Comprehensive Unit-Based Safety in Burn ICU Reduces Mortality
Johns Hopkins Bayview Medical Center
Baltimore, Maryland, USA
Team
Stephen Milner, MBBS, BDS, FACS, Chief, Burn Services
Zeina Khouri, RN, PhD, Director of Nursing
Barbara Ward, RN, MSN, Patient Care Manager, Burn Intensive Care
Rowena Orosco, RN, BSN, Safety Nurse, Burn Intensive Care Unit
Mary Clark, RN, BSN, Advanced Practice Nurse, Burn Intensive Care Unit
Laurel Stocks, RN, MSN, Clinical Nurse Specialist
Lisa deGrouchy, RN, MS, Performance Improvement Specialist
Janet McIntyre, RN, MSN, Senior Director, Quality and Patient Safety
Aim
To decrease mortality in the Burn Intensive Care Unit by 25 percent within 12 months by implementing a comprehensive unit-based safety program focusing on improved communication and standardization of care.
Measures
- Mortality (Deaths per 100 Discharges) in the burn population
Changes
In July 2005, the Burn team at Johns Hopkins Bayview Medical Center identified a number of patient safety issues specific to the unit. These issues included a need to improve communication among the members of the patient care team, to standardize practice in the Burn Unit using evidenced-based protocols, and to implement measures focusing on reducing infections in their population. After the initial meetings, the team:
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Developed and implemented a daily patient-specific goal sheet for use by all members of the health care team.
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Adopted a process of having twice daily multidisciplinary care rounds for all patients in the Burn Center as a means of improving communication.
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Implemented a Protocol Committee to address evidence-based practices to be standardized in the Burn Center.
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Completed, adopted and implemented 26 different protocols for care provided in the Burn Center.
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Implemented the blood stream infection bundle as a protocol in an effort to reduce catheter-related blood stream infections.
Results
Summary of Results / Lessons Learned / Next Steps
Following implementation of the multidisciplinary Burn Protocol Committee, the Burn Team began to track mortality rates against the project goal of 3.46 percent. At the end of the fiscal year, the mortality rate in the Burn Program had decreased to a rate of 1.83 percent, in spite of having 65 more patients than in the prior fiscal year and no change in average severity of injury.
Lessons Learned
- Establish a multidisciplinary protocol committee with each member and discipline having equal voice.
- Provide a forum for review, debate, and adoption of evidence-based practices that focus on management of patients with burn injuries.
- Establish clear communication channels for all health care providers within the Burn Program related to protocols.
- Develop an education plan related to specific protocols; include the protocols as part of the orientation program for the unit.
- Set the protocols as the expected behavior within the Burn Program. Ensure that staff and physicians understand that use of the protocols is not optional.
- Identify consequences for not adhering to protocols.
- Monitor compliance.
Contact Information
Janet McIntyre, RN, MSN, CPHQ
Senior Director, Quality and Patient Safety
Johns Hopkins Bayview Medical Center
jmcintyr@jhmi.edu
[Storyboard presentation at IHI's National Forum, December 2006]
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