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Background: Patient and family satisfaction with care in intensive care units is not reflected in Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Gaps may be unknown. Local Problem: In a cardiothoracic intensive care unit, patient satisfaction scores were not assessed and gaps could not be addressed. The primary aim was to obtain baseline data on patient and family satisfaction. The secondary aim was to improve identified gaps in satisfaction. Methods: A preintervention-postintervention, 2-cycle quality improvement project and a 12-month sustainability assessment were conducted to evaluate patient and family satisfaction in a cardiothoracic intensive care unit in a large academic health system from August 2022 to August 2023. The Nursing Intensive Care Satisfaction Scale was used to measure patients' satisfaction and the European Quality Questionnaire was used to measure family members' satisfaction with intensive care unit nursing care. Standardized scripting, processes for patient and family engagement during rounds, and structured communication were used to enhance patient and family engagement. Results: At baseline (47 patients, 35 family members), overall patient and family satisfaction was high (mean [SD] satisfaction scores: patients, 87.6 [19.3]; family members, 94.6 [9.7]; P =.06). After intervention cycle 2, family members (n = 50) had high mean satisfaction scores on the Information Needs sub-scale of the European Quality Questionnaire. Family participation in rounds improved from 18.5% of rounds at baseline to 76.5% after intervention cycle 2 and was 61.5% at 12 months. Conclusion: Strategies that engage family members in rounds improve communication and satisfaction. [ABSTRACT FROM AUTHOR]

Nationally, nurse turnover is 18.7%, and 24.1% of nurses leave their organizationwithin a year of hire. On boarding is a key component of a nurse's intent to stay and job satisfaction. This article describes the implementation and results of an onboarding program in a large intensive care unit. [ABSTRACT FROM AUTHOR]

Purpose: The Surgical Thoracic Society defines prolonged ventilation as longer than 24 hours and early extubation as occurring within 6 hours of surgery. The ability to extubate patients promptly after cardiac surgery is multifactorial and requires collaboration among members of the interprofessional team. The purpose of this replication study was to determine the current intubation time in stable patients who had undergone cardiac surgery and delineate barriers to early extubation within 6 hours. Background/Significance: Early extubation in stable patients who have undergone cardiac surgery decreases resource use and length of stay (LOS) in the intensive care unit (ICU) and is associated with decreased mortality and morbidity rates without increasing postoperative complications or reintubation rates when compared with conventional care (ie, not fast tracked). In contrast, longer ventilation times are associated with increased ICU and hospital LOS, higher health costs, and increased risk of pulmonary complications. Method: This prospective, descriptive study used a convenience sample of 101 patients who had undergone cardiac surgery and were identified by the interprofessional surgical team as stable. Data collection occurred in 2 cohorts to account for variability in cohort definitions in our academic health system in July 2016. Cohort 1 (n = 50) underwent cardiac surgery in 2016 between June and July and cohort 2 (n = 51) underwent surgery in September or October 2016. Intubation times were obtained from the electronic health record (EHR). Barriers to extubation were defined for consistency, identified from the EHR and care nurse documentation, and validated across cohorts. Barriers tracked were system and patient problems. Results: In cohort 1, 52% of patients (26 of 50) were extubated within 6 hours (mean time, 6 hours 55 minutes; median, 5 hours 44 minutes), and 36% (18 of 50) were extubated between 6 and 8 hours. In cohort 2, 56.8% of patients (29 of 51) were extubated within 6 hours (mean time, 6 hours 55 minutes; median, 5 hours 57 minutes), and 23.5% (12 of 51) were extubated between 6 and 8 hours. Barriers to extubation were categorized in 3 system-specific groups and 1 patient-specific group: (1) work-flow issues (orders and ventilator changes not made during a 2-hour window at shift change); (2) lack of clarity about what defined stable patients (no standard definition existed); (3) variations in weaning process (eg, slow propofol weaning); and (4) patient specific (eg, respiratory or metabolic acidosis, altered mental status). Conclusion: Findings that only 54.4% of stable patients who had undergone cardiac surgery (55 of 101) were extubated within the defined early extubation period and an additional 29.7% (30 of 101) were extubated within 6 to 8 hours suggest that eliminating barriers could significantly improve extubation times. Next steps include dissemination to the interprofessional team, standardization of eligibility criteria for early extubation, and implementation of a fast-track extubation protocol. [ABSTRACT FROM AUTHOR]

Purpose: This project evaluated an integrated strategy to actively promote sleep in patients in a cardiothoracic intensive care unit (ICU). A multidisciplinary sleep guideline was developed to create a patientcentered environment that maximizes opportunities to promote sleep and rest. Practices addressed by the guideline are keeping the patient care environment quiet at night, clustering nursing care to minimize disruption, and scheduling patient care activities during awake times as a priority instead of at nurses' convenience. Background: Hospitalized patients commonly experience poor sleep and report poor sleep quality. Sleep is an essential biological function that is crucial to supporting immune function and promoting recovery and restoration of health. In the presence of illness, sleep deprivation may complicate illness and impair recovery. Our unit research team identified poor sleep and its consequences as a source of patient dissatisfaction and a modifiable patient outcome. Method: The team collected baseline data on unit noise, patients' sleep satisfaction, and modifiable tasks that disrupt patients' sleep. Before the new sleep guideline was implemented, staff was educated on the importance of sleep for hospitalized patients, what patients in our unit report, and how to use the guideline to provide a multifaceted approach to promote quiet and sleep. This training included strategies to improve environmental light and noise, attention to assessing and providing sleep hygiene for patients, and rescheduling nonessential tasks. After the implementation of the guideline, 6-month and 1-year data were collected at 2-week intervals. Results: Improvements in practice were achieved in areas of quietness, decreased number of nighttime baths, and discussing sleep with patients. The barriers to sleep cited by patients show the inherent problems in providing sleep for postoperative patients in the ICU and areas for improvement. Changing embedded practice patterns is a recursive, long-term process that requires ongoing feedback for staff and persistence of the intervention to achieve the stated goal. [ABSTRACT FROM AUTHOR]

Overusing blood cultures (BCxs) can lead to false positives, unnecessary antibiotics and increased healthcare costs. Despite studies on inpatient BCx algorithms, none have focused on cardiothoracic surgery (CTS) patients, with complex postoperative care and invasive devices. This study aimed to evaluate the impact of a BCx algorithm on BCx event (BCE) rates in CTS step-down units. The study was conducted in three CTS step-down units at Duke University Hospital. The BCx algorithm, based on Seidelman et al. (2023), was implemented in June 2023. BCE rates, incidence rate ratios (IRRs) and adverse outcome IRRs were compared between pre- and post-intervention periods using ITS and χ2 tests. We analysed 4978 BCE during the study period: 3439 (893 patients) pre-intervention and 1539 (452 patients) post-intervention. BCE rates decreased [IRR = 0.78 (95% confidence interval (CI) 0.74, 0.83, P-value< 0.01)] without significant differences in adverse outcomes such as central line-associated bloodstream infection (CLABSI) rates (IRR = 0.6, 95% CI 0.17, 2.30), readmission rates (IRR = 0.99, 95% CI 0.88, 1.12) or in-hospital mortality (IRR = 3.53, 95% CI 0.32, 38.90). Our study supports the beneficial effects of a BCx algorithm, which reduces unnecessary BCxs in CTS patients without compromising patient safety., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)