Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Introduction
- Barriers to Best Practice
- Ward Round Structure
- Other Housekeeping Issues
- Conclusion
- Epidemiology of Infection in the ICU
- Mechanisms of Infection in the ICU
- Approach to Infection Control
- Prevention of Infection in the ICU
- Why Assess Perioperative Risk?
- How Do We Identify High-Risk Patients?
- Population-Based Risk Scores
- Individualised Risk Prediction Models
- Objective Functional Capacity Assessment
- Biomarkers
- Assessment of Frailty
- Limitations of Scoring Systems
- Introduction
- Validity
- Scoring Systems
- Considerations and Limitations
- Disease-Specific Scoring systems
- Introduction
- The Responsibility Spiral
- The Lead Clinician/Clinical Director
- The Importance of Communication in ICU
- Effective Communication with Patients and Their Representatives
- Maintaining Accurate, Legible Legal records
- Teamwork and Collaboration
- Ensuring Continuity of Care through Effective Handover of Clinical Information
- Supporting Clinical Staff outside ICU and Contribution of Appropriate Supervision, Training and Delegation
- Introduction
- Capacity
- Consent
- Best Interests
- Conflict Resolution
- Introduction
- Assessment of Capacity
- Competent Adults
- Adults who Lack Capacity
- Advance Care Plans
- Prolonged Disorders of Consciousness
- Do Not Attempt Cardiopulmonary Resuscitation
- Futile Medical Treatment
- Gross Negligence Manslaughter
- Resources and Rationing
- Introduction
- What Is CoBaTrICE?
- Educational Approaches
- Integration in Clinical Practice
- Conclusion
- 11.1 Leading the Daily Intensive Care Ward Round
- 11.2 Principles and Compliance with Local Infection Control Measures
- 11.3 Principles of Outcome Prediction, Prognostic Indicators and Treatment Intensity Scales and Limitations of Scoring Systems in Predicting Individual Patient Outcome
- 11.4 Scoring Systems for Severity of Illness in Critical Care
- 11.5 Managerial and Administrative Responsibilities of the Intensive Care Medicine Specialist
- 11.6 Communication in Intensive Care
- 11.7 Professional Relationships with Members of the Healthcare Team
- 11.8 Legal and Ethical Issues in Intensive Care
- 11.9 The Legal Framework
- 11.10 CoBaTrICE: The Importance of Learning Opportunities and Integration of New Knowledge in Clinical Practice
- Index
- References
11.3 - Principles of Outcome Prediction, Prognostic Indicators and Treatment Intensity Scales and Limitations of Scoring Systems in Predicting Individual Patient Outcome
from Section 11 - Professionalism, Patient Safety, Governance and Health Systems Management
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Introduction
- Barriers to Best Practice
- Ward Round Structure
- Other Housekeeping Issues
- Conclusion
- Epidemiology of Infection in the ICU
- Mechanisms of Infection in the ICU
- Approach to Infection Control
- Prevention of Infection in the ICU
- Why Assess Perioperative Risk?
- How Do We Identify High-Risk Patients?
- Population-Based Risk Scores
- Individualised Risk Prediction Models
- Objective Functional Capacity Assessment
- Biomarkers
- Assessment of Frailty
- Limitations of Scoring Systems
- Introduction
- Validity
- Scoring Systems
- Considerations and Limitations
- Disease-Specific Scoring systems
- Introduction
- The Responsibility Spiral
- The Lead Clinician/Clinical Director
- The Importance of Communication in ICU
- Effective Communication with Patients and Their Representatives
- Maintaining Accurate, Legible Legal records
- Teamwork and Collaboration
- Ensuring Continuity of Care through Effective Handover of Clinical Information
- Supporting Clinical Staff outside ICU and Contribution of Appropriate Supervision, Training and Delegation
- Introduction
- Capacity
- Consent
- Best Interests
- Conflict Resolution
- Introduction
- Assessment of Capacity
- Competent Adults
- Adults who Lack Capacity
- Advance Care Plans
- Prolonged Disorders of Consciousness
- Do Not Attempt Cardiopulmonary Resuscitation
- Futile Medical Treatment
- Gross Negligence Manslaughter
- Resources and Rationing
- Introduction
- What Is CoBaTrICE?
- Educational Approaches
- Integration in Clinical Practice
- Conclusion
- 11.1 Leading the Daily Intensive Care Ward Round
- 11.2 Principles and Compliance with Local Infection Control Measures
- 11.3 Principles of Outcome Prediction, Prognostic Indicators and Treatment Intensity Scales and Limitations of Scoring Systems in Predicting Individual Patient Outcome
- 11.4 Scoring Systems for Severity of Illness in Critical Care
- 11.5 Managerial and Administrative Responsibilities of the Intensive Care Medicine Specialist
- 11.6 Communication in Intensive Care
- 11.7 Professional Relationships with Members of the Healthcare Team
- 11.8 Legal and Ethical Issues in Intensive Care
- 11.9 The Legal Framework
- 11.10 CoBaTrICE: The Importance of Learning Opportunities and Integration of New Knowledge in Clinical Practice
- Index
- References
Summary
Key Learning Points
1. Precise estimates of post-operative mortality and morbidity are difficult to obtain and both are recognised to vary greatly, depending on a patient’s pre-operative functional status, the type and urgency of surgery and whether or not post-operative complications occur.
2. Risk scores apply a weighting to each factor, usually representing a component value for the score, with the resultant score corresponding with predicted risk.
3. Prognostic indicators may include population-based risk scores, individualised risk prediction models, objective functional capacity assessment and biomarkers.
4. Model discrimination describes how well a model discriminates between high- and low-risk patients, and is measured using a receiver operator characteristic curve (ROC) to calculate the area under the curve (AUC).
5. Technically, risk assessment tools are only valid for the specific patient population for whom the tool has been developed and on whom it has been tested.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 746 - 748Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Bilimoria, KY, Liu, Y, Paruch, JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013;217:833–42.e1–3.CrossRefGoogle ScholarPubMed
Ferreira, FL, Bota, DP, Bross, A, Mélot, C, Vincent, JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754–8.CrossRefGoogle ScholarPubMed
Moran, J, Wilson, F, Guinan, E, McCormick, P, Hussey, J, Moriarty, J. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. Br J Anaesth 2016;116:177–91.CrossRefGoogle ScholarPubMed
Protopapa, KL, Simpson, JC, Smith, NCE, Moonesinghe, SR. Development and validation of the Surgical Outcome Risk Tool (SORT). Br J Surg 2014;101:1774–83.CrossRefGoogle ScholarPubMed
Prytherch, DR, Whiteley, MS, Higgins, B, Weaver, PC, Prout, WG, Powell, SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg 1998;85:1217–20.Google ScholarPubMed
Vincent, JL, Moreno, R, Takala, J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–10.CrossRefGoogle Scholar