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Intensive Care

The intensive care unit (ICU) provides highly complex medical care requiring precision, synchronization, and coordination of multiple services and personnel.

 

Among the most challenging aspects of this clinical setting is the necessity to avoid complications from ventilators and central lines, particularly ventilator-associated pneumonia (VAP) and catheter-related bloodstream infections.

 

The consistent application of best science using protocol-based strategies for ventilator management, ventilator weaning, sedation and analgesia management, and central line protocols have proven to significantly improve outcomes and reduce costs.

 

This process involves implementing an ICU model of care that establishes an organized system of ICU care, including daily rounds and daily goals, and improving clinical outcomes through the use of care "bundles" (for patients requiring ventilators and central lines) and the implementation of Rapid Response Teams to avoid "failure to rescue" scenarios.

 

Implementation of these changes can help improve ICU length of stay, ICU mortality, and overall hospital mortality. These results have been demonstrated in the literature and in IHI’s collaborative efforts. These interventions are detailed extensively herein and available now for performance improvement in your hospital.


Implement the Ventilator Bundle
Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees the early recognition of pneumonia along with the uniform and consistent application of the best evidence-based practices.

Implement the Central Line Bundle
The Central Line Bundle is a series of interventions that helps to decrease the incidence of catheter-related bloodstream infections.

Establish a Rapid Response Team
The Rapid Response Team — known by some as the Medical Emergency Team — is a team of clinicians who bring critical care expertise to the bedside.

Implement Multidisciplinary Rounds
Multidisciplinary rounds enable all members of the team caring for critically ill patients to come together and offer expertise in patient care.

Implement Daily Goals Assessment
Daily goals assessment allows teams to keep track of plans established either on patient care rounds and/or multidisciplinary rounds and to verify their completion.

Implement an Intensivist Model in the Intensive Care Unit (ICU)
Establishing an intensivist led model of ICU care has improved ICU mortality and decreased length of stay.

Implement Effective Glucose Control
Effective glucose control in the ICU has been shown to decrease morbidity across a large range of conditions and also to decrease mortality.

   


Improvement Tip

What is a "bundle"?

 

A "bundle" is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. Providing each element of care within a bundle leads to more reliable care for patients.


Examples of bundles include:

 

 

Read more about bundles: