Rethinking Critical Care: Decreasing Sedation, Increasing Delirium Monitoring, and Increasing Patient Mobility

Sedation management, delirium monitoring, and mobility programs have been addressed in evidence-based critical care guidelines and care bundles, yet implementation in the ICU remains variable. As critically ill patients occupy higher percentages of hospital beds in the United States and beyond, it i...

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Bibliographic Details
Published in:	Joint Commission journal on quality and patient safety Vol. 41; no. 2; pp. 62 - 74
Main Authors:	Bassett, Rick, Adams, Kelly McCutcheon, Danesh, Valerie, Groat, Patricia M., Haugen, Angie, Kiewel, Angi, Small, Cora, Van-Leuven, Mark, Venus, Sam, Ely, E. Wesley
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Inc 01-02-2015
Subjects:	Critical Care - organization & administration Delirium - diagnosis Delirium - therapy Humans Hypnotics and Sedatives - administration & dosage Intensive Care Units - organization & administration Length of Stay Pain Management - methods Patient Care Bundles Quality of Health Care - organization & administration Reproducibility of Results Respiration, Artificial - methods United States Walking United States
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Summary:	Sedation management, delirium monitoring, and mobility programs have been addressed in evidence-based critical care guidelines and care bundles, yet implementation in the ICU remains variable. As critically ill patients occupy higher percentages of hospital beds in the United States and beyond, it is increasingly important to determine mechanisms to deliver better care. The Institute for Healthcare Improvement’s Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. Case studies of a convenience sample of five participating hospitals/health systems chosen in advance of the determination of their clinical outcomes are presented in terms of how they got started and process improvements in sedation management, delirium management, and mobility. The IHI-RCC program involved one live case study and five iterations of an in-person seminar in a 33-month period (March 2011–November 2013) that emphasized interdisciplinary teamwork and culture change. Qualitative descriptions of the changes tested at each of the five case study sites demonstrate improvements in teamwork, processes, and reliability of daily work. Improvement in ICU length of stay and length of stay on the ventilator between the pre- and postimplementation periods varied from slight to substantial. Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The key lessons of the IHI-RCC program are as follows: the importance of testing changes on a small scale, feeding back data regularly and providing sufficient education, and building will through seeing the work in action.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1553-7250 1938-131X
DOI:	10.1016/S1553-7250(15)41010-4