Reduce ICU Length of Stay by goal setting

In my previous article on Critical care or Intensive care(The link betweek efficiency and patient safety), we saw how efficiency can impact patient safety and thereby the outcome. Now let us examine a recent innovation in the area of critical care that has actually accomplished this at the John’s Hopkins Hospital, Baltimore,MD.

The Problem

Poor and inconsistent communication among providers in the intensive care unit (ICU) can lead to a lack of understanding of daily goals and the failure to deliver needed services that accelerate recovery and discharge.
ICU patients tend to have life-threatening problems and complex care needs that require a combination of many treatments and services in order to achieve timely recovery and discharge.
Lack of communication among providers can lead to a lack of understanding about what needs to occur each day in the ICU.
The net result is that patients remain in the ICU longer than necessary, and are at greater risk of harm, including morbidities and mortality.

The Solution

The ICU care team (which includes the attending physician and/or fellow, anesthesia and surgery residents, a nurse practitioner, a nurse, and a pharmacist) visits each ICU patient every day between 20 and 25 minutes and uses the ICU Daily Goals Form to document the This creates a standardized way to communicate with one another and a focussed plan of care.

Expected Benefits

The benefit of this innovation may be greatest with high-intensity patients, such as those in the ICU. It also may be most applicable in academic medical centers and other organizations where ICU care is provided by many different types of practitioners.
Reduced LOS – At Johns Hopkins where this innovation was pioneered, the mean length of stay in the ICU reduced from 2.2 days to 1.1 days

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