Improving Daily Patient Goal-Setting and Team Communication: The Liber8 Glass Door Project.

Objectives: To develop and implement a tool to improve daily patient goal setting, team collaboration and communication.

Design: Quality improvement implementation project.

Setting: Tertiary-level PICU.

Implementation and facilitation of post-resuscitation debriefing: a comparative crossover study of two post-resuscitation debriefing frameworks.

Background: Post-resuscitation debriefing (PRD) is the process of facilitated, reflective discussion, enabling team-based interpersonal feedback and identification of systems-level barriers to patient care. The importance and benefits of PRD are well recognized; however, numerous barriers exist, preventing its practical implementation. Use of a debriefing tool can aid with facilitating debriefing, creating realistic objectives, and providing feedback.

Paediatric health care access in community health centres is associated with survival for critically ill children who undergo inter-facility transport: A province-wide observational study.

Background: Diverse settlement makes inter-facility transport of critically ill children a necessary part of regionalized health care. There are few studies of outcomes and health care services use of this growing population.

Methods: A retrospective study evaluated the frequency of transports, health care services use, and outcomes of all critically ill children who underwent inter-facility transport to a paediatric intensive care unit (PICU) in Ontario from 2004 to 2012.

Applications of Postresuscitation Debriefing Frameworks in Emergency Settings: A Systematic Review.

Objectives: Postresuscitation debriefing (PRD) is a valuable educational tool in emergency medicine. It is recommended by international resuscitation guidelines, has been shown to improve both patient outcomes and resuscitation team performance, and is frequently requested by medical learners. However, there is limited research comparing standardized debriefing frameworks.

Hamilton-DONATE: a city-wide pilot observational study of the ICU management of deceased organ donors.

Purpose: Improving the medical care of deceased organ donors to increase transplant rates and improve allograft function requires an understanding of the current epidemiology and clinical practices of deceased donation within intensive care units (ICUs). Herein, we report the results of our investigation into the feasibility of a multicentre prospective cohort study addressing the afformentioned issues.

Methods: We conducted a 12-month prospective observational cohort study in six ICUs and one coronary care unit in Hamilton, Canada.

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report.

Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada.

Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology.

The offering of family presence during resuscitation: a systematic review and meta-analysis.

Background: Family members may wish to be present during resuscitation of loved ones, despite concerns that they may interfere with the resuscitation or experience psychological harm.

Methods: We conducted a systematic review to determine whether offering family presence during resuscitation (FPDR) affected patient mortality, resuscitation quality, or family member psychological outcomes. We searched multiple databases up to January 2014 for studies comparing FPDR to usual care.

Family presence during resuscitation: A Canadian Critical Care Society position paper.

Background: Recent evidence suggests that patient outcomes are not affected by the offering of family presence during resuscitation (FPDR), and that psychological outcomes are neutral or improved in family members of adult patients. The exclusion of family members from the resuscitation area should, therefore, be reassessed.

Objective: The present Canadian Critical Care Society position paper is designed to help clinicians and institutions decide whether to incorporate FPDR as part of their routine clinical practice, and to offer strategies to implement FPDR successfully.

Assessing family members' satisfaction with information sharing and communication during hospital care at the end of life.

Context: Despite the fact that most deaths occur in hospital, problems remain with how patients and families experience care at the end of life when a death occurs in a hospital.

Objectives: (1) assess family member satisfaction with information sharing and communication, and (2) examine how satisfaction with information sharing and communication is associated with patient factors.

Methods: Using a cross-sectional survey, data were collected from family members of adult patients who died in an acute care organization.

Acute rehabilitation in critically ill children.

Immobility increases morbidity, while early mobilization improves outcomes in adults. Rehabilitation practices in critically ill children, and the degree to which they are immobilized, are currently not well understood. The objective of this retrospective cohort study was to evaluate acute rehabilitation practices and potential barriers to mobilization in a tertiary care pediatric critical care unit (PCCU).

Opening the black box of ethics policy work: evaluating a covert practice.

Hospital ethics committees (HECs) and ethicists generally describe themselves as engaged in four domains of practice: case consultation, research, education, and policy work. Despite the increasing attention to quality indicators, practice standards, and evaluation methods for the other domains, comparatively little is known or published about the policy work of HECs or ethicists. This article attempts to open the "black box" of this health care ethics practice by providing two detailed case examples of ethics policy reviews.

A framework for resolving disagreement during end of life care in the critical care unit.

Background: End-of-life decisions regarding the administration, withdrawal or withholding of life-sustaining therapy in the critical care setting can be challenging. Disagreements between health care providers and family members occur, especially when families believe strongly in preserving life, and physicians are resistant to providing medically "futile" care. Such disagreements can cause tension and moral distress among families and clinicians.