Reducing 72-hour Returns to the ICU: Success in Rapid Process Improvement
The overarching goal of this project was to reduce the rate of returns to the ICU within 72 hours from the intermediate care unit (TCU) from 19% to 12%.
Relevance/Significance:
The changes resulting from examining the previous process of patient handoff and follow-up resulted in increased communication between staff of both units and between providers,increased staff satisfaction, reduction in LOS rate, and subsequent cost savings. This project aligns well with the conference objective of disseminating and implementing best practices in evidence-based, interprofessional, patient-centered care.
Strategy and Implementation:
Once a spike in returns to the ICU was identified, an interdisciplinary group (providers, RTs, bedside staff, management, and a Lean Six Sigma consultant) convened to evaluate opportunities for improvement in the process of patient transfers/hand-off. Using Lean Six Sigma methodology and tools, areas for improvement were identified, a plan was laid to make positive changes, the staff and other disciplines were prepared, and the modifications went live January 26th, 2015. Improvements to the process included mandatory bedside report and assessment at the time of transferring out of the ICU to TCU, 72-hour follow-up by the ICU CNS and charge nurse, education to providers of TCU capabilities, and education to TCU staff on early detection of clinical deterioration.
Evaluation:
To date, of the 77 patients transferred out of the ICU to TCU, 2 have returned to the ICU within the 72 hour window. Debriefs are being conducted for each identified bounce back. Post-surveys from the multidisciplinary team and their respective departments revealed an increase in satisfaction (nursing) and improved communication (all) and collaboration, and reduction in LOS.
Implications for Practice:
Streamlining process improvement strategies by using an established PI methodology can enable multidisciplinary teams to convene and uncover opportunities for change in the nursing process. In addition, successful strategies in PI can aid in building the evidence base for best practice.