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Improvement Report: Decreasing the Incidence of Antibiotic Resistant Infection and Colonization in the ICU: A Multidisciplinary Collaborative
Patients with drug resistant organisms (DRO) have a documented higher rate of mortality, complications, and ICU hospitalization. The team at Maine Medical Center (Portland, Maine, USA) responded to an outbreak of VRE and MRSA in the Special Care Unit and implemented changes that led to a dramatic and sustained decrease in the incidence of DRO.
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Improvement Report: Real Change Leads to Improved ICU Patient Care
Baptist Memorial Hospital-Memphis (Memphis, Tennessee, USA) achieved improved ICU patient outcomes, including reduced rates of ventilator associated pneumonia, catheter-related blood stream infections and decreased ICU length of stay, by implementing evidence-based practices (e.g., ventilator and central line bundles), promoting patient-centered care, and by developing a culture of collaboration and improvement.
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Improvement Report: Reducing Ventilator-Associated Pneumonia
Naval Medical Center San Diego (San Diego, California, USA) developed and implemented a ventilator bundle protocol that led to a decrease in mechanical ventilator days and a decrease in ventilator-associated pneumonia by almost 100 percent.
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Don Berwick's Challenge: Eliminate Restrictions on Visiting Hours in the Intensive Care Unit
I would like to make a rather bold suggestion regarding "visiting hours" in critical care units. After several years of work in the IOM "Chasm" report context, ongoing instruction from Susan Edgman-Levitan and other true experts in authentic "patient-centeredness," many exchanges with scholars in service industries, and study of leading-edge redesign efforts like Planetree, I have come to believe strongly that visiting restrictions of any type in intensive care units are relics, which will be proven to be unnecessary, and potentially even harmful to the trajectory of healing, communication, and patient safety.
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A Challenge Accepted: Open Visiting in the ICU at Geisinger
Open visiting hours: Allow family members to visit loved ones in the intensive care unit whenever they want, for as long as they want, 24/7. When Donald Berwick, MD, IHI's President and CEO, issued this challenge to the hospitals enrolled in IHI's IMPACT network, several rose to the occasion. Geisinger Medical Center, in Danville, PA, tells the story of how doctors, nurses, patients, and families responded to the change.
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Improvement Report: Revising Inappropriate Admissions and Lengthy Stays
At Northside Hospital (Atlanta, Georgia, USA) we were able to increase the number of appropriate patient days by 9 percent and save a projected $305,000 in annual costs with no negative impact on the 24-hour readmission rate to the Critical Care Department.
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