Transforming Care in the ICU Seven Year Path to Excellence

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.

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

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.

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

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

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

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

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

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

Improved Bed Flow Bed Huddles Color Coding System

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

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

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

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