Reducing length of stay in the ICU of a community hospital

Interim ICU leadership helps decrease infection rates and LOS

Improving patient and staff satisfaction, along with ICU performance

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.

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.

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%.

Improving patient and staff satisfaction, along with ICU performance