1. Improving outcomes in acute spinal cord injury (tetraplegia/paraplegia)
PAMC ICU Outcomes Data 2017

2. Problem identification
Bedside nursing asked for more education on best practice in caring for acute spinal cord injuries
Physicians, nurses, case managers, and therapies asked: “Are we providing the best care possible?” and “How can we do better?”
2016—ICU saw a reduction in VAP rate, but the majority of VAPs declared were Acute Spinal cord injury patients
Team agreed that this population were at high risk for CAUTI, CLABSI, increased LOS, hospital readmission, and other performance, indicators

3. Problem identification: 16 patients, 24 safety events (13 months)

4. Analysis/Information learned
ICU: Acute SCI vs. general ICU
VAP: 28.2 vs. 1.3 (per 1000 vent days)
HAPU 34% vs. 7.5% (patients with HAPI/total patients)
ICU LOS: 11.9 vs. 3.4
Acute SCI house-wide vs. general ICU population
CAUTI: vs (per 1000 line days)
Acute SCI during entire hospital stay vs. house-wide
C-diff versus 6.67 (per 10,000 patient days)
Also noted:
Three 30-day readmissions (1 ED, 2 inpatient) seems disproportionately high

5. Acute Spinal Cord Injury Guidelines
Protocols:
Respiratory/VAP prevention
Bowel regimen
Catheter removal/CAUTI prevention
Pressure Injury prevention
Mobility guide
Communication emphasis—
Positioning/bracing/activity orders
ICU/Rehab
ICU/OR
Caregivers/family/patient

6. Prioritization for Implementation
How will we implement all of the guidelines effectively?
Education focus starting with VAP and HAPU prevention
Acute Spinal Cord Injury Protocol Implemented December 2016

7. Post-Implementation Findings (Dec 2016-Aug 2017)
Zero VAPs and zero 30 day readmissions

8. Post-implementation Outcomes
Similar patient population
Significant reduction in ICU LOS
Significant reduction in VAP rate
Significant Reduction in HAPI rate
(Only pressure injury was one patient with very small suspected DTI on toe. This patient was post- ICU in a department where protocol was not yet fully implemented)
2016 Baseline
N=16
Post- Implementation
N=13
ICU LOS
11.88
8.85
average vent days
15.8
14.7
VAP rate (per 1000 vent days)
28.2
catheter utilization
.66
.59
central line utilization
.31
.63
CAUTI rate (per 1000 line days) 11 16
CLABSI rate (per 1000 line days)
HAPI rate (per patient)
34%
7.5%
Cdiff rate (per patient days)
50.13
47.4

9. Continuing Quality Improvement
Continue focus on VAP and HAPI to sustain improvements
New measures to reduce CDIFF and CAUTI underway
Disseminate EBP for care of acute spinal cord injuries via Epic focused order set November 2017