Transforming Care in the ICU

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 ChangesBig 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 gt150 mg/dL
Goal gt 80
Nurse-driven policy to initiate Insulin Drip
Protocol for two BG gt150 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
FYTD 08 3.45
FY02 5.72
Goal lt4 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