Johns Hopkins University, Submitted by Peter Pronovost, MD, PhDBaltimore,
Maryland, USA
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.
Directions
During daily rounds in the ICU, have the ICU team visit each patient and develop a plan of care for the day and complete the ICU Daily Goals Worksheet. The fellow or attending physician should sign the worksheet and hand it to the patient’s nurse before moving on to the next patient.
All providers, physicians, nurses, respiratory therapists, and pharmacists should review the goals for the day and initial the worksheet three times a day. The team should update the worksheet if the goals of care change.
