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Transforming Care in the ICU

Transforming Care in the ICU

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Transforming Care in the ICU

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Presentation Transcript

  1. Transforming Care in the ICU Seven Year Path to Excellence

  2. Baptist Memorial Hospital-Memphis • Tertiary care hospital • 736 total beds • 68 ICU beds • 38 bed general ICU • 28 medical-surgical beds • 10 bed neuro unit.

  3. Improved Patient Outcomes: • 35% reduction in ICU length of stay • 45% reduction in ICU mortality rate • 47% decrease in central line associated blood stream infections rate • 48% drop in ventilator associated pneumonia rate • 57% reduction in Sepsis mortality rate for protocol patients

  4. Objectives • Foundational Elements • Multidisciplinay Rounds • Intensivist Program • Daily goals • Small Tests of Change • Keep it simple • Small Changes=Big Impact • Reliability • Bundles • Evidence based-care How we did it.

  5. Our Aim • October 2002 • To promote patient/family centered care, prevent harm and improve patient outcomes by providing safe, efficient, evidence-based care.

  6. Transforming ICU Care: • “We ALREADY do all that” • Baseline for Head of Bed 30%, eye opener • Practiced in SILOS – with no determined plan or focus

  7. Established Foundational Elements • Multidisciplinary Rounds • start small • ICU Daily Goal/Patient Plan of Care • Start Small • Intensivist Coverage

  8. Implemented reliable evidence-based practices • Pre-extubation worksheet for RN/RT collaboration in the weaning – start small • Care bundles: Ventilator, Central Line – start small • Glycemic Control- a nurse driven-policy to initiate the Insulin Drip Protocol - start small • Severe Sepsis/Septic Shock protocol and bundles (resuscitation and management) – start small • MRSA screening – start small • Sedation/analgesia protocol and initiatives –start small

  9. ICU Glucose Control Revised policy to institute Insulin Drip Protocol for one BG >150 mg/dL Goal: > 80% Nurse-driven policy to initiate Insulin Drip Protocol for two BG >150 mg/dL

  10. :Implemented processes to identify and rescue worsening patients • Medical Response Team (MRT) • Sepsis Screening- • Code H • Early Warning System

  11. Improved Bed Flow • Bed Huddles • Color Coding System

  12. ICU Length of Stay FY02: 5.72 FYTD 08: 3.45 Goal: <4 days

  13. Implemented processes for integration of patient and family into care: • Flexible “open-visitation” • Family orientation to ICU • Family in MDR • Involved in daily goal settings

  14. Keys to Sucess • Involve frontline staff • Collaboration is Key • Design reliaiblity into processes • Use data to drive improvements • Design processes to be “the way we work” • Enlist Leadership • Celebrate Success

  15. Next Steps • Sustain, Sustain, Sustain • Sedation/Analgesia Protocol • Sepsis Work • Any challenge that will improve care and safety of our patients