator synchrony. A major advantage of the scale is that its domains parallel common goals of sedation therapy for critically ill patients. The proposed measurements for each domain are based on a comprehensive evaluation of the science and expert recommendations. Before the scale is widely used, clinical testing is required to determine its validity and reliability in a variety of critically ill patients and care situations.

Anxiety↗
PubMed2004

The science of weaning: when and how?

Weaning patients from long-term mechanical ventilation continues to be a goal of clinicians and scientists and the hospitals charged with their care. This article describes the science of the "wean" and the "how" of weaning. A goal of scientists has been to develop predictors that determine accurately the optimal time to initiate weaning. Unfortunately to date none has emerged as superior. Quite simply, predictors do not predict. In contrast, methods that decrease variation in care practices have demonstrated positive outcomes. The methods include protocols for weaning trials and sedation and other system initiatives inclusive of a multidisciplinary plan of care or clinical pathway.

Clinical Protocols↗
PubMed2004

The experience of four outcomes managers: an institutional approach to weaning patients from long-term mechanical ventilation.

Care of patients requiring long-term mechanical ventilation (LTMV) is the focus of many hospitals nationwide. Because the care of patients who require LTMV is complex and morbidity and mortality are high, associated costs often exceed reimbursement. This article describes a successful institutional program for the care of the patient population requiring LTMV using advanced practice nurses (APNs) in the role of outcomes managers (OMs). So that others may benefit from the experiences of the clinicians, this article describes the historical background, the selection and qualifications of APNs, the process APNs use to manage and monitor the patients, role challenges, and associated outcomes.

Case Management↗
PubMed2003

Working with respiratory waveforms: how to use bedside graphics.

Respiratory waveform graphics packages are available on many ventilators. Despite the prevalence of the waveforms, accurate interpretation and clinical application are not widespread. In fact, many clinicians find the waveforms confusing and choose to ignore them. This article provides a straightforward description of how to interpret the waveforms and suggests ways that the information might be used to improve clinical outcomes.

Critical Care↗
PubMed2003

Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: one-year outcomes and lessons learned.

OBJECTIVE: To determine the effect of an institutional approach to the care of patients requiring mechanical ventilation for longer than three consecutive days in five adult intensive care units (ICU) on clinical and financial outcomes. DESIGN: A multidisciplinary team was selected from five adult ICUs to design the approach. Planning occurred from August 1999 to September 2000. The process was called outcomes management (OM) and included an evidence-based clinical pathway, protocols for weaning and sedation use, and the selection of four advanced practice nurses (called outcomes managers) to manage and monitor the program. SETTING: The project was completed in a 550-bed mid-Atlantic academic medical center. The ICUs included the following: coronary care, medical ICU, neuroscience ICU, surgical trauma ICU, and thoracic cardiovascular ICU. PATIENTS: The sample included 595 pre-OM patients and 510 post-OM patients mechanically ventilated for greater than three consecutive days. INTERVENTIONS: Full implementation of the OM approach occurred in March 2001. Retrospective baseline (18 months pre-OM) and prospective (12 months OM) clinical and financial data were compared. MEASUREMENTS AND MAIN RESULTS: Statistically significant differences in clinical outcomes were demonstrated in the managed patients compared with those managed before the institutional approach. Outcomes include ventilator duration (median days declined from ten to nine; p =.0001), ICU length of stay (median days declined from 15 to 12; p =.0008), hospital length of stay (median days declined from 22 to 20; p =.0001), and mortality rate (declined from 38% to 31%, p =.02). More than 3,000,000 US dollars cost savings were realized in the OM group. CONCLUSIONS: This institutional approach to the care of patients ventilated >3 days improved all clinical and financial outcomes of interest. To date, few similar initiatives have demonstrated similar results. The approach and lessons learned in this process improvement project may be helpful to other institutions attempting to improve outcomes in this vulnerable population.

Academic Medical Centers↗
PubMed2002

Improving outcomes for mechanically ventilated medical intensive care unit patients using advanced practice nurses: a 6-year experience.

The value of an APN in a role such as for the management of patients requiring LTMV is easily recognized. There are few healthcare providers who are as uniquely qualified to ensure the successful resolution of the many complex clinical and system issues that affect these patients' outcomes. Similar models of care using APNs in similar roles have been used successfully in other populations of patients at our institution. We hope that other hospitals will implement models using the APN to manage and monitor complex patient populations and continue to report the results so that the true value of the APN is recognized.

Critical Pathways↗
PubMed2002

Clinical research is part of what we do: the experience of one medical intensive care unit.

Clinical research remains a desired goal of the profession. Unfortunately, the methods we have traditionally used to spark the interest and commitment of clinicians have not been universally accepted or successful in attaining our goal. Although nothing is inherently wrong with journal club meetings, research forums, and partnering with academicians, these methods of inspiring research rarely do so. Partially, that failure is because a leader, perhaps a cheerleader, is needed, someone who is willing to teach, support, coach, and call to task the clinicians who wish to "do" clinical research. As noted by Hanneman, the presence of a unit-based expert is necessary for the "catalytic conversion" of others: "Expert nurses methodically build non-expert nurse expertise through flexible, context dependent strategies." The mentor must understand the abilities, the background, and the time commitments of the clinicians so that the support is appropriate for the task. For example, an academician friend who wished to do some research "partnering" with some clinicians in a practice area of interest thought that the main role of the clinicians would be as data collectors. In this collision of philosophies and understanding, the clinicians, who wanted the academician to "show them" how to do the research and teach them at each step, were angered by the academician's perspective of their potential to contribute to the research process. The project was not successful because neither the clinicians nor the academician understood the perspective or expectations of the other. For clinical research to thrive and prosper, indeed to become part of what we do in practice, we must learn from the clinicians who can tell us what works and what does not. The comments of the clinicians recorded in Table 1 are filled with advice, should we choose to listen. Clinical research is part of what our MICU does. The clinicians are proud of their accomplishments, and some are now mentoring others in the process. The success of the program can easily be duplicated in other settings. I hope that we begin to acknowledge the power of teaching research as part of clinical practice and start to reward and acknowledge our clinicians for their involvement.

Clinical Nursing Research↗
PubMed2002

Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners.

OBJECTIVE: To improve clinical and financial outcomes for neuroscience patients by using an "outcomes-managed" model of care delivery and 2 acute care nurse practitioners as outcomes managers. METHODS: Baseline data from the year before implementation of the care model were compared with data from the first 6 months of implementation. A random list of 122 adult patients admitted to the neuroscience intensive care unit or the acute care neurosurgery unit of a university teaching hospital between January and December 1998 was generated to provide the baseline data. The prospective sample included 402 patients admitted to either unit during the first 6 months of the project (January through June 1999). The acute care nurse practitioners used an evidence-based multidisciplinary plan of care to manage all patients. RESULTS: No differences were found in age, sex, or ethnicity between groups. Patients managed by acute care nurse practitioners had significantly shorter overall length of stay (P = .03), shorter mean length of stay in the intensive care unit (P < .001), lower rates of urinary tract infection and skin breakdown (P < .05), and shorter time to discontinuation of the Foley catheter and mobilization (P <.05). The outcomes-managed group was hospitalized 2306 fewer days than the baseline group, at a total cost savings of $2,467328. CONCLUSIONS: Clinical and financial outcomes are improved significantly by identifying patients at risk, monitoring for complications, and having acute care nurse practitioners manage the patients.

Adolescent↗
PubMedDate not supplied

Ventilating patients with acute severe asthma: what do we really know?

The goal of mechanical ventilation for patients with acute severe asthma is to ensure adequate oxygenation, ventilation, and gas exchange while simultaneously preventing hyperinflation, auto-positive end expiratory pressure, and subsequent barotrauma. Though existing evidence on the topic is relatively scarce, the application of current knowledge may guide our practice and prevent iatrogenic complications. To that end, this article describes selected ventilatory management strategies for the patient with acute severe asthma, such as the limitation of tidal volume size and respiratory rate, selection of specific inspiratory and expiratory ratios, the use of positive end expiratory pressure, and the application of helium-oxygen mixtures.

Acute Disease↗