This issue contains a series of articles focused on various initiatives aimed at improving the quality of patient care delivery and promoting safe passage across the continuum of care. Exemplary, evidence-based nursing practice is the cornerstone of quality care, and this issue highlights many ways in which nurses have led changes to optimize patient outcomes. In addition, quality care enhances cost-effectiveness by reducing avoidable complications and diminishing avoidable hospital readmissions, a concept more important than ever due to value-based purchasing and the Affordable Care Act. Articles are specifically devoted to prevention of delirium in critical care patients, palliative care in the intensive care unit, prevention of pressure ulcers, fall prevention in high-risk patients, prevention readmissions, preventing sepsis mortality, and nursing interventions in the elderly critical care patient, to name a few.

In consultation with Consulting Editor, Dr. Jan Foster, Drs. Garbee and Danna have put together a state-of the-art issue of the Critical Care Nursing Clinics devoted to Quality Outcomes and Costs. Clinical review articles are specifically devoted to the following: Information Technology, Electronic Medical Records, and Practice Alerts; Telehealth Use to Promote Quality Outcomes and Reduce Costs; Impact of a Mobility Team on ICU Patient Outcomes; MACRA and MIPS Impact on Quality and Cost Outcomes; Leadership’s Impact on Quality, Outcomes, and Costs; Big Data Sets Use for Quality, Outcomes, and Cost; Pediatric Quality Metrics Related to Quality Outcomes and Cost; Geriatric Outcomes Related to Quality and Cost; Mental Health/Behavioral Health Metrics; Obstetric Quality Outcomes and Cost; Emergency Department Throughput; and Veteran Outcomes. Readers will come away with the latest information they need to improve quality and improve out comes in critically ill patients.

In this issue, guest editors bring their considerable expertise to this important topic.Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

In this issue of Critical Care Nursing Clinics, guest editor and Instructor of Clinical Nursing Dr. Sherry Rivera brings her considerable expertise to the topic of Nephrology. Nurses care for patients with acute, chronic, and end-stage kidney disease in all patient care settings. Early recognition of risk and disease can improve health outcomes and delay progression of disease. In this issue, top experts provide expert coverage of issues frequently encountered when providing nursing care to individuals with kidney disease. - Contains 14 practice-oriented topics including medications and the kidney; race-based estimated glomerular filtration rate; acid-base disturbance and electrolyte disorders in nephrology patients; complications of kidney disease; COVID-19 and kidney disease; and more. - Provides in-depth clinical reviews on nephrology in critical care nursing, offering actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Dr. Chapa has assembled top-notch authors to write clinical reviews on the important topic of psychologic issues in the ICU. The issue focuses not only psychologic issues of patients in the ICU but also on issues facing critical care nurses working in the ICU. Articles are devoted to the following topics: Caring for the Caregiver in the ICU; Delirium vs. Dementia in ICU; Pediatric Delirium in ICU; Sarcopenia and Psychosocial Variables in ICU; Impact of Early Mobility in ICU on Psychological Issues; Intensive Care Syndrome; PTSD in ICU Nurses; Burnout Syndrome; Management Strategies in the ICU to Improve Psychosocial outcomes; and Psychologic Issues of Patient Transition from Intensive Care to Palliative Care. Readers will come away with current information they need to provide quality care with positive patient outcomes.

Intensive care units (ICUs) provide comprehensive, advanced care to patients with serious or life-threatening conditions and consequently, a significant amount of end-of-life care (EOLC). Indeed, approximately 20% of deaths in the U.S. are associated with an ICU stay, and nearly half of U.S. patients who die in hospitals experience an ICU stay during the last 3 days of life. Despite the commonality of the ICU experience, ICU patients typically suffer from a range of distressing symptoms such as pain, fatigue, anxiety, and dyspnea, causing families significant distress on their behalf. Thus, there is a growing imperative for better provision of palliative care (PC) in the ICU, which may prevent and relieve suffering for patients with life threatening illnesses. Effective palliative care is accomplished through aggressive symptom management, communication about the patient and family’s physical, psychosocial and spiritual concerns, and aligning treatments with each patient’s goals, values, and preferences. PC is also patient-centered and uses a multidisciplinary, team-based approach that can be provided in conjunction with other life-sustaining treatments, or as a primary treatment approach. Failure to align treatment goals with individual and family preferences can create distress for patients, families, and providers. If implemented appropriately, palliative care may significantly reduce the health care costs associated with intensive hospital care, and help patients avoid the common, non-person centered treatment that is wasteful, distressing, and potentially harmful. Due to the success of many PC programs, administrators, providers, and accrediting bodies are beginning to understand that palliative care in the ICU is vital to optimal patient outcomes.

In Collaboration with Consulting Editor, Dr. Jan Foster, Drs. Martin and Badeaux have created an issue where top authors in critical care nursing provide current updates on sepsis care and management. Authors have written clinical reviews on the following topics: International Sepsis Guidelines 2016; Pros and Cons of Early Administration of Intravenous Fluids; PTSD After ICU Stay; Role of Vitamin C and Carbon Monoxide in Sepsis; Neonatal Sepsis; Use of Etomidate in the Septic Patient; Simulation to Manage the Septic Patient in the ICU; Cardiogenic Shock Complicating Sepsis management; Hospital Costs associated with Sepsis Compared to other Medical Conditions; Special Considerations for the Septic Patient Going to the Operating Room; Management of the Septic Patient in the Emergency Room; and Management of Sepsis in the Obstetrical Patient. Reader will come away with the information they need to improve patient outcomes.