Volume 19 Supplement 2

Eighth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Appraisal of the daily clinical rounds performed in an open and general ICU

  • Roberto R Filho1,
  • Ana Maria Cavalheiro1,
  • Denise C Cazati1,
  • Frederico Lomar1,
  • Gustavo FJ de Matos1,
  • Murillo SC de Assunção1,
  • Roberto R Filho1,
  • Tatiana Mohovic1 and
  • Thiago D Correa1
Critical Care201519(Suppl 2):P16

https://doi.org/10.1186/cc14670

Published: 28 September 2015

Introduction

Daily multidisciplinary clinical rounds involving physicians, nurses, respiratory therapists, nutritionists and clinical pharmacists improve the quality and outcomes of ICUs [1]. However, data regarding performance of these clinical rounds in an open-ICU model are limited.

Objective

To address the characteristics and the main interventions proposed and made during multiprofessional clinical rounds performed in a clinical-surgical open ICU.

Methods

This observational study was conducted in a 41-bed open clinical-surgical ICU of a tertiary-care, private hospital in São Paulo, Brazil. From February 20 through March 28 2013, demographic data, SAPS 3, the participants of the ICU clinical rounds, the number and type of the proposed interventions, and the number of performed interventions by the multidisciplinary team were recorded and analyzed.

Results

A total of 158 clinical rounds were included in this analysis. Fifty-four percent (85/158) of the patients were male with median (IQR) age of 73 (60-84) years and SAPS 3 score of 52 (44-65). The multidisciplinary team was composed of a senior physician (157/158 (99%)), nurses (157/158 (99%)), an on-call staff physician (150/158 (95%)), respiratory therapists (149/158 (94%)), a clinical pharmacist (89/158 (56%)) and nutritionists (62/158 (39.2%)). The median (IQR) number of interventions proposed during the multidisciplinary rounds was 1 (0-2) and the number of performed interventions was 1 (0-2) (Table 1). Interventions were more frequently proposed by senior physicians (82/158 (52%)) followed by respiratory physiotherapists (43/158 (27%)) and a clinical pharmacist (29/158 (18%)).

Conclusion

In our open ICU model where decisions should be shared with assistant doctors, the implementation of daily clinical rounds was associated with an intense participation of the multidisciplinary team and with a high level of performance of the proposed interventions. These actions are probably associated with better care of the critically ill patients. However, further studies are needed to correlate such interventions with clinical outcomes.
Table 1

Main interventions proposed and performed during the multiprofessional rounds.

Main intervention

Proposed

Performed

Changes in nutritional support

39/158 (24.7%)

39/39 (100.0%)

Early mobilization

37/158 (23.4%)

35/37 (94.6%)

Adjustments on sedation or analgesia

51/158 (32.3%)

49/51 (96.1%)

Adjustments on

26/158 (15.8%)

26/26 (100.0%)

Withdrawal of invasive devices

23/158 (14.6%)

19/23 (82.6%)

Adjustments of ventilatory parameters

23/158 (14.6%)

23/23 (100.0%)

Adjustments on glycemic control

25/158 (14.6%)

25/25 (100.0%)

Deep vein thrombosis prophylaxis

13/158 (8.2%)

12/13 (92.3%)

Stress ulcer prophylaxis

6/158 (3.8%)

5/6 (83.3%)

Values represent n (%).

Authors’ Affiliations

(1)
Department of Intensive Care Medicine, Hospital Israelita Albert Einstein

References

  1. Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM: The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010, 170 (4): 369-376.PubMed CentralView ArticlePubMedGoogle Scholar
  2. Weiss CH, Moazed F, McEvoy CA, Singer BD, Szleifer I, Amaral LA, et al: Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. Am J Respir Crit Care Med. 2011, 184 (6): 680-686. 10.1164/rccm.201101-0037OC.PubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Filho et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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