1. ICU Based MD-RN Collaboration: Platform for Performance
Todd E. Griner, RN, MSN, NEA-BC
Claude Killu, MD, FCCP, FACP
Cedars-Sinai Medical Center, Los Angeles, California
I. Multidisciplinary Rounding
Key Strategies for Success
II. Resource Management
III. Front Line Engagement
MD-RN Meeting is co-chaired by an RN who has advanced on our clinical ladder. RNs serve other roles such as contributor and scribe. Medical Director and other ICU MDs are involved. Projects generated out of MD-RN are led by frontline MDs and RNs and are geared directly to the intersection of MD and RN practices. Delivered projects include Difficult Airway Carts, Procedure Carts, and an Electrolyte Repletion Protocol projects include an RN led 6-Part Education Module concerning Procedural Safety in the ICU.
Recognized silos among disciplines have prevented early review of patients’ holistic needs by a multidisciplinary team. In order to counter this deficit, a multidisciplinary team rounds each day. Rounds include Physicians, Social Work, RN Case Management, Clinical Ethicist, Chaplain Service Representative, and Charge RN.
Multidisciplinary Rounding
Resource Management
Frontline Engagement
Clinical Activity – Procedure Cart
MD-RN Lecture Series
Conclusions
MD-RN
Collaborative Structure
Along with the impact on patient care, we have seen a culture shift demonstrated in our 2011 MD/RN community survey ’s survey outperformed 2009 MICU results and 2011 organizational results in each category. The overall effectiveness of the MD/RN Collaborative moved from 3.17 on a five-point scale in 2009 to 4.35 in A regularly occurring MD/RN Collaborative with commitment from both nursing and physicians is a platform for driving patient care success in the ICU and creating a team environment conducive to weathering the challenges of an Urban Tertiary ICU.
Medical ICU MD-RN Collaborative sets a structure where multidisciplinary activities can effectively produce improvements in practices and operations. The monthly meeting model focuses on safety and regulatory issues, electronic health information and HAIs. Learning from each member of the unit and previous cases the committee provides the necessary tools for improving future practices. During 2011, our collaboration operationalized five interventions with direct impact in frontline care.
IV. Bedside Procedure Cart
Ensuring patients have everything they need but nothing more than necessary involved daily patient identification and a monthly ICU Resource Management Dashboard that resulted in the following reductions:
Chest X-Ray repeat dropped 6.8%
Unnecessary repeated blood work dropped by 17%
During bedside rounds, value is assessed by reviewing consultation, imaging, and lab work which are readdressed by obtaining information from the multidisciplinary team serving as a daily reminder to avoid excess.
Our Bedside Procedure Cart prevents infections, disarray and chaos before and during procedures by placing the necessary equipment to be utilized at bedside in a consistent structured manner helpful for nurses and proceduralist.
V. MD/RN Lecture Series
Acknowledgements
MD-RN lectures were provided by the multidisciplinary team to bridge knowledge to the bedside. Examples of a few of the topics covered were: Sepsis, Shock, Blood Gas Analysis, Chest X-Ray Interpretation, Fluid Resuscitation, Antimicrobial Therapy, Acid Base, Mechanical Ventilation, GI Bleeding, Acute Coronary Syndrome, and Blood Transfusion.
The authors offer special thanks and acknowledgement to the contributions of Lorie Sheffield and Barbara Sheppard the RN leads on MD/RN during We also acknowledge the multidisciplinary team which includes: Social Worker Samantha Stewart, Ethicist Virginia Bartlett, Clergy Laura Young, and CNS Jennie Steen. We specifically acknowledge Case Manager Lidia Limenes for data collection on Multidisciplinary Outcomes Data.