It really starts with you. As taboo as the topic may be, its a must for every individual to think about this and most importantly discuss it with the ones you love most. This is the most effective way to ensure that your wishes are truly upheld.
Here’s a great tool available online – The One Slide Project
Here is a link to the US Living Will Registry where you can find out more specific information. The link takes you directly to the state specific forms.
Several measures of ICU performance have been proposed in the past 30 years. It is intuitive, and correct, to assume that ICU mortality may be a useful marker of quality. However, crude mortality rates does not take into consideration the singular aspects of each specific patient population that is treated in a certain geographic region, hospital or ICU. Therefore approaches looking for standardized mortality ratios that are adjusted for disease severity, comorbidities and other clinical aspects are often sought. Severity of illness is usually evaluated by scoring systems that integrates clinical, physiologic and demographic variables. Scoring systems are interesting tools to describe ICU populations and explain their different outcomes. The most frequently used are the APACHE II, SAPS II and MPM. However, newer scores as APACHE IV and SAPS III have been recently introduced in clinical practice. More than only using scoring systems, one should search for a high rate of adherence to clinically effective interventions. Adherence to interventions as deep venous thrombosis prophylaxis, reduction of ICU-acquired infections, adequate sedation regimens and decreasing and reporting serious adverse events are essential and have been accepted as benchmarking of quality.
The complex task of collecting and analyzing data on performance measures are made easier when clinical information systems are available. Although several clinical information systems focus on important aspects as computerized physician order entry systems and individual patient tracking information, few have attempted to gather clinical information generating full reports that provide a panorama of the ICU performance and detailed data on several domains as mortality, length of stay, severity of illness, clinical scores, nosocomial infections, adverse events and adherence to good clinical practice. Through implementing quality initiatives, increasing the quality of care and patient safety are major and feasible goals. Such systems are available for clinical use and may facilitate the process of care on a daily basis and provide data for an in-depth analysis of ICU performance.
List of Useful Resources:
American Society of Anesthesiology:
Ohio Board of Nursing
ACG (American College of Gastroenterology) Practice Guidelines
ASGE (American Society for Gastrointestinal Endoscopy) Practice Guidelines
Her is a presentation that goes over what my vision is for the “FUTURE ICU.” I originally presented this about a year ago during my fellowship. Enjoy!
There are several societies, publications, interest groups dedicated to patients suffering from ESLD in need of liver transplantation. One of the most respected of those is the Americal Association for the Study of Liver Disorders. They publish Hepatology and Liver Transplantation and have an excellent website for review of recent updates on these topics. In june 2005 they published a thorough set of guidelines entitled “Evaluation of a Patient for Liver Transplantation.” This is an excellent resource and reviews the most recent recommendations regarding the pre-operative workup of patients undergoing a Liver transplant and any provides evidence based medicine guidelines for clearance of surgery. To the best of my knowledge these are the most recent guidelines published in the literature as of today.
Upon searching the web, I found another excellent resource of narrated powerpoint lectures co-sponsored by AASLD, International Liver Transplantation Society (ILTS) and The Americal Society of Transplantation(ATS). You can watch the presentations here.
Up next, stay tuned for the EXPANDED CRITERIA discussion….
