Critical Care Plus: Idealized ICU Design Project Approaching Completion
Final report expected in peer-reviewed literature
By Julie Crawshaw, Editor, CRC Plus
Vha, a nationwide network of community-owned health care systems and their physicians, and the Harvard-based Institute for Health Care Development are coming down the home stretch on their joint Idealized Design of the ICU (IDICU) project begun more than a year ago.
James Vance, MD, vice president of clinical affairs at VHA/Irving, Tex, says he’s confident the project has found ways to solve many of the chronic and costly problems currently associated with intensive care settings. Vance expects final reports on the project will be published in peer-reviewed literature by the end of this year.
IDICU was conceived to develop new designs for care that will produce better clinical outcomes, much higher levels of patient and family satisfaction, lower costs, and improved satisfaction and retention rate among ICU providers, Vance says. He notes that the 11 hospital teams that have been meeting as a group with progress-interval coaching since early spring of 2001 may continue to work together after the formal collaborative series ends this June. Critical care experts, most of whom are intensivists, serve as faculty for workshops.
IDICU focuses on patient and family members, Vance says, guaranteeing for the patient such things as timely and appropriate care from an appropriate provider and the assurance that evidence-based medicine will underlie the ICU care.
Vance says IDICU "puts the patient in middle, surrounded by a care team working around the patient’s needs." The care team, he adds, is supported by leadership that ensures needed resources are at hand to provide optimum and cost-effective care. "This system has been working great," Vance says. "The teams are highly engaged communicating daily on a list serve, sending out questions and getting answers back almost instantly."
Vance says certain themes are evolving. "You find that many are struggling with the same things, which has driven bringing in experts in those areas," he says, adding that VHA has provided robust measurements for data tracking.
Each IDICU team provides monthly input and receives quarterly reports on progress in meeting improvement goals. The first few months of the project, Vance says, saw significant progress in reducing infection rates and clotting problems, improving efficiency getting in and out of the ICU, and increasing patient and family satisfaction.
With today’s much sicker patient population, Vance observes there’s a bottleneck getting into and out of the ICU today. The underlying IDICU "driver," he adds, is developing standards that allow patients who really need ICU to be admitted, then move to a monitored step-down unit with specialty nursing when they’re better.
Thus far, hospitals participating in the IDICU collaborative have begun to:
- Establish daily goals for each patient written on the treatment plan for each day;
- Monitor patients with control charts to anticipate risk and identify potential problems that could worsen patient’s condition;
- Use multidisciplinary rounds as a hub so patient is almost always seen by coordinated group of specialists, which more efficiently coordinates disciplines;
- Communicate team findings and actions with patient’s family;
- Set and track quality, safety and productivity goals for ICU;
- Look at business end by measuring financial liability.
The umbrella that circles the whole process is improving leadership and systems, Vance says, by putting clear, accurate protocols in place. The IDICU teams track and measure compliance with protocols and outcomes through the various layers of care. For more information, contact James Vance, MD, at (972) 830-6908.
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