Reducing length of stay (LOS) in the ICU of a community hospital

Interim ICU leadership enables decreased infection rates and LOS with process improvement in healthcare

A 17-bed ICU of a not-for-profit community hospital was struggling with high length of stay (LOS) and infection rates, staff turnover, and an inability to implement sustainable change.

They looked to Philips Blue Jay Consulting to provide a long-term interim ICU leader and help reduce LOS and infection rates, implement performance improvement initiatives, improve staff retention.
 

Results* of the client engagement included:
 

  • Reduced LOS from 4.5 to 2.2 days (51% improvement).
  • Reduced central line associated bloodstream infections (CLABSI) from 10 to 0.
  • Reduced central line utilization rates from 0.529 to 0.294.
  • Increased nursing staff retention rate of 83%.
     

A strategic approach with hands-on implementation

Assessment

As the interim ICU Manager, our consultant made immediate progress to increase staff morale and recommended an overall operational assessment of the ICU. All key stakeholders – including ICU staff, leaders, and providers – were interviewed and observed to document observations of processes, patient and staff flow, and areas of concern.
 

Data was analyzed to assess the flow and environment and identify insights for improvement opportunities. The ICU had inconsistent criteria for intensivist consult which contributed to the high LOS.

 

Approach

Based on the assessment as well as national leading practices and evidenced-based literature, a list of prioritized recommendations was created and new unit goals were agreed upon. Next, a process improvement   implementation plan with supporting leadership structure was developed.
 

Four assistant supervisors were hired and participated in a weekly training and development program to support the new goals of the unit and the organization. A unit based practice council was established; the first of its kind in the organization.  A list of practice issues were prioritized by this group and action plans developed to be reviewed every two weeks with the Chief Nursing Officer (CNO) and the interim leader.

 

Implementation

During the 55-week engagement, several initiatives were implemented including:

  • A hand hygiene program was established based on The Joint Commission tst (Targeted Solutions Tool) program1 with hand sanitizer stations installed at each ICU room and unit entry;
  • TheraWORX® bathing every 24 hours; urinary catheter care monitored;
  • Deep cleaning and painting of the unit; biweekly rounds with Environmental Services;
  • Interdisciplinary daily rounding on all patients; intensivist consult on every patient;
  • Clinical practice policies were updated;
  • Severe sepsis screening with a sepsis order set were added;
  • Enhanced communication with twice daily change-of-shift huddles, frequent and routine staff meetings, and a twice monthly staff newsletter;
  • A Progressive Care Unit adjacent to the ICU was added;
  • A mobility program initiated with business case for dedicated physical therapist coverage.

Results

At the end of the engagement, results* included:

  • Reduced LOS from 4.5 to 2.2 days (51% improvement) in the first quarter following the engagment.
  • Reduced central line associated bloodstream infections (CLABSI) from 10 to 0.
  • Reduced central line utilization rates from 0.529 to 0.294.
  • Hired 38 RN staff with an increased nursing staff retention rate of 83%.
  • TheraWORX bathing conducted on 100% of patients.
     

In addition, AHRQ (Agency for Healthcare Research and Quality) Patient Safety Survey results specific to the ICU included:

  • Supervisor/Manager expectations and actions promoting patient safety: 83% vs 73% for the hospital overall.
  • Teamwork within unit: 90% vs 85% for the hospital overall.
  • I am knowledgeable about the hospital’s quality initiatives: 97%.
  • My Supervisor treats me with respect: 92%.

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* Results are rates measured prior to this engagement compared to rates measured at the end or after the engagement was completed. Results from case studies are not predictive of results in other cases. Results in other cases may vary.

1 The Joint Commission Hand Hygiene tst Program, link.

TheraWORX is a copyright of Avadim Technologies, Inc.