IT MATTERS! RIGHT CARE, RIGHT LOCATION, RIGHT PHYSICIAN BEST OUTCOME! Implementation of an Intensivist Model in the ICU

Oconee Regional Health System Milledgeville, Georgia Includes: Oconee Regional Medical Center Jasper Hospital/Retreat Nursing Home Cancer Treatment Center Wound Healing Center Oconee Orthopedics Oconee Family Practice Oconee Primary Care Hospital Services Offered *Emergency Department- 30,000+ annual visits*Medical/Surgical/Telemetry/Peds Unit *Women’s and Newborn Services- Level I with 600 deliveries/year*Skilled Nursing Unit- 15 beds *Critical Care-ICU and Intermediate Care Unit*Surgical Services

Focus 12 bed Adult ICU 3 Board certified Pulmonologists Goals Improve ICU throughput Decrease ICU LOS Improve patient outcomes for HAC’s Objective

Developed physician contract (including 24 hr. coverage) Intensivist in ICU 7a-7p On call for remaining 12 hours Hospitalist to field ICU admits/consults Establish buy in from stakeholders Including Quality Board, Hospital Board, MEC, staff physicians Establish daily rounding w/ multidisciplinary team Discussed the “why” behind the approach Input on what to include in rounding Expectations of team members Report Tool Developed by ICU nurses & Intensivists For handoff as well as for rounding w/ MD Project Planning

Assigned scribe daily Record any issues, ideas, or changes needing immediate attention Track items to be discussed at end of initial 2 weeks Metric dashboard created (including HEN model) VAP/CLABSI Foley catheter days Central line bundle compliance 90 day data collected & compared w/ Previous year Establish daily rounding w/ multidisciplinary team Discussed the “why” behind the approach Input on what to include in rounding Expectations of team members Report Tool Developed by ICU nurses & intensivists For handoff as well as for rounding w/ MD Implementation (January 2014)

Patient assignments When ICU census<12, Intensivist assigned to non-ICU pts. Didn’t serve the intent of managing ICU pts. Solution: Quickly corrected assignment to only include pts. contiguous to the ICU. Daily Rounds Significant $ due to 12 disciplines in attendance (5 hrs./wk.) Solution: Decreased team to 5 essential (Pharmacy/Dietary/Case Mgmt./Resp/Infection Control/others ad-hoc) Time of rounds- Insufficient time for Intensivist to get report High volume of meds being administered at this time. Solution: Changed from 10 am to 11am Place of rounds Traffic flow/space/privacy were problematic Solution: Changed to stationary location within the ICU that is accessible to family. Challenges

ICU DAYS: 17 % decrease VENT DAYS: 11% decrease CENTRAL LINE DAYS: 17% decrease FOLEY DAYS: 13% decrease CLABSI: 0 (previous was in 8/13) CAUTI: 3 ICU DEATHS: 35% decrease *Admits relatively same for same period in previous year WINS Infection Control Practitioner involved in rounds Greatly decreased overall catheter days Allowed for Foley process improvement Case Management Involvement Involved much earlier in the patients ICU stay Has led to decrease in ICU LOS Results/Wins Metrics shared throughout organization

Physicians remain engaged with the process A hospitalist is added to rounding during periods of exceptionally high acuity days. Added afternoon rounding time specifically designed to meet family members needs Where we are today