The Challenge of the ICU
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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.
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
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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