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Johns Hopkins University, Submitted by Peter Pronovost, MD, PhD
Baltimore,
Maryland,
USA
The goal of the ICU Daily Goals Worksheet is to reduce ICU length of stay and mortality while increasing the care team’s understanding of the daily goals for patients in the ICU, including what work needs to happen for the patient to leave the ICU; what is the greatest safety risk to the patient; what are the key processes for ventilator patients; what are the scheduled labs for the patient; catheter; and what can be done to assist in facilitating communication with the family.
The tool is designed to facilitate explicit communication, allow for independent redundancy, require local modification, empower nursing, increase nurse morale, and avoid duplicate work.
Background
The tool was developed as part of a prospective cohort study in collaboration with the Volunteer Hospital Association (VHA), the Institute for Healthcare Improvement (IHI), and Johns Hopkins Hospital's (JHH) 16-bed surgical oncology ICU. All patients admitted to the ICU were eligible. The main outcome variables were ICU length of stay (LOS) and percent of ICU residents and nurses who understood the goals of care for patients in the ICU. Baseline measurements were compared with measurements of understanding after implementation of a daily goals form. At baseline, less than 10 percent of residents and nurses understood the goals of care for the day. After implementing the daily goals form, greater than 95 percent of nurses and residents understood the goals of care for the day. After implementation of the ICU Daily Goals Worksheet, ICU LOS decreased from a mean of 2.2 days to 1.1 days.
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