DOCSLIB.ORG

35 General Principles of Postoperative Intensive Care Unit Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
35 General Principles of Postoperative Intensive Care Unit Care 35 General Principles of Postoperative Intensive Care Unit Care Michael J. Hockstein | Laura S. Johnson CHAPTER OUTLINE POSTOPERATIVE EVALUATION Management of Agitation and Delirium RECOVERY FROM ANESTHESIA Management of Blood Glucose level Postoperative Resuscitation POSTOPERATIVE NUTRITION Awakening from Anesthesia Timing and Route Postoperative Extubation Feeding Considerations in General BEST PRACTICES Surgery Patients Prevention of Venous Thromboembolism and WOUND HEALING AND CARE Deep Venous Thrombosis Physiology and Biology of Wound Healing Stress Ulcer Prophylaxis Epithelialization and Wound Care Preventing Nosocomial Pneumonia Optimizing Wound Healing Regionalization within a health care structure allows for volume resuscitation, or administration of vasoactive medi- more efficient control and use of limited resources. The cations, make ICU care unavoidable. Monitoring of level of intensive care unit (ICU) contains specially trained staff and consciousness, airway, bleeding, pulses, rhythm, acidosis, a variety of support devices, such as mechanical ventilators, urine output, and global perfusion also is facilitated by ICU intra-aortic balloon pumps, ventricular assist devices, and admission. Identifying patients who may need postoperative dialysis machines, which in most cases cannot be used else- ICU care can be difficult. Although there are scoring systems where. Optimally, the location of a patient is determined by to assess risk and fatality (APACHE, SAPS, MPM, SOFA), it matching the patient’s needs with a location’s resources and is difficult to apply these predictions to specific disease states expertise. or individual patients. Some prediction models utilize physi- Generally, the surgical ICU is where experience, staffing, ologic data for patients after admission to the ICU and have skills, and technology converge to provide services that not been validated as preadmission screening tools.7,8 Physi- cannot be provided anywhere else within the hospital. cians may predict mortality risk even better than scoring Highly skilled nurses, often greater in number than the systems.9 In practice, most physicians do not use these tools patients themselves, work intimately with intensivists and to determine postoperative ICU admission. Admission cri- ancillary staff in an environment designed to stabilize, diag- teria based on priority, diagnosis, and objective parameter nose, and simultaneously treat the most acutely ill patients. models have been published by the Task Force of the Ameri- ICU management by intensivists allows for improved staff can College of Critical Care Medicine and the Society of and family satisfaction, reduced complication rates, lower Critical Care Medicine.10 costs, shorter length of stay, improved processes of care, and a morbidity and mortality risk advantage.1-4 ICU systems focused on an environment of safety and compliance with POSTOPERATIVE EVALUATION evidence-based standards promote improvement in many outcome metrics.5 Safe and efficient patient throughput Obtaining a comprehensive medical and surgical history is allows for greater institutional procedural volume, which, a fundamental step in understanding a patient in the surgi- when paired with surgeon procedural volume, has been cal ICU. The medical record, traditionally written but now shown to be associated with reduced mortality risk.6 more commonly electronic, should contain all of the ele- Classic postoperative indications for ICU admission ments necessary to assemble the story up until the time of include advanced age or prolonged duration of the opera- ICU admission, although deciphering a chart, particularly tion, both criteria without specifically defined thresholds. when it is long, requires time, patience, and detective skills. Other factors, such as the need for mechanical ventilation, Data gathering usually begins by word of mouth from the 594 CHAPTER 35 — GENERAL PRINCIPLES OF POSTOPERATIVE INTENSIVE CARE UNIT CARE 595 providers delivering the patient. Effective “hand-off” is intravenous fluid rates are 80 to 125 mL/hour, but can be essential to maintain the continuity of care and to ascertain substantially higher in the presence of ongoing intravascu- important operative events that may have escaped docu- lar volume loss. Isotonic fluids are the most appropriate mentation. It is in fact a standard expected by The Joint maintenance fluids. It is useful to inquire about the last time Commission.11 Certain questions are common to virtually all the patient received narcotics, benzodiazepines, or paralyt- admissions: ics and if reversal agents were given. Finally, any intra- operative laboratory values, particularly ones that require 1. How old is the patient? immediate attention, should be reviewed. 2. What are the highlights of the medical/surgical history? When time permits, attention should be directed back to 3. Was the operation elective or emergent? the medical record. The clinician should scan the history 4. What operation was performed, and what are the details and physical examination, progress notes, and consultations of the surgery? to develop a cohesive story line of events that led up to the 5. Are there any drains? operation. Did the illness have an impact on nutrition or 6. What are the current ventilator settings if the patient is functional state? How are other comorbid conditions or past intubated? operations related to the current presentation? The past 7. What medications is the patient receiving currently? medical history and the medication list should be scruti- 8. Where are the vascular access points? Were they placed nized; the two are complementary. Inclusion of a disease in under sterile conditions? the past medical history and absence of an expected medica- 9. What was the intubation and anesthetic course like? tion warrants further investigation (and vice versa). The 10. What were the complications, if any? medication list should be scanned in particular for anti- seizure medications, bronchodilators, antihypertensives, Age, comorbid conditions, and emergency operations all antiarrhythmics, anticoagulants, diuretics, steroids, thyroid affect mortality risk. The details of the operation are key, replacement, and insulin. It must be decided which medica- often aided by diagrams in the chart. Resections, diversions, tions must be continued in the immediate postoperative anastomoses, transplantations, use of prosthetic materials, period and which can be temporarily delayed. If antibiotics and other surgical findings are some of the details that were administered preoperatively, the clinician should iden- should be obtained. In addition, the type and location of tify what they were and how long had they been given and each drain must be accounted for. Only by knowing where for what indication. In general, if administered preopera- a drain is placed can a care provider know how to interpret tively, bronchodilators, steroids, and insulin are resumed the quantity and quality of the effluent. Each drain or wire postoperatively. Long-acting antihypertensives should be must be labeled correctly. Also, the completion of wound avoided in the early postoperative period, and short-acting closure must be ascertained (skin and fascia closed?). intravenous agents should be used to control hypertension. Finally, if the operation was incomplete or intentionally Diuretics should be avoided in the immediate postoperative staged, the health care provider needs to inquire about period unless directed by invasive monitoring or required intentions and timing of return to the operating room. because of some other medical necessity. The use of early The significance of the anesthesia record should not be postoperative beta blockade in patients with coronary artery minimized. The details about trends in gas exchange, blood disease is encouraged if the overall hemodynamic perfor- pressure, urine output, medications, and summary fluid mance allows. Most other medications can be safely delayed balance should be reviewed. Always identify if the intubation until the postoperative patient has shown satisfactory cardio- was easy or difficult. Reviewing the ventilator settings that pulmonary performance and stability. were used in the operating room sheds some light on any Postoperative laboratory, imaging, and electrocardio- possible gas exchange difficulties and provides a first oppor- gram studies should be selected on a case-by-case basis. tunity to make corrections. Tidal volumes in the operating Patients who have been moved from operating room table room are often much larger than those used in the ICU. to bed and then transported for any distance are at risk for Identification of current medications and the purpose of displacement of tubes and catheters. The admission chest each help to formulate short-term therapeutic strategies. radiograph allows for the evaluation of intravascular cathe- Assessing the adequacy of intraoperative resuscitation ter and endotracheal, nasogastric, and thoracostomy tube begins with a review of the quantifiable gains and losses. positions in addition to visualization of the pleural, medias- Resuscitation fluids, blood products, urine output, cavity tinal, and parenchymal structures. Measurements of blood fluid, and blood losses should all be reviewed. Evaporative counts and chemistries are usually routine, but may be and extravascular (third space) losses may be more difficult deemed unnecessary if preoperative or intraoperative values to accurately quantitate. Major surgical procedures such as were unremarkable
Load more

Recommended publications
  • Patient Referral Guidelines
    SULTANATE OF OMAN MINISTRY OF HEALTH MANUAL ON PATIENT REFERRAL GUIDELINES SECOND EDITION – 2004 DIRECTORATE GENERAL OF HEALTH AFFAIRS 1 PREFACE Patient Referral system is the back-bone of health services infrastructure, offering highest possible levels of health services to each and every member of the community through a network of Primary, Secondary, & Tertiary Health Care providing institutions. MOH assigns high priority to this essential component of health services, evidenced by a recent National Workshop and revision of the Manual on Patient Referral Guidelines within five years of publication of the previous edition of the manual. Manual on Patient Referral Guidelines has been revised in consideration with the changing needs of the community, rapid development of health services in Oman, and changing concepts in the medical profession. We have also attempted to make the referral system even more patient friendly, as well as making the manual user-friendlier. Following changes in the manual (and policies therein) make it simpler to read and understand, despite further elaboration of referral protocols and inclusion of beneficial and relevant information. 1. Permissibility of skipping service levels with certain explicit criteria applied. Thereby, offering referring clinicians a margin to select appropriate referral institution and save precious time of patients, making the referral system more patient friendly. 2. Necessary amendments in the Patient Referral Form, making it suitable to serve the purpose as an appointment request form and monitoring the referral system as well. 3. Revision of concepts and definitions for referral assessment criteria, and their incorporation in Monitoring & Reporting system. 4. Inclusion of scientific definitions for clinical categories of referrals i.e.
    [Show full text]
  • The Provision of American Medical Services at Or Via Southampton During WWII
    The Provision of D-Day: American Medical Stories Services at or via from Southampton the Walls during WWII During the Maritime Archaeology Trust’s National Lottery Heritage Funded D-Day Stories from the Walls project, volunteers undertook online research into topics and themes linked to D-Day, Southampton, ships and people during the Second World War. Their findings were used to support project outreach and dissemination. This Research Article was undertaken by one of our volunteers and represents many hours of hard and diligent work. We would like to take this opportunity to thank all our amazing volunteers. Every effort has been made to trace the copyright hold-ers and obtain permission to reproduce this material. Please do get in touch with any enquiries or any information relating to any images or the rights holder. The Provision of American Medical Services at or via Southampton during WWII Contents Introduction ..................................................................................................................................... 2 Planning for D-Day and Subsequently ............................................................................................. 2 Royal Victoria Hospital, Netley near Southampton ......................................................................... 3 Hospital Trains .................................................................................................................................. 5 Medical Services associated with 14th Port ...................................................................................
    [Show full text]
  • Fleet Medicine Pocket Reference 2001
    Fleet Medicine Pocket Reference 2001 Surface Warfare Medicine Institute This booklet is designed to be useful to senior medical officers filling billets for CATF Surgeons and Officers-in-Charge of Fleet Surgical Teams. The information herein is derived from primary sources that are usually identified within the text. Non-referenced information is included in order to tap the experience of previous CATF Surgeons. Please send all correspondence concerning the content and style of this booklet to CDR Ralph Pene, MC, USN, at the address below. All feedback is useful, and updates are scheduled for release annually. This 2001 edition was updated by CDR Doug Kempf, MC, USNR. Surface Warfare Medicine Institute Building 500, Room 114 50 Rosecrans Street Naval Submarine Base San Diego CA 92106-4408 (619) 553-0097 email: [email protected] TABLE OF CONTENTS Acronyms and Abbreviations ................................................... 5 Bibliography............................................................................ 11 Blood Program ...................................................................... 14 BUMED-14 Message ............................................................. 23 Casualty Receiving and Treatment Ships .............................. 24 CATF Surgeon Tasks............................................................. 30 CLF Surgeon Tasks ............................................................... 32 Communications .................................................................... 33 Crisis Management
    [Show full text]
  • Review Style Sheet
    xxxxxxxxxx Canadian Military Hospitals at Sea 1914-1919 Jonathan C Johnson, OTB S there was an ocean between Canada and the fighting during WWI, the movement of casualties needing lengthy treatment required special arrangements. Many of the Acasualties returning home, especially in 1915 and 1916, came back to Canada on relatively empty troop ships (ex-passenger ships) and were accompanied by a small medical team. The more serious casualties came home on either hospital ships or ambulance transports, most of which were equipped as floating convalescent hospitals. Hospital ships and ambulance transports generally were identically equipped. The former were commissioned naval auxiliaries painted white with green stripe and large red crosses and protected by the Geneva Convention (Figure 1). The latter were normal naval auxiliaries painted troop ship colours that sailed in convoy and were not protected by the Geneva Figure 1. Colour postcard of HMHS LETITIA with the correct Convention. Like most military colour scheme for a commissioned hospital ship under the Geneva Convention. units each ship had an ‘Orderly Room’ where mail could be posted and, if lucky, picked up upon arrival at port. Military service personnel overseas could post mail unpaid. For much of the war, the Canada Post Office added postage upon arrival in Canada so postage due would not be applied. Canada had six hospital ships and ambulance transports during WWI. Of this number, two were lost while in service. A return trip from Liverpool to Canada and back took one month. HMCHS PRINCE GEORGE The HMCHS PRINCE GEORGE was Canada’s only naval hospital ship.
    [Show full text]
  • South Dakota Health and Educational Facilities Authority (The “Authority”) Will Issue Its $213,690,000* Revenue Bonds
    PRELIMINARY OFFICIAL STATEMENT DATED AUGUST 14, 2017 NEW ISSUE RATINGS: See “RATINGS” herein. BOOK-ENTRY ONLY Subject to compliance by the Authority and the Members of the Obligated Group with certain covenants, in the opinion of Bond Counsel, under present law, interest on the Series 2017 Bonds is excludable from gross income of the owners thereof for federal income tax purposes and is not included as an item of tax preference in computing the alternative minimum tax for individuals and corporations. See “TAX EXEMPTION” herein for a more complete discussion. $213,690,000* SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY Revenue Bonds, Series 2017 (Regional Health) Dated: Date of Delivery Due: September 1, as shown on the inside front cover Maturities, Principal Amounts, Interest Rates, Yields/Prices and CUSIPs® as Shown on the Inside Front Cover The South Dakota Health and Educational Facilities Authority (the “Authority”) will issue its $213,690,000* Revenue Bonds, Series 2017 (Regional Health) (the “Series 2017 Bonds”) through a book-entry system under a Bond Trust Indenture dated as of September 1, 2017 (the “Bond Indenture”), between the Authority and The First National Bank in Sioux Falls, as bond trustee for the Series 2017 Bonds (the “Bond Trustee”), and loan the proceeds thereof to Regional Health, Inc., a South Dakota nonprofit corporation (the “Corporation”), for the purpose of financing the improvement of certain facilities of the Corporation and other Members of the Obligated Group (as defined herein) located in South Dakota and refunding all or a portion of certain outstanding bonds. See “PLAN OF FINANCE” herein.
    [Show full text]
  • Fm 8-10-14 Employment of the Combat Support Hospital Tactics, Techniques, and Procedures
    FM 8-10-14 FIELD MANUAL HEADQUARTERS No. 8-10-14 DEPARTMENT OF THE ARMY Washington, DC, 29 December 1994 FM 8-10-14 EMPLOYMENT OF THE COMBAT SUPPORT HOSPITAL TACTICS, TECHNIQUES, AND PROCEDURES Table of Contents PREFACE CHAPTER 1 - HOSPITALIZATION SYSTEM IN A THEATER OF OPERATIONS 1-1. Combat Health Support in a Theater of Operations 1-2. Echelons of Combat Health Support 1-3. Theater Hospital System CHAPTER 2 - THE COMBAT SUPPORT HOSPITAL 2-1. Mission and Allocation 2-2. Assignment and Capabilities 2-3. Hospital Support Requirements 2-4. Hospital Organization and Functions 2-5. The Hospital Unit, Base 2-6. The Hospital Unit, Surgical CHAPTER 3 - COMMAND, CONTROL, AND COMMUNICATIONS OF THE COMBAT SUPPORT HOSPITAL DODDOA-004215 ACLU-RDI 320 p.1 3-1. Command and Control 3-2. Communications CHAPTER 4 - DEPLOYMENT AND EMPLOYMENT OF THE COMBAT SUPPORT HOSPITAL 4-1. Threat 4-2. Planning Combat Health Support Operations 4-3. Mobilization 4-4. Deployment 4-5. Employment 4-6. Hospital Displacement 4-7. Emergency Displacement 4-8. Nuclear, Biological, and Chemical Operations APPENDIX A - TACTICAL STANDING OPERATING PROCEDURE FOR HOSPITAL OPERATIONS A-1. Tactical Standing Operating Procedure A-2. Purpose of the Tactical Standing Operating Procedure A-3. Format for the Tactical Standing Operating Procedure A-4. Sample Tactical Standing Operating Procedure (Sections) A-5. Sample Tactical Standing Operating Procedure (Annexes) APPENDIX B - HOSPITAL PLANNING FACTORS B-1. General B-2. Personnel and Equipment Deployable Planning Factors B-3. Hospital Operational Space Requirements B-4. Logistics Planning Factors (Class 1, II, III, IV, VI, VIII) APPENDIX C - FIELD WASTE Section I - Overview DODDOA-004216 ACLU-RDI 320 p.2 • C-1.
    [Show full text]
  • Joint CAFM Comments on the FY 2022 IPPS Proposed Rule
    June 8, 2021 The Honorable Chiquita Brooks-LaSure Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 7500 Security Boulevard Baltimore, MD 21244 Re: CMS-172-P; Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2022 Rates Dear Administrator Brooks-LaSure: On behalf of the Council of Academic Family Medicine (CAFM), including the Society of Teachers of Family Medicine, Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, and the North American Primary Care Research Group, as well as the American Academy of Family Physicians (AAFP) we write to provide comments on the FY 2022 Medicare Inpatient Prospective Payment System proposed rule. The Graduate Medical Education (GME) provisions included in the Consolidated Appropriations Act, 2021, will help strengthen the GME program and diversify training options for resident physicians. A recent report projects that the U.S. will face a shortage of between 54,100 and 139,000 physicians by 2033.1 Currently, most physicians are trained at large academic medical centers in urban areas. Evidence indicates physicians typically practice within 100 miles of their residency program, meaning that the current distribution of trainees also leads to physician shortages in medically underserved and rural areas.2 These shortages result in access barriers and disparities in health outcomes for Medicare beneficiaries and other patients living in rural communities.3 However, our organizations believe that the implementation of these GME provisions could help to correct the maldistribution of physicians and ultimately improve equitable access to high-quality care.
    [Show full text]
  • Medical Railroading During the Korean War 1950-1953
    Medical Railroading During the Korean War By Dr. Eric A. Sibul PhD Baltic Defence College, Tartu, Estonia 1950-1953 hile the role of rail transportation during the of the conflict were carefully studied in Prussia and other American Civil War, World War I, and World German states.3 In the Franco-Prussian War (1870-1871), WWar II has largely been acknowledged by historians, the the Prussians improved on American evacuation concepts, importance of railroads in the Korean War 1950-1953, devising an elaborate medical evacuation system based on like the conflict itself, has mostly been forgotten. Both railway transport. The relatively small number of deaths sides, the United Nations Command and the Communist from wounds of German forces attested to the success of forces, relied heavily on railroad transportation during this system. Casualties were evacuated from the front lines the hostilities. to the interior of Germany by special trains that were staffed Though described as a limited war, the Korean Conflict by surgeons, nurses, pharmacists, and cooks. The most was not a small war: Large quantities of men and materiel heavily wounded were removed from the train into hospitals moved up and down the Korean peninsula. Due to the situated in towns nearest the frontier, and their places were inherent efficiency of railways in large-scale movements filled with men whose wounds were healing; the process and the inadequacy of roads and air transport, railways held continued into the interior of Germany. Observers of the a paramount role in UNC-theater military transportation. German medical evacuation system noted the favorable Approximately 95 percent of all supplies that were cleared effect on the morale of soldiers.
    [Show full text]
  • Preparing Your ICU for Disaster Response
    PREPARING YOUR ICU FOR DISASTER RESPONSE J. Christopher Farmer, MD, FCCM, Editor Randy S. Wax, MD, FCCM, Editor Marie R. Baldisseri, MD, FCCM, Editor ix CONTENTS FOREWORD xi CHAPTER ONE What Matters? The Role of an ICU During Disaster 1 D. E. Amundson, MS, DO, FCCM; Mary J. Reed, MD, FCCM TWO Assessing Your ICU: Are You Ready to Respond to Disaster? 9 John S. Parrish, MD; Jeffry L. Kashuk, MD THREE Leadership During a Disaster 23 Asha Devereaux, MD, MPH; Jeffrey R. Dichter, MD FOUR Building an ICU Response Plan for Disasters 49 Christian Sandrock, MD, MPH, FCCP FIVE Implementing an Effective ICU Disaster Response Plan 67 Vincent M. Nicolais, MD, Macp, FCCM; Elizabeth Bridges, PhD, RN, CCNS, FAAN, FCCM SIX Communication During Disaster 79 James A. Geiling, MD, FCCM SEVEN How to Build ICU Surge Capacity 93 Lisa Burry, PharmD; Dauryne L. Shaffer, MSN EIGHT Ethical Decision Making in Disasters: Key Ethical Principles 107 and the Role of the Ethics Committee Dan R. Thompson, MD, MA, Facp, FCCM NINE Behavioral Health Issues 117 Merritt Schreiber, PhD; Sandra Stark Shields, LMFT, ATR-BC, CTS; Dan Hanfling, MD TEN Pediatric Considerations: What Is Needed in My ICU to 127 Care for These Casualties? Dana A. Braner, MD, FCCM; JoDee M. Anderson, MD, MEd APPENDIX ONE Disaster Education and Training Resources 141 Abhijit Duggal, MD, MPH, Facp; Jonathan Simmons, DO, MS; Pablo A. Perez D’Empaire, MD TWO Additional Resources and Websites 151 Brittany A. Williams, MS, Bsrt, NREMT-P x THREE Clinical Strategies During Disaster Response 155 John L. Hick, MD FOUR Developing an ICU Supply and Other Templates for 173 Disaster Response Lisa Burry, PharmD; Jana A.
    [Show full text]
  • Employment of the Combat Support Hospital Tactics, Techniques, and Procedures
    FM 8-10-14 Table of Contents RDL Document Download Homepage Information Instructions FM 8-10-14 FIELD MANUAL HEADQUARTERS No. 8-10-14 DEPARTMENT OF THE ARMY Washington, DC, 29 December 1994 FM 8-10-14 EMPLOYMENT OF THE COMBAT SUPPORT HOSPITAL TACTICS, TECHNIQUES, AND PROCEDURES Table of Contents PREFACE CHAPTER 1 - HOSPITALIZATION SYSTEM IN A THEATER OF OPERATIONS http://www.adtdl.army.mil/cgi-bin/atdl.dll/fm/8-10-14/toc.htm (1 of 9) [1/9/2002 10:43:35 AM] FM 8-10-14 Table of Contents 1-1. Combat Health Support in a Theater of Operations 1-2. Echelons of Combat Health Support 1-3. Theater Hospital System CHAPTER 2 - THE COMBAT SUPPORT HOSPITAL 2-1. Mission and Allocation 2-2. Assignment and Capabilities 2-3. Hospital Support Requirements 2-4. Hospital Organization and Functions 2-5. The Hospital Unit, Base 2-6. The Hospital Unit, Surgical CHAPTER 3 - COMMAND, CONTROL, AND COMMUNICATIONS OF THE COMBAT SUPPORT HOSPITAL 3-1. Command and Control 3-2. Communications CHAPTER 4 - DEPLOYMENT AND EMPLOYMENT OF THE COMBAT SUPPORT HOSPITAL 4-1. Threat 4-2. Planning Combat Health Support Operations 4-3. Mobilization 4-4. Deployment http://www.adtdl.army.mil/cgi-bin/atdl.dll/fm/8-10-14/toc.htm (2 of 9) [1/9/2002 10:43:35 AM] FM 8-10-14 Table of Contents 4-5. Employment 4-6. Hospital Displacement 4-7. Emergency Displacement 4-8. Nuclear, Biological, and Chemical Operations APPENDIX A - TACTICAL STANDING OPERATING PROCEDURE FOR HOSPITAL OPERATIONS A-1. Tactical Standing Operating Procedure A-2.
    [Show full text]
  • Accounting for the Invisible Work of Hospital Orderlies: Designing For
    Accounting for the Invisible Work of Hospital Orderlies: Designing for Local and Global Coordination Allan Stisen, Nervo Verdezoto, Henrik Blunck, Mikkel Baun Kjærgaard, and Kaj Grønbæk Department of Computer Science, Aarhus University Aarhus, Denmark {allans, nervo, blunck, mikkelbk, kgronbak}@cs.au.dk ABSTRACT from it” [45, p. 58]. Invisible work includes situations The cooperative, invisible non-clinical work of hospital where the result of the work is visible but the person doing orderlies is often overlooked. It consists foremost of the work is somehow invisible as in the case of design work transferring patients between hospital departments. As the [28], domestic work (e.g., cleaning) and other kinds of overall efficiency of the hospital is highly dependent on the service work [41]. There are also situations in which the coordination of the work of orderlies, this study investigates person performing the work is quite visible but some of the the coordination changes in orderlies’ work practices in work is “functionally invisible” [41, p. 20] or taken for connection to the implementation of a workflow application granted. The work (e.g., registering appointments, at the hospital. By applying a mixed methods approach monitoring patients, taking medication) performed by (both qualitative and quantitative studies), this paper calls secretaries, nurses, patients, families, and “on-call” service for attention to the changes in orderlies’ coordination workers, are examples of work that often remains in the activities while moving from a manual and centralized form background [28, 41, 48]. Making this work more visible to a semi-automatic and decentralized approach after the [45], through technology [37, 42], can support the practices introduction of the workflow application.
    [Show full text]
  • Healthcare You See an Efficient, State-Of-The-Art Hospital We See Our Essential Services Redefining Healthcare
    HEALTHCARE YOU SEE AN EFFICIENT, STATE-OF-THE-ART HOSPITAL WE SEE OUR ESSENTIAL SERVICES REDEFINING HEALTHCARE. REDEFINING HEALTHCARE. Spotless works with more than 25 hospitals and health boards across Australia and New Zealand: • Bathurst Hospital • Mercy Ascot • Bay of Plenty District • Modbury Hospital Health Board • Northern Hospital, • Bendigo Hospital Broadmeadows Health • Blenheim Hospital • Northland District Health Board • Calvary Health • Orange Hospital • Canterbury District • Royal Children’s Hospital Health Board • Royal Eye and Ear Hospital • Capital and Coast District • Rotorua Hospital Health Board • Sunshine Coast University Hospital • Central Alliance District Health Board • Tauranga Hospital • Flinders Medical Centre • The Alfred Hospital • Lakes District Health Board • Timaru Hospital • Masterton Hospital • Westcoast District Health Board At Spotless, the safety of our employees, contractors, clients and the community is paramount. We believe safety awareness is not just work-related—it’s about a personal commitment to injury prevention 24 hours a day, 7 days a week. A TRUSTED PARTNER Spotless has a 40-year history of supporting the daily operations of hospitals across Australia and New Zealand. We are not simply a supplier, but a trusted partner. Trusted to deliver care-associated services, that creates a safe environment for hospital staff, patients and their guests. As healthcare providers we support hospitals and senior living facilities. Every year Spotless delivers more than 3.5 million hours of non-clinical
    [Show full text]