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Pituitary adenomas (PAs) are common and often require complex multidisciplinary care with multiple specialists. This may result in a healthcare system that is challenging for patients to navigate. Audits of care at our institution revealed opportunities for improvement to better align care with patients’ needs.
A quality improvement initiative that incorporated a patient advisory committee of patients who had received treatment for PA at our center and their family members were used to help identify opportunities for improvement. The patient-identified gaps in care included the need to coordinate and minimize appointments and the desire for better communication and education. Based on this information, changes were implemented to the pituitary program, including increasing access to the Multidisciplinary Clinic and developing a standardized and centralized triage process.
A pre- and post-intervention analysis consisting of retrospective chart reviews revealed that these changes had an impact on wait times for first assessment, and a significant shift in the location of this first visit – with a larger proportion of patients being seen in the Multidisciplinary Clinic after an intervention.
We demonstrate that patient involvement, beyond individual patient–physician interactions, can lead to meaningful and observable changes, and can improve the quality of care for PA.
Analgesia and sedation are frequently used in intensive care unit (ICU) patients. Appropriate analgesia is of great importance in ICU patients. Fentanyl is the most frequently used drug for this purpose but can lead to a substantial overhang after prolonged administration. Remifentanil is a promising alternative with a stable context-sensitive half-life. Agitation is the most frequent reason to sedate the patient, and the drug of choice is usually midazolam. There is a growing trend to use propofol in ICU sedation. Propofol has the advantage of less accumulation and, therefore, has a more stable context-sensitive half-life. Although propofol seems to be an almost ideal sedative, there is concern about the propofol infusion syndrome. Volatile anesthetics are frequently used for anesthesia in pregnant patients. More recently, volatile anesthetics have also been used for sedation in the ICU.