1. Dougherty, Catherine M. MA, RN, Issue Editor

Article Content

This special issue of Critical Care Nursing Quarterly features technological applications and architectural innovations that improve efficiency, clinical outcomes, and patient safety. The articles reveal a remarkable range of novel strategies for solving long-standing problems within the complex hospital environment. In response to the industry-wide emphasis on patient safety, there is an accelerated interest in the acquisition and utilization of automated clinical surveillance tools to track physiological data, predict events, and support sophisticated therapeutic equipment. Hospital administrators have also realized that nursing unit and room design are vital factors in workflow efficiency and care process improvement, and can greatly influence both patient and staff satisfaction.


Ann O'Neill and Donna Miranda's article, "The Right Tools Can Help Critical Care Nurses Save More Lives," provides an excellent overview of real-time automated surveillance and how such data can be used to streamline and improve care processes. The authors note that when critical care nursing resources are in short supply there is tremendous value in a system that can communicate and analyze clinical data in real time, permitting nurses to promptly intervene using evidence-based strategies. Dashboards of key information displayed in a variety of locations throughout the hospital, and even remotely, can be used to alert both caregivers and administrators to obstructions in workflow or impending clinical problems. These types of technological innovations also facilitate benchmarking initiatives and ensure that hospitals have the vital information to determine compliance with protocols and processes.


Mahbub Rashid's article, "A Decade of Adult Intensive Care Unit Design: A Study of the Physical Design Features of the Best-Practice Examples," is an engaging study of the transitions in intensive car unit (ICU) design in recent years. Characteristics of award-winning ICU designs are critiqued in terms of both assets and limitations. Dr Rashid considers crucial design-related issues such as privacy, patient safety, family presence, aesthetics, lighting, and staff hand-washing. This author admits that even with dramatic upgrades in ICU design, there are several pitfalls that must be avoided to achieve optimum outcomes for patients, staff, and visitors.


Technological advances extend beyond computers, software, and dashboards into imaging and instrumentation. Acute DVT has been one of the dread complications associated with surgery, critical illness, or prolonged hospitalization. Gail Marchigiano, Debra Riendeau, and Carol Jo Morse's article, "New Technology Applications: Thrombolysis of Acute Deep Vein Thombosis," showcases a new technology using high-frequency, low-power ultrasound to facilitate a mechanical thrombectomy. The technique permits a catheter-directed delivery of the thrombolytic drug, specifically targeting the clot.


Kathy Brown and Dennis Gallant build on Dr Rashid's article by presenting how room designs can effect care quality enhancements. Their article, "Impacting Patient Outcomes Through Design: Acuity Adaptable Care and Universal Room Design," explains how several facilities have realized improved efficiency and patient outcomes by taking advantage of enhancements inherent in innovative design initiatives.


Emily Hamilton and Elizabeth Wright's work, "Labor Pains: Unraveling the Complexity of OB Decision Making," introduces nurses to a technology that can improve human performance in the obstetrical suite by providing advance warning when high-risk states are developing. Case studies highlighting the value of predictive technology illustrate how staff can use consolidated computerized assessments to recognize clinical problems earlier, permitting time for mitigating efforts. Extending similar strategies into the ICU could greatly enhance evidence-based problem solving.


Marie Egan's article, "Clinical Dashboards: Impact on Workflow, Care Quality and Patient Safety," discusses how one hospital utilizes dashboard displays of key information to track workflow as well as care processes. The author demonstrates how dashboards can support benchmarking and ensure that hospitals have the vital information to determine compliance with protocols and processes as part of care improvement initiatives.


Myra Popernack's article, "A Critical Change in a Day in the Life of Intensive Care Nurses: Rising to the e-Challenge of an Integrated Clinical Information System," recounts the challenges inherent in changing processes in the ICU. She discusses one hospital's experiences in making the transition to a computerized provider order-entry (CPOE) system and how it has changed the lives of critical care nurses. The author shares data about the perceptions of the experience 1 year after initiation of CPOE. This hospital's medication administration processes are now virtually seamless, medication delivery time has been improved, and medication errors have been reduced with pharmacy verification prior to administration. These benefits, Popernack believes, are well worth the challenges involved in the introduction of new technology.


Technology and design innovations are ever streaming into the ICU environment. What appears in this issue of Critical Care Nursing Quarterly is only the "tip of the iceberg." However, they are examples of some of the industry's finest efforts to improve the ICU environment by making it more efficient, comfortable, and safe, all factors contributing to improved practice and healthier financial outcomes.


Catherine M. Dougherty, MA, RN


Issue Editor


Baylor Health Care System, Dallas, Tex