In the Spotlight
Critical Care
Maurita Kiesman, Critical Care Clinical Nurse Educator at Health Sciences Centre
We asked Maurita Kiesman to provide some suggestions and ideas to inspire nurses who work in critical care about how they can help facilitate improved patient flow. Here are her thoughts:
Push end of flow
The nature of ICU work can require quick accommodation - the push end of the flow, if you will. I work at Health Sciences Centre (HSC), which is the specialized tertiary centre for trauma and neuro so if there's an accident on the highway, often the patients come to HSC and we have to accommodate patients who require that level of critical care.
Critically ill patients push patient flow. When someone survives a critical illness, they are transferred to a medicine or surgery ward, which is also full of patients. Getting patients to the ward is difficult, and often times what happens is a last minute push to the ward when a new critically ill patient arrives.
Nurses and flow
The people who manage the beds meet daily. The charge nurses in the ICUs know how many beds they have, how many patients are waiting for transfer and typically have an idea of who might be coming in each shift. Constant communication between the staff who admits patients and charge nurses is what keeps things running, shift to shift.
Nurses are very well positioned to assist with patient flow - they're the ones who know all the details of the patient's progress day in day out. Nurses know a lot of detail about each individual patient that may assist in where they may be served best.
Conversations around advance care planning
Nurses have a leadership role to play in communication with family members and significant others or whoever supports them and visits them in ICU. Family are often available to have conversations when the person is most critically ill and often unable to. Nurses often open up conversations about resuscitation and advance care planning. This is where nurses can help with patient flow. If we have an awareness about the level of care the person wants, it makes things clear. That's better for the person, family and bed utilization.
Being resuscitated is dramatic and traumatic and it's not always what's best, nor what's most appropriate for a person.
Nurses can help coordinate
Due to better medications and more advanced technology, we can look at having a person return home with quality of life. That means they may require specific community supports for discharge. Nurses can often help link a person with social services, and community supports in ways that could improve some of the bottle necks.
Educating the public
Nurses have a role to play in health promotion and prevention. If you want to keep out of the ICU, wash your hands. Wear a helmet. Don't speed.