The Challenge of the ICU

Joe Cantlupe, for HealthLeaders Media , May 13, 2011
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“We all thought that was the price of doing business,” recalls Young. “Some patients would get infections or VAP [ventilator-associated pneumonia], the price of doing everyday care. But we looked at organizations focusing on driving down their mortality rates, and then we looked at ours, and the way we were delivering care to these patients. We found that we were able to make the same kind of progress as those health systems.”

Crozer-Keystone, which includes five hospitals in Delaware, New Jersey, and Pennsylvania, has designed multidisciplinary approaches at its hospitals to promote early detection and rapid resuscitation of patients heading into severe sepsis. The hospital system established committees to identify quality measures to monitor performance and assess clinical practices specifically to develop comprehensive evidence-based sepsis care programs, says Young.

As it focused on reducing sepsis in the ICU, Young says, the health system eventually began to see results. Mortality rates were reduced from 50% in 2008 to 35% in 2010. In one month, December 2010, the mortality rate was measured at 23.4%.

To carry out its program targeting sepsis, Young says Crozer-Keystone followed the Society of Critical Care Medicine’s Surviving Sepsis Campaign guidelines, which include extensive education programs for physicians and nurses.

The team representatives include nurses and physicians from different departments, including the emergency, pulmonary, and pharmacy, Young says, with “each having a role in making rounds, reviewing patients’ medication and profiles.”

 With resuscitation as a focus, the hospital system “created a screening protocol that is nurse-driven and approved by our medical staff leadership so that the nurses could assess their patients and if they felt the patients met the criteria for sepsis they could go ahead” and move forward to obtain laboratory-related work, or other protocols needed to help the patient, Young says.

 Over time, hospitals in a position to standardize and coordinate care of patients with sepsis in the ICU may perform fewer procedures and diagnostic tests, seek the most cost-effective therapies, and eventually minimize the time the patients spend in the ICU, resulting in lower costs without adversely affecting patient outcomes.

Success Key No.2: Rapid response team

Kent Hospital in Warwick, RI, has introduced a rapid response team on patient floors to improve transfers to the ICU, while bringing ICU clinicians to the care units to evaluate patients who are experiencing a change in
their conditions.

Under the program, hospital officials monitor patients who may have had subtle changes in vital signs that could be indicative of a more serious condition, says Michael Dacey, MD, FACP, senior vice president for medical affairs and chief medical officer of the 300-staffed-bed Kent Hospital. In that way, the team responds sooner, which may reduce time a patient needs to spend in the ICU, minimizing logjams in the unit.

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2 comments on "The Challenge of the ICU"

Nick King (5/16/2011 at 11:40 AM)
The article briefly mentions telemedicine but it is worth expounding on. One of the more promising high technology approaches to improving ICU care is the use of tele-ICUs. This technology has been shown to have clinical benefits for patients and cost-saving benefits for hospitals and insurers. By staffing specially-trained critical care doctors and nurses in a command center to monitor and care for patients in multiple and remote hospital units, tele-ICUs can also absorb the expected increase in ICU demand at a time when there is a shortage of critical care cluinicians. Command centers can be licensed to monitor up to 500 adult ICU beds. Recent research on tele-ICUs is worth a read:

Scott Arnold, PT (5/13/2011 at 2:14 PM)
I would like to add to the above items the impact early ICU patient mobility programs are having on reducing ICU length of stay and improving quality of life of ICU survivors including vent-dependent patients. Physical and occupational therapists have partnered with intensivists and nursing staffs at our hospital to get ICU patients moving as soon as possible. Evidence-based literature shows the safety and cost-savings associated with this practice change. Scott Arnold PT, Mayo Clinic Hospital, Jacksonville, FL




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