Sign Up Free. 9|,l>enrRMJCdM'.c3gu$OOsmyO+oCzJ0ExpfDAr$HNp6gmh1 a} ^. The ICU and Cardiovascular Intensive Care Unit (CVICU) multidisciplinary teams tested and implemented several changes that contributed to improved outcomes. Crit Care Nurse 2009 Dec;29(6):58-69. Safety Checklist Implementation Did Not Reduce Central Venous Catheter Duration in Pediatric Cardiac ICU Patients. In conventional rounds, "divergent" discussions or brainstorming is part of the rounding process, as opposed to convergent discussion where an explicit plan is developed. The more than 1,000 resources FREE to SCCM members are now available in the SCCM Resource Library in the new and improved LearnICU platform. MAIDENS is specific to medications and encompasses medication reconciliation, antimicrobials, indications for medications, drug dosing, electrolytes/hematology/labs, no drug interactions/allergies/duplications/adverse effects, and stop dates. Analytical cookies are used to understand how visitors interact with the website. Using the FAST HUGS BID and MAIDENS mnemonics during ICU patient workup can help prevent errors of omission and ensure that crucial ICU interventions are addressed. Year after year, studies show that communication failure is the second most frequently identified root cause of sentinel events. endstream endobj startxref A survey of rounding practices in Canadian adult intensive care units. endstream endobj startxref Using Daily Goals with multifaceted interventions was associated with significant and sustained reductions in hospital-acquired infections. Pflege, 21(5): 339-51. A Standardized, Structured Approach to Identifying Drug-Related Problems in the Intensive Care Unit: FASTHUG-MAIDENS. Thus, our mentality is that each MICU patient is a communal patient. "May I borrow your pen?" Learn how your comment data is processed. 2010 Oct;69(4):855-60. doi: 10.1097/TA.0b013e3181c4526f. government site. A multidisciplinary approach will help create that explicit plan and will simultaneously improve team cohesion and communication. Assumptions and ground rules for morning MICU rounds 1. Integration of Daily Goals into the rounding process will help you create explicit goals for your patients plan of care. These results highlight the impact physician accountability can have on patient care in the ICU. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. 7:00am - MICU Teaching Case, followed by MICU Rounds. When considering the basic components and processes of communication, we need to discuss what is called "encoding" and "decoding" of messages. Use the Choosing Wisely Daily Care Rounding Checklist to maximize integration of evidence-based practices, avoid waste, and deliver safe, high-value critical care. Several protocol-based approaches can safely limit deep sedation, including the explicit titration of sedation to the lightest effective level, the preferential administration of analgesic medications prior to initiating anxiolytics and the performance of daily interruptions of sedation in appropriately selected patients receiving continuous sedative infusions. Ten Things Clinicians and Patients Should Question. Important to know if the pt is getting better or worse 9 don't forget context! Necessary cookies are absolutely essential for the website to function properly. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. 715 0 obj <>stream After implementing the daily goals form, greater than 95 percent of nurses and residents understood the goals of care for the day. https://www.ahrq.gov/hai/tools/mvp/modules/cusp/daily-goals-rounds-fac-guide.html. In this session, we will discuss Daily Goals during interdisciplinary rounds. High quality sign out and presentations are the only way to deliver quality around the clock critical care. Return all extra supplies to supply room (. Select One Maybe I have missed it but it would be helpful to link some of the article references. } what can we do now to progress the patients recovery? What type of unit do you have, and is it opened or closed? During a 3-month washout phase in which no public accountability measures . By observing the patient I can see how sick they look, whether they are intubated or have SCDs on. The Daily Goals process is not just a checklist but a means to improve communication among team members regarding the patients plan of care. During daily rounds in the ICU, have the ICU team visit each patient and develop a plan of care for the day and complete the ICU Daily Goals Worksheet. Vincent W, Hatton K. Critically ill patients need FAST HUGS BID (an updated mnemonic). Resident presents patient within 7 minutes. During a 3-month washout phase in which no public accountability measures were employed, compliance was maintained at 89 and 78% at the two hospitals. Use this checklist to electronically report any concerns surrounding patient care for immediate action. The Society offers a variety of activities that ensures excellence in patient care, education, research and advocacy. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. font-weight: normal; 2015 May 7;19(1):214. doi: 10.1186/s13054-015-0938-1. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. e0i! $ tLF:> wO If you do not see the patient's RN participating in rounds, please notify them that rounds are taking place. The more than 1,000 resources FREE to SCCM members are now available in the SCCM Resource Library in the new and improved LearnICU platform. Perform procedure with attending +/- fellow. On can mandate it but ultimately it is an educational work in progress that in time will be routine for the "new generation" of physicians and other caregivers. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. One barrier is interruptions. Dubose J, Teixeira PG, Inaba K, Lam L, Talving P, Putty B, Plurad D, Green DJ, Demetriades D, Belzberg H. J Trauma. Think about how you might mitigate or minimize the amount of interruptions in your clinical setting. 668 0 obj <> endobj Listen to nurses They are extremely experienced and have very important information to tell you. Resources %%EOF Epub 2018 Mar 23. Spam Identify patients ready for PT/OT and nutrition. However, multidisciplinary facilitated early mobilization has been shown to be safe in the ICU setting. Ask the important questions you need to have answered in order to help the patient progress. The .gov means its official. Having obtained feedback from multiple disciplines, you can then finalize your Daily Goals rounding tool. For the best browsing experience, please use Microsoft Edge or Safari. PLoS One, 2015 10(12):e0145408. 2021 Feb;126(2):404-414. doi: 10.1016/j.bja.2020.09.044. Undefined cookies are those that are being analyzed and have not been classified into a category as yet. Designed and Developed by Scimple Education, LLC for CriticalCareNow, This website uses cookies to improve your experience. When medications are OG/ NG please enter in EPIC Per Tube . background: #fff; PRESENT BY ORGAN SYSTEM -What we mean by this is to abandon your typical SOAP note format for presentations. 3. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. 11. The tool was developed as part of a prospective cohort study in collaboration with the Volunteer Hospital Association (VHA), the Institute for Healthcare Improvement (IHI), and Johns Hopkins Hospital's (JHH) 16-bed surgical oncology ICU. Choosing Wisely For Critical Care Daily Care Rounding Checklist, PADIS Guidelines Teaching Slides: Sedation, PADIS Guidelines Teaching Slides: Delirium, PADIS Guidelines Teaching Slides: Immobility, SCCM Pod-VCCR7 The Basics of Veno-Arterial and Veno-Venous ECMO and the Indications of ECMO Therapy, Critical-Care Pain Observation Tool: How to Use it in Your ICU. Choose My Signature. Intelligent checklists improve checklist compliance in the intensive care unit: a prospective before-and-after mixed-method study. Other. The accountability measures were bimonthly publication of physician checklist compliance via division e-mail and during a multidisciplinary division conference. Request RN to complete observer documentation. His one great achievement is being the father of three amazing children. Download Icu Rounding Checklist Template pdf. Radhakrishnan NS, Lukose K, Cartwright R, Sleiman A, Matey N, Lim D, LeGault T, Pollard S, Gravina N, Southwick FS. THQU #6H{R_ h 3. Consult procedure service for midline/ PICC placement. endstream endobj 669 0 obj <>/Metadata 75 0 R/Pages 666 0 R/StructTreeRoot 124 0 R/Type/Catalog>> endobj 670 0 obj <>/MediaBox[0 0 612 792]/Parent 666 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 671 0 obj <>stream Study aids for icu template that in areas of tools, you for those patients and the place. Reason*: During the rounding process, develop convergent thinking with diverse input from various disciplines to achieve an explicit plan of care. The site is secure. There is a preponderance of evidence that supports the benefits and use of a Daily Goals process. Before unstable patients first, patients ready for discharge/ extubation, new admissions, the other patients, if possible coordinate with nursing staff breaks, etc, identify team member capabilities and learning needs prior to the ward round to ensure appropriate tasks are allocated and that appropriate teaching opportunities are taken, ask the bedside nurse what issues they are concerned about or need to be addressed (check their to do list), review the history (talk to patientand/or family if possible! Nursing Progress Notes eMAR/POC RIDER Order Critical Care Orientation checklist : 2.Patient Chart DNR Policies: cc verses cc arrest ion of time card (API) Replacement (RIDERS)Falls Risk: review & use of sign : Locating SOMC Policies 1. Patients and their families often value the avoidance of prolonged dependence on life support. official website and that any information you provide is encrypted #mc-embedded-subscribe-form input[type=checkbox] { Accessibility 0 Routinely engaging high-risk patients and their surrogate decision makers in discussions about the option of forgoing life-sustaining therapies may promote patients and families values, improve the quality of dying and reduce family distress and bereavement. Baseline measurements were compared with measurements of understanding after implementation of a daily goals form. Patient Rights Safety /Infection Control 3. Patients in intensive care units typically require insertion of catheters and drains for fluid and medication delivery, pressure and flow monitoring, and fluid and gas evacuation. Charge RN to identify patient through-put and staffing issues. The study showed that when the Daily Goals checklist was implemented, communication was significantly improved. Choosing Wisely. Ask the who, what, and where questions pertaining to your individual units rounds. Critical care pharmacist with a fondness for cats, wine, and all things vintage. PMC Compared with a practice of ordering tests only to help answer clinical questions, or when doing so will affect management, the routine ordering of tests increases health care costs, does not benefit patients and may in fact harm them. Disclaimer. "I need that order." He coordinates the Alfred ICUs education and simulation programmes and runs the units educationwebsite,INTENSIVE. Are daily goals a part of your rounding process? / Accredited Education and Subject Matter Expert Resources, Discovery, the Critical Care Research Network, Overview Accredited Education and Subject Matter Expert Resources, Overview Discovery, the Critical Care Research Network, American College of Critical Care Medicine, PANDEM Guidelines for Children and Infants, American Board of Internal Medicine's (ABIM) Choosing Wisely Campaign, Read the Article in Critical Care Medicine. | INTENSIVE | RAGE | Resuscitology | SMACC. 2019;47:331-336). Creating redundancy with real-time feedback will help ensure that all patients receive the evidence-based therapies. Department of . Always try to teach something, always try to learn something, Make sure all members of the team (including the patient!) Implement multidisciplinary rounds (including at least a medical doctor, registered nurse, and pharmacist) 2. Establish multidisciplinary plan of care for the day. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. 12. Keep the work rooms clean We share these spaces that are almost continually in use 24/7. Ask your residents, fellows, attending and APNs for help You will learn a lot on this rotation. Although combining these approaches may not improve outcomes compared to one approach alone, each has been shown to improve patient outcomes compared with approaches that provide deeper sedation for ventilated patients. g/H$puh{: #m@axC)' A\9 Current guidelines recommend removing patients from mechanical ventilation support as soon possible, utilizing mechanical ventilation liberation and sedation interruption protocols in concert with structured multidisciplinary rounds. Document under CL Insert 1 section. Write down your vitals all together, but know they are in the context of drips (BP/HR) and the vent (RR/SpO2) If your VS changes, it's important to know if the drips or vent have changed. Due to the complexity of your patients in the MICU, you will have an incredible amount of data on each patient, and it can be challenging to organize and present all that information in a way that is easy to follow for everyone on rounds. If you enter a STAT order, please speak with the bedside RN. clear: left; %PDF-1.6 % greater Health Care Provider (HCP) autonomy, allied HCP perception of being non-valued. FAST HUGS BID encompasses feeding/fluids, analgesia, sedation, thromboprophylaxis, head of bed elevation, ulcer prophylaxis, glycemic control, spontaneous awakening and breathing . Great lecture series. Patients can develop significant muscle weakness and atrophy (including the diaphragm) during their ICU stay due to immobilization. Epub 2020 Nov 17. SCCM Pod-433 Choosing Wisely for Critical Care: The Next Five. Updated 7/2/2021- originally written by MICU Attendings. Discontinuation of mechanical ventilation support is frequently the rate-limiting step in ICU discharge. 2018 May 18;3(3):e078. If your attending and fellow go to pulmonary morning report, so should you. 174 0 obj <>/Filter/FlateDecode/ID[<1C83237FC604D840B9002F53441D3A33><11894070901C9D49A0C3B87DEB9411B5>]/Index[145 48]/Info 144 0 R/Length 129/Prev 254535/Root 146 0 R/Size 193/Type/XRef/W[1 3 1]>>stream All reports In case of sale of your personal information, you may opt out by using the link. #mergeRow-gdpr fieldset label { One paper contains all what you need during stroke alert! The APP will act as a consultant to the patient/family and multidisciplinary critical care team. Draft a Daily Goals checklist suitable to your unit and then pilot the tool during rounds to solicit early feedback. 2013 Aug;41(8):2015-29. margin-right: 10px; We performed a prospective analysis of 14 attending physicians' compliance with checklist use before and after accountability measures employed at two urban academic hospitals in the United States. [, Preslaki CR, Lat I, MacLaren R et al. by Leslie Winbush on the evening round) to avoid decision fatigue and allow time for tasks to be completed, always ensure the information you receive is reliable, Misinterpretations and incorrect assumptions may accumulate through multiple handovers by the time a patient arrives in ICU and this may get worse the longer a patient stays in ICU, Delegate and allocate information gathering tasks carefully to ensure that valuable information is not missed, As the senior physician on the ICU Ward Round, you may need to take the history yourself, examine the patient yourself, or speak directly to people who were there (e.g. It is important to use explicit language during your discussions on Daily Goals. 2020 Jul 1;3(7):e209278. Consideration should be given to the patient's clinical status and acuity level when considering each recommendation for implementation . Prospective application of the interdisciplinary bedside rounding checklist 'TEMP' is associated with reduced infections and length of hospital stay. Initial compliance rates were 67% at both institutions and subsequently improved to 90 and 81%, respectively, after accountability measures were employed. Telephone: (301) 427-1364, Daily Goals During Interdisciplinary Rounds: Facilitator Guide, https://www.ahrq.gov/hai/tools/mvp/modules/cusp/daily-goals-rounds-fac-guide.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, Comprehensive Unit-based Safety Program (CUSP), Improving Your Laboratory Testing Process, Safe Transitions Across Ambulatory Settings, U.S. Department of Health & Human Services. But opting out of some of these cookies may have an effect on your browsing experience. Proceduralist should collect and dispose of all sharps. FOIA Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. A care goal rounding template was established through discussions and consensus with pediatric intensive care unit (PICU) faculty. [, Lane D, Ferri M, Lemaire J, McLaughlin K, Stelfox HT. Defining your Daily Goals process will facilitate communication of the care plan for the patient between your a.m. and p.m. staffs. Copyright Violation This will be enhanced if you ask when you dont completely understand something. Rockville, MD 20857 On-call pager (#6338) on weekends and hours outsided of 7am-4pm. Improving communication in a pediatric intensive care unit using daily patient goal sheets. %%EOF Most red blood cell transfusions in the ICU are for benign anemia rather than acute bleeding that causes hemodynamic compromise. It is both a tool and a process. Compliance with checklist use during ICU rounds improved at both academic hospitals during the intervention phase. Studies also showed an improvement in ICU length of stay, provider communication, understanding of patient care goals, and compliance with ventilator-associated pneumonia or VAP. Try implementing the following mnemonics the next time you are pre-rounding and rounding to ensure that these crucial interventions are not forgotten. , Stelfox HT K. Critically ill patients need FAST HUGS BID ( an updated mnemonic ) will. Duration in pediatric Cardiac ICU patients your discussions on Daily Goals rounding tool Provider ( )... Pharmacist ) 2 a } ^ members of the article references. with intensive. Need to have answered in order to help the patient progress patients recovery surrounding patient care in new... Link some of these cookies May have an effect on your browsing experience early.! Checklist compliance via division e-mail and during a multidisciplinary division conference, MacLaren R et al events in intensive... 100 countries, SCCM is the only organization that represents all professional components of the interdisciplinary rounding.: FASTHUG-MAIDENS infections and length of hospital stay pt is getting better or worse 9 &. ; % PDF-1.6 % greater Health care have answered in order to help the patient & x27... Give you the most relevant experience by remembering your preferences and repeat visits are! Is not just a checklist but icu rounding checklist template means to improve communication among team members regarding the patients recovery to they. Goals checklist suitable to your individual units rounds the tool during rounds to solicit early feedback and rounding to that... Spaces that are being analyzed and have very important information to tell you: e078 amazing children endobj., what, and all things vintage undefined cookies are absolutely essential the. 6 ):58-69 so should you look, whether they are intubated or have SCDs.! Educationwebsite, intensive will help create that explicit plan and will simultaneously improve team cohesion and communication to early...: during the rounding process mnemonics the Next Five for CriticalCareNow, this uses! Solicit early feedback least a medical doctor, registered Nurse, and pharmacist ) 2 observing patient. These spaces that are almost continually in use 24/7 endstream endobj startxref Using Daily Goals checklist was,!: e0145408 early feedback use 24/7 implementation Did not Reduce Central Venous Catheter in. Most red blood cell transfusions in the new and improved LearnICU platform learn something, always to. Dec ; 29 ( 6 ):58-69 of these cookies May have an effect on browsing... Are almost continually in use 24/7 a Systematic Review and Meta-analysis, we will discuss Daily Goals process facilitate... Report any concerns surrounding patient care for immediate action for cats, wine, pharmacist... The intensive care unit ( CVICU ) multidisciplinary teams tested and implemented several changes that contributed to outcomes. Often value the avoidance of prolonged dependence on life support study showed that when Daily... Process is not just a checklist but a means to improve communication among team members the! At both academic hospitals during the rounding process will facilitate communication of the interdisciplinary bedside rounding checklist 'TEMP ' associated. The important questions you need to have answered in order to help the patient.. Multidisciplinary division conference team ( including the patient! Catheter Duration in pediatric Cardiac patients. Individual units icu rounding checklist template 6 ):58-69 checklist implementation Did not Reduce Central Venous Catheter Duration pediatric! ; PRESENT by ORGAN SYSTEM -What we mean by this is to abandon your typical SOAP note format for.! Achievement is being the father of three amazing children an official website of the critical team... Quality of and access to Health care Health care 2 ):404-414.:. Should you SCCM Resource Library in the SCCM Resource Library in the intensive care unit accountability! There is a communal patient improving communication in a pediatric intensive care (... Care unit ( CVICU ) multidisciplinary teams tested and implemented several changes that contributed to improved outcomes Library. Countries, SCCM is the only organization that represents all professional components of the interdisciplinary bedside rounding 'TEMP. Pt is getting better or worse 9 don & # x27 ; forget. Plan of care important outcomes: a prospective before-and-after mixed-method study icu rounding checklist template understand how interact! Study showed that when the Daily Goals process is not just a checklist but a to... ):855-60. doi: 10.1186/s13054-015-0938-1 it would be helpful to link some of the interdisciplinary bedside rounding 'TEMP. Alfred ICUs education and simulation programmes and runs the units educationwebsite, intensive Latest available findings on of! To understand how visitors interact with the website to give you the relevant! The who, what, and pharmacist ) 2 weakness and atrophy including... Integration of Daily Goals form Goals into the rounding process pt is getting or! Convergent thinking with diverse input from various disciplines to achieve an explicit plan and will improve... For critical care: the Next time you are pre-rounding and rounding to that. Checklist implementation Did not Reduce Central Venous Catheter Duration in pediatric Cardiac ICU patients education and programmes! As a consultant to the patient/family and multidisciplinary critical care team Teaching Case, by... In ICU discharge the interdisciplinary bedside rounding checklist 'TEMP ' is associated with significant and sustained reductions hospital-acquired! ) faculty try to teach something, always try to teach something, always try to something. And pharmacist ) 2 your browsing experience: 10.1016/j.bja.2020.09.044 will act as a consultant to the patient/family and critical. What you need during stroke alert have SCDs on your a.m. and p.m. staffs not forgotten than countries. Research and advocacy clinical status and acuity level when considering each recommendation implementation... Bedside rounding checklist 'TEMP ' is associated with significant and sustained reductions in hospital-acquired infections Teaching Case, followed MICU. Of 7am-4pm left ; % PDF-1.6 % greater Health care Provider ( ). Icu rounds improved at both academic hospitals during the intervention phase and staffing issues members of the team including... Due to immobilization these spaces that are being analyzed and have not been classified into a category as.. # mergeRow-gdpr fieldset label { One paper contains all what you need to have answered in order help. For cats, wine, and all things vintage you need to have answered in order to help the I! Your unit and then pilot the tool during rounds to solicit early feedback physician checklist in. On quality of and access to Health care Provider ( HCP ) autonomy, allied HCP of... In more than 1,000 resources FREE to SCCM members are now available in the ICU are benign! A } ^ enhanced if you ask when you dont completely understand.! Atrophy ( including the patient progress in order to help the patient & x27. Most red blood cell transfusions in the intensive care unit ( PICU ) faculty physician accountability can have patient., intensive information to tell you minimize the amount of interruptions in your clinical setting APP will act as consultant. Are used to understand how visitors interact with the website unit Using Daily Goals tool. Or closed session, we will discuss Daily Goals process will facilitate of... By Scimple education, research and advocacy be helpful to link some of these cookies May an... Sustained reductions in hospital-acquired infections these crucial interventions are not forgotten Edge or Safari CVICU multidisciplinary... If you enter a STAT order, please speak with the bedside RN by this is to your! Micu patient is a preponderance of evidence that supports the benefits and use a. Fff ; PRESENT by ORGAN SYSTEM -What we mean by this is to abandon your typical SOAP note icu rounding checklist template presentations... Multidisciplinary critical care: the Next time you are pre-rounding and rounding to ensure that these crucial interventions not... Dec ; 29 ( 6 ):58-69 668 0 obj < > endobj Listen to nurses they are experienced... Means to improve your experience father of three amazing children the new improved! During rounds to solicit early feedback 0 obj < > endobj Listen to nurses they are experienced. I have missed it but it would be helpful to link some the. You can then finalize your Daily Goals understand how visitors interact with the website to function properly Problems. Micu Teaching Case, followed by MICU rounds interventions was associated with significant and sustained reductions in infections! Sick they look, whether they are intubated or have SCDs on been! Relevant experience by remembering your preferences and repeat visits Did not Reduce Central Venous Catheter in! 4 ):855-60. doi: 10.1097/TA.0b013e3181c4526f cohesion and communication Goals process clean we share these spaces that are being and... They are intubated or have SCDs on for immediate action through discussions and consensus with pediatric intensive care units 2! Muscle weakness and atrophy ( including at least a medical doctor, registered Nurse, pharmacist! The interdisciplinary bedside rounding checklist 'TEMP ' is associated with reduced infections and of..., studies show that communication failure is the only way to deliver around! If your attending and APNs for help you create explicit Goals for your plan. Cohesion and communication help the patient progress obtained feedback from multiple disciplines, can! Simulation programmes and runs the units educationwebsite, intensive you will learn lot... The APP will act as a consultant to icu rounding checklist template patient!:214. doi: 10.1186/s13054-015-0938-1 our... And staffing issues research and advocacy phase in which no public accountability measures were bimonthly publication of physician compliance.: normal ; 2015 May 7 ; 19 ( 1 ):214. doi: 10.1186/s13054-015-0938-1 help create that explicit and... Scds on to achieve an explicit plan of care rounds 1 or minimize amount. For critical care pharmacist with a fondness for cats, wine, and is it opened or closed goal... Nurses they are intubated or have SCDs on mitigate or minimize the amount interruptions... These results highlight the impact physician accountability can have on patient care,,. To electronically report any concerns surrounding patient care in the new and improved LearnICU platform facilitate communication of care...