Introduction. Number of ICUs. First ICU. ICU organization and management. How many total ICUs in your hospital use the APACHE system?

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1 Introduction We are conducting a survey of s as part of an NIH-funded study to understand the relationship between ICU organization and patient outcomes. Please answer the following questions about each ICU in your hospital that uses the APACHE system. We will ask you to repeat the survey separately for each ICU (i.e. if there are two distinct ICUs that use APACHE, you will complete the survey twice). If you are unsure about the answers to some questions, we encourage you to contact that ICU s medical director. All questions pertain to calendar year If major changes were made in the ICU during 2009, please respond about the ICU as it was at the end of the year. We will give you the opportunity to describe any changes at the end of the survey. We anticipate that this survey will take 10-1 minutes to complete. As a token of appreciation, after completing the survey we will you a $0 Amazon.com gift certificate. If you have any questions or concerns, please feel free to contact us at your convenience, either via telephone at or via at nbenson@mail.med.upenn.edu. Please click next to begin. Number of ICUs How many total ICUs in your hospital use the APACHE system? First ICU Please answer the following questions with the first ICU in mind ICU organization and management The first questions ask about how this ICU is organized and managed. Please give a name to this ICU:

2 How would you best describe this ICU in terms of the type of patients usually admitted here? Mixed medical, surgical and cardiac Mixed medical and surgical, no cardiac Mixed medical and cardiac Medical only Surgical only Cardiac (both coronary care and CT surgery) Cardiac (primarily coronary care) Cardiac (primarily CT surgery) Neurological (neurosurgery, neurology, or both) Burn unit Other If you selected other, please explain Does this ICU have a dedicated physician ICU director? An intensivist is a doctor with specialized training in critical care medicine with special responsibilities in the ICU. Which one of these statements about intensivists best applies to this ICU? A. intensivist is available B. An intensivist consults on patients when requested by the attending physician C. An intensivist consults on all patients by ICU policy D. An intensivist has primary responsibility for all patients upon admission E. Intensivists are present but have another role If you selected E, please explain

3 If an intensivist is available, are ALL patients managed or co-managed by an intensivist?, intensivists manage some but not all patients, intensivists manage or co-manage all patients ICU organization and management continued Is one or more intensivist ordinarily present in the ICU during daytime hours for at least 8 hours per day, 7 days per week? ICU organization and management continued Which one of these statements best describes which providers are involved in bedside care during night-time hours (NOTE: by involved in bedside care, we mean either physically present or in the hospital and immediately available for ICU emergencies, such as in an on-call room): An intensivist physician is present in the ICU at night A non-intensivist physician (such as a hospitalist) is present in the ICU at night A resident, fellow or other trainee is present in the ICU at night A non-physician provider (NP or PA) is in the ICU at night clinician is in the ICU at night: ED physicians or hospitalists are available for emergencies Other If you selected other, please explain Does this ICU use a system for remote patient monitoring by intensivists at night (i.e. telemedicine, or the eicu )? ICU care providers The next questions ask about interaction between different care providers in this ICU.

4 Besides physicians and nurses, which clinicians also routinely provide direct patient care in this ICU? (CHECK ALL THAT APPLY) Respiratory therapists Clinical Pharmacists Nutritionists Physician Assistants/Nurse Practitioners Does this ICU have formal, daily multi-disciplinary rounds with care providers other than just the physician and the bedside nurse? ICU care providers continued Which of the following care providers consistently participate in these rounds? (CHECK ALL THAT APPLY) Nurse managers Respiratory therapists Clinical pharmacists Nutritionists Physicians Assistants/Nurse Practitioners ICU care providers continued Which statement best describes the role of respiratory therapists in this ICU? There are no respiratory therapists Respiratory therapists make ventilator adjustments but do not participate in clinical decisions. Respiratory therapists participate in clinical decisions but do not participate in formal, daily rounds Respiratory therapists actively participate in formal daily rounds

5 Which statement best describes the role of clinical pharmacists in this ICU? There are no clinical pharmacists Clinical pharmacists provide drug advice when asked but do not participate in clinical decisions. Clinical pharmacists participate in clinical decisions but do not participate in formal, daily rounds Clinical pharmacists actively participate in formal daily rounds Clinical protocols The next questions ask about the use of clinical protocols and checklists. By protocol, we mean a written clinical pathway that provides a standardized algorithm for caring for patients with a given condition. Does this ICU have an established protocol for liberation from mechanical ventilation (i.e. respiratory therapist-driven trials of spontaneous breathing)? Does this ICU have an established protocol for a low tidal volume ventilation strategy for patients with acute lung injury (i.e. lung protective ventilation)? Does this ICU have an established protocol for management of sedation for patients on mechanical ventilation? Does this ICU have an established protocol for therapeutic hypothermia for treatment of patients after cardiac arrest? Does this ICU use a standardized checklist prior to inserting central venous catheters in order to prevent blood stream infections?

6 General information The last questions ask some general questions about this ICU How many beds are in this ICU? Do medical students, residents or other physician trainees routinely participate in patient care in this ICU? Does this ICU have electronic flow sheets (i.e. bedside charting) for nurses? Does this ICU have computerized physician order entry? Please describe any major changes to this ICU during 2009, or anything else about this ICU you would like us to know: First ICU (2 total) Please answer the following questions with the first ICU in mind First ICU (2 total): ICU organization and management The first questions ask about how this ICU is organized and managed. Please give a name to this ICU: