To address reductions in hospital-acquired infections and enhance patient outcomes in your facility, Critical Care Units must be vigilant in the pursuit of quality. It is important to involve management, staff, and physicians in the development and monitoring of quality indicators. Patients’ diagnoses and co-morbidities will vary by facility location, type of facility, and scope of services offered. Thus, quality indicators should be customized to the patient population that each Critical Care Unit serves.
Training and education of physicians and staff not only on the quality indicators, but prevention strategies is critical to success. Patient management in the critical care setting in areas such as mobility, infection prevention, delirium recognition, and pain control is imperative. This article will provide you with key strategies in the development, implementation, and achievement of quality indicators for your Critical Care Departments/Units.
1. Top quality indicators for critical care patients include:
- Low incidence of:
- MDRO (Multi-Drug Resistant Organisms)
- C. diff (Clostridium difficile)
- Prevention of:
- VAP (Ventilator-Associated Pneumonia)
- CAUTI (Catheter-Associated Urinary Tract Infections)
- CLABSI (Central Line-Associated Blood Stream Infections)
- Pressure ulcers and device-related pressure ulcers
- Implementation of early mobilization
2. Developing and Monitoring Quality Indicators
Ensure that the individuals who are overseeing quality will monitor and follow through on issues discovered. The following people within your facility/department are candidates for developing and monitoring quality:
- Department managers
- Quality department
- Medical director
- Nursing Informatics personnel
3. Customizing Quality Indicators
Since no two Critical Care Units are the same, it is important to customize quality indicators for your facility. Although diagnoses may be similar, populations vary. Your patients’ individual medical backgrounds, histories, and compliance levels should help you determine your quality indicators.
- Quality indicators should be customized based on the type of patients your Critical Care Unit serves
- Evaluate the typical patient profile and diagnoses specific to your unit
- Focus efforts on your patient population
4. Engaging Physicians and Staff in Meeting Quality Indicators
The engagement of physicians and staff is critical to the development and attainment of quality indicators.
- Ask the physicians and staff what they think the focus should be
- Include physicians on the quality teams—establish physician champions and leaders
- Staff at the bedside have the best ideas and know realistically what is practical and logistically possible
- Listen to their concerns: Quickly find solutions to as many of their issues as possible. This process will help build relationships of cooperation and collaboration
- Provide consistent feedback to validate that they have been heard
- Use data to support findings and feedback—Physicians tend to respond well to data
- If certain solutions are unavailable or unattainable, explain why
- Include physicians on quality committees and Performance Improvement teams
5. Patient ManagementImplement multi-disciplinary rounds, which focus on monitoring patients’ progression and the overall total management of the patient, especially the following areas:
- Mental status: Evaluate CAM-ICU and RASS scores to make sure the patient is appropriately pain controlled—not over sedated, to prevent delirium
- Oxygenation: Implement tight VAP prevention controls and practices, and utilize ventilation liberation protocols and spontaneous breathing trials to help in early removal of mechanical ventilation
- Mobility: Utilize early mobility strategies such as PT in the Critical Care Unit, which reduces incidence of delirium, improves oxygenation, and decreases LOS in Critical Care Units
- Cardiovascular and hemodynamic: Once hemodynamic stability is achieved, remove central lines and pressors as soon as possible
- Infections: Use appropriate antibiotic management and meticulous practices to assess and prevent infections. Timely foley catheter removal and implementation of GI protocols support infection prevention
- Skin: Implement vigilant, proactive, and aggressive pressure ulcer prevention practices
- Nutritional Status: Involve clinical nutritionists to assess caloric needs
6. Meeting Quality Indicators
You can excel in meeting your quality indicator goals by focusing on educating, training, and engaging your staff.
- Look at Length of Stay in the ED for ICU admits. The sooner the patient is transferred out of the ED and arrives in the Critical Care Unit or to the appropriate level of care, the better the opportunity for an improved outcome
- Develop tools to monitor each patient’s status daily. These tools will allow your staff and physicians to identify and quickly address concerns as they arise
- Focus on early mobility, as applicable
- Educate staff to recognize delirium
If you have additional questions related to Quality Indicators for Critical Care, or would like to engage Soyring Consulting in the development of tools and processes to improve your Critical Care Department, please contact our team today. Soyring Consulting provides clinical and managerial consulting services to healthcare facilities. Our team has worked in more than 35 states across the United States on healthcare system, hospital, and department-specific projects. By combining our experience, proven knowledge, and time-tested skills, we work with your team to identify targeted opportunities along with plan development and implementation.