Some practical uses of Project IMPACT
From patient placement to extubations
Who's using Project IMPACT - an automated data entry system developed by the Society of Critical Care Medicine (SCCM) in Anaheim, CA - and what are they doing with it? Here are some examples offered by SCCM:
4 Providence St. Vincent Hospital and Medical Center in Portland, OR.
Providence has used Project IMPACT data to analyze the prevalence, risk factors, and outcomes of delirium (encephalopathy) in the critical care setting. Preliminary findings suggest that this condition is common in the critical care setting and is consistently associated with increased mortality. Among survivors, it is strongly associated with increased length of stay and poor return to functional status. The medical center will follow up the preliminary findings to design and test programmatic interventions to improve the negative prognosis for these patients.
4 NorthEast Medical Center in Concord, NC.
NorthEast used IMPACT data to document improvement in ICU care as a result of multidisciplinary rounds, which include nursing, pharmacy respiratory therapy, and nutrition specialists. DVT prophylaxis, enteral nutrition, and length of stay all improved with the adjustment in rounds policy. The center has also used the data to develop a sedation protocol and assess changes in practice patterns and benefits.
4 Spectrum Health, Downtown Campus in Grand Rapids, MI.
Spectrum improved its placement patterns for patients with an ICU length of stay less than 24 hours. Patients who had received an intracoronary stent were transferred to the Medical Intermediate Unit post procedure. Need for subsequent care in the Medical ICU has been rare among these patients.
4 The Leonard J. Chabert Medical Center in Houyma, LA.
Leonard J. Chabert targeted unplanned extubations in its reporting and found an inappropriate number of occurrences of endotracheal tubes being removed by patients and staff members.
A multidisciplinary team consisting of nurse managers, respiratory therapy, medical staff, and quality management staff was convened to develop a response to this problem, with the goal of reducing unplanned extubations by 50%. The team recommended changes including reinforcing endotracheal tube tape with waterproof tape, staff education, patient and family education, and proper placement of soft wrist restraints. The result was a decrease in the number of accidental extubations from 2.63 per month to one per month, with significant cost savings.
4 Baylor College of Medicine in Houston.
Baylor addressed the criticism that prediction models, designed to relate patient condition to probability of survival, are not effective with all groups of patients. The team analyzed the scores for 1,000 patients using four survival prediction methods employed in Project IMPACT: SAPS II, MPMO, MPM24, and APACHE II. Researchers found that the prediction methods performed worse for patients who were extremely ill at admission. In particular, the systems did not work well for very ill neurosurgical ICU patients. Some form of weighting for the severity of head injury is needed, the group concluded.
Participating units are required to submit 86 specified pieces of data on each patient admitted to the critical care unit. This patient data are submitted quarterly to the Project IMPACT central repository. "We have defined the data set from admission to ICU to discharge from the hospital," says IMPACT's General Manager Meg Wilson. The required data include the following types of information:
4 Information about the hospital and ICU.
- Description of hospital.
- Training/education program.
- Description of the ICU.
- Medical director description.
- ICU management information.
- Information about the specific procedures and severity scoring (optional).
4 Patient data.
- Demographics information.
- Admission information/patient status history.
- Assessments made at ICU admission.
- Assessment made within first 24 hours in ICU.
- Physiology during first 24 hours in ICU.
- ICU medical therapies.
- Procedures in ICU and related complications
- Patient complications (not procedure related).
- ICU transfer information.
- Hospital discharge information.
- Information on patients dying after ICU discharge.
- Outcome memo.
- System memo.
4 Optional data elements.
- APACHE II and III scoring.
- Pulmonary artery catheter information.
- ICU tests.
- Blood product transfusions.
- Out-of-ICU patient transfers.
- ICU patient consultations.
- Autopsy & organ donation information.
Information on Project IMPACT is available by contacting the Society of Critical Care Medicine, 8101 E. Kaiser Boulevard, Suite 300, Anaheim, CA 92808. Telephone: (714) 282-6066. Fax: (714) 282-6050. E-mail: [email protected].
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