Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

Engel, Heidi J.; Tatebe, Shintaro; Alonzo, Philip B.; Mustille, Rebecca L.; Rivera, Manuel

doi:10.2522/ptj.20110420

Cited by 85 publications

(82 citation statements)

References 51 publications

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“…Hence, observational studies of unselected patients undergoing urological surgery are likely to be the best source of estimates of VTE and bleeding risk. Because baseline risk has changed over time [11–13], we included studies that recruited all or a majority of participants after the year 2000. Because the complication estimates depend on the length of follow-up, we included only studies that clearly defined the time period of follow-up (up to 3 months).…”

Section: Methodsmentioning

confidence: 99%

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Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology

et al. 2014

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BackgroundPharmacological thromboprophylaxis in the peri-operative period involves a trade-off between reduction in venous thromboembolism (VTE) and an increase in bleeding. Baseline risks, in the absence of prophylaxis, for VTE and bleeding are known to vary widely between urological procedures, but their magnitude is highly uncertain. Systematic reviews and meta-analyses addressing baseline risks are uncommon, needed, and require methodological innovation. In this article, we describe the rationale and methods for a series of systematic reviews of the risks of symptomatic VTE and bleeding requiring reoperation in urological surgery.Methods/designWe searched MEDLINE from January 1, 2000 until April 10, 2014 for observational studies reporting on symptomatic VTE or bleeding after urological procedures. Additional studies known to experts and studies cited in relevant review articles were added. Teams of two reviewers, independently assessed articles for eligibility, evaluated risk of bias, and abstracted data. We derived best estimates of risk from the median estimates among studies rated at the lowest risk of bias. The primary endpoints were 30-day post-operative risk estimates of symptomatic VTE and bleeding requiring reoperation, stratified by procedure and patient risk factors.DiscussionThis series of systematic reviews will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding. Our work advances standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at best estimates of risk (including modeling of timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate certainty in estimates of risk. The results will be incorporated in the upcoming European Association Urology Guideline on Thromboprophylaxis.Systematic review registrationPROSPERO CRD42014010342.Electronic supplementary materialThe online version of this article (doi:10.1186/2046-4053-3-150) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

“…Fifth, the choice of studies to use for best estimates (e.g., synthesis from all studies or only from those at lowest risk of bias) is uncertain [10]. Sixth, the incidence of VTE has changed over time due to advances in surgical technique and care (e.g., early mobilization) [11–13]. …”

Section: Introductionmentioning

confidence: 99%

Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology

et al. 2014

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“…Because the majority of thromboembolic events occur after discharge, in-hospital prophylaxis will have limited impact in reducing VTE risk [3,[18][19][20]. Similarly, the estimated risks of VTE and bleeding reported in the AUA Best Practice statement may be misleading, first because guidance was not informed by evidence-based knowledge synthesis, and secondly because they may not reflect current practice because of advances in surgical technique and care [21][22][23].…”

Section: Trade-off Of Bleeding and Venous Thromboembolism Risk For Pamentioning

confidence: 99%

Guideline of guidelines: thromboprophylaxis for urological surgery

Violette¹,

Cartwright

Briel

et al. 2016

BJU International

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Decisions regarding thromboprophylaxis in urologic surgery involve a trade-off between decreased risk of venous thromboembolism (VTE) and increased risk of bleeding. Both patient-and procedure-specific factors are critical in making an informed decision on the use of thromboprophylaxis. Our systematic review of the literature revealed that existing guidelines in urology are limited. Recommendations from national and international guidelines often conflict and are largely based on indirect as opposed to procedure-specific evidence. These issues have likely contributed to large variation in the use of VTE prophylaxis within and between countries. The majority of existing guidelines typically suggest prolonged thromboprophylaxis for high-risk abdominal or pelvic surgery, without clear clarification of what these procedures are, for up to 4 weeks post-discharge. Existing guidance may result in the undertreatment of procedures with low risk of bleeding and the over-treatment of oncological procedures with low risk of VTE. Guidance for patients who are already anticoagulated are not specific to urological procedures but generally involve evaluating patient and surgical risks when deciding on bridging therapy. The European Association of Urology Guidelines Office has commissioned an ad hoc guideline panel that will present a formal thromboprophylaxis guideline for specific urological procedures and patient risk factors.

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“…Most reports about starting a new mobilization program in the ICU have described phases of team engagement and implementation that occur over 2 to 3 years. [64][65][66][67] Generally, when caring for critically ill patients, each discipline has their prescribed roles and duties (eg, prescription vs dispensing vs administration of medications). However, mobilizing the critically ill patient is not one person's job because, unlike administering medications, mobilizing patients can rarely be performed alone.…”

Section: Specific Leadership Activities: Mobility Examplesmentioning

confidence: 99%

Pain, Agitation, and Delirium Guidelines: Nurses’ Involvement in Development and Implementation

Davidson

Winkelman

Gélinas

et al. 2015

Critical Care Nurse

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The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses’ involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation.

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Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

Abstract: The improvements in outcomes demonstrated the value and feasibility of a physical therapist-led early mobilization program.

Cited by 85 publications

References 51 publications

Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology

Systematic reviews of observational studies of risk of thrombosis and bleeding in urological surgery (ROTBUS): introduction and methodology

Guideline of guidelines: thromboprophylaxis for urological surgery

Pain, Agitation, and Delirium Guidelines: Nurses’ Involvement in Development and Implementation

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