Development of a special care unit for chronically critically ill patients

Article Abstract:

Cost containment efforts by the federal government aimed at rapidly rising health care costs have created funding problems for hospitals at a time when many of them are faced with a growing population of ''chronically critically ill'' patients, who require disproportionately expensive services. Intensive care units (ICUs) are among the most costly of hospital services, and a number of factors has increased the demand for this type of care. The AIDS epidemic, an aging population, and technology that can keep desperately ill patients alive indefinitely have all contributed to this situation. Although the absolute number of nurses has increased, demand has increased even faster, creating a shortage in hospitals, and especially in ICUs. A special care unit (SCU) has been designed to meet the demands of the chronically critically ill patient, including family involvement and rehabilitation and a case management practice model. Physically, the SCU would have private rooms which open from a central hallway. They would be large enough to accommodate overnight family stays, and would have a home-like atmosphere and an exterior view. Traditional ICUs are noisy, lack privacy, and are constantly lit. They are not comfortable for patient or family members, and are run on a bureaucratic model. The SCU would maintain a completely different atmosphere, concentrating on patient comfort and rehabilitation, and family involvement. Implementation of the SCU represents a new approach and the staff will have to be taught the purposes and operation of the unit. So far, the SCU has been well received by patients and their families, and the concept has the support of medical personnel. This is one way to deal with the rising cost of critical care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Hospitalization, Critically ill, Critical care medicine

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Acetazolamide in the treatment of metabolic alkalosis in critically ill patients

Article Abstract:

Metabolic alkalosis (MA) is an acid-base imbalance, occurring when the pH of body fluids increases, becoming more basic. It is a common disorder in critically ill patients that can be caused by abnormally low amounts of potassium in the blood (hypokalemia), treatment with corticosteroid drugs, excessive vomiting, or a decrease in the amount of fluid in the body caused by diuretics. Severe MA can lead to lung failure and it increases mortality among critically ill patients. MA also reduces the amount of oxygen that can be carried in the blood to the body tissues. Treatment of MA involves replacing lost body fluids and correcting electrolyte deficits. Solutions of ammonium chloride, hydrochloric acid, or arginine hydrochloride have been used. However, these solutions require administration of large amounts of fluid. Acetazolamide is a drug that promotes the excretion of bicarbonate, a substance that contributes to MA. Therefore, acetazolamide may be an effective treatment. To test this idea, 30 patients with MA who did not respond to other forms of treatment were given acetazolamide. Within two hours of treatment, the amount of bicarbonate in the blood began to decrease. The maximal effect was obtained 16 hours after treatment. Forty-eight hours after treatment the blood levels of bicarbonate remained low. There were no adverse side effects to the treatment. These findings indicate that acetazolamide may be useful for treating patients with MA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Causes of, Drug therapy, Alkalosis, Acid-base imbalances, Acid-base imbalance, Acetazolamide

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When special care is needed: a Special Care Unit for chronically critically ill patients in Cleveland, USA, is proving its worth in terms of both the outcome for patients and the cost savings

Article Abstract:

A Cleveland, OH, hospital created a unit to take care of elderly patients that needed intensive care for a prolonged time. To facilitate operations and keep costs to a minimum, it was designed as a nurse-managed unit that emphasized recovery and emotional support.

Health aspects, Innovations, Services, Hospitals, Cleveland, Ohio, Intensive care nursing

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