Critical Care: Safety & Quality

Critical Care TeamStamford Health’s Intensive Care Unit (ICU) provides patients with the safest and most advanced intensive care in a patient-centered, family-friendly setting. The ICU is equipped with state-of-the-art technology, from highly sophisticated bedside monitors to leading-edge ventilators and defibrillators. A distinguishing feature of our approach to critical care is the numerous multidisciplinary patient care protocols that have been developed to guide many aspects of the daily care of patients in the Unit.

Care for the Critically Ill

Patients with critical illness require very specialized care and expertise. Because of the complexity of this patient population, a focus on quality of care is essential. Survival for these patients can be improved by using a number of different types of interventions. These interventions include the skill and training of the staff in the Intensive Care Unit (ICU), precautionary steps to prevent infections and complications, and adherence to the most up to date professional guidelines.

Approach

Critical Care Team Meeting

The ICU team at Stamford Health is led by a national leader in Critical Care, James Krinsley, MD. A Professor of Medicine at the Columbia University College of Physician and Surgeons, Dr. Krinsley has served in an advisory capacity to professional organizations nationally and internationally, and authored a number of papers and presentations on the subject of best practices for critically ill patients.

The ICU care model employs a team approach to strive for best outcomes. The team includes physicians with board certification in internal medicine, critical care and lung disease who are in the ICU or available 24/7, specialized critical care nurses, pharmacists, respiratory therapists, nutritionists, and palliative care specialists. The team reviews each patient’s care plan and treatment goals daily, including the need for and best use of ventilators, different types of catheters, preventive medications, nutritional intake, and skin care precautions. Several “bundles,” or groups of these interventions, are monitored.

An area where Stamford is a national leader in quality of ICU care is in blood sugar control. Studies have shown that patients who are hospitalized in an ICU, both with and without diabetes, have better survival if their blood sugars are controlled closely. The ICU team developed a protocol where nurses check patients’ blood sugars on admission to the ICU, and based upon these results, follow a physician-ordered continuous insulin protocol with close blood sugar monitoring. (Insulin is a medication that lowers blood sugar). Nurses check sugars frequently and alert physicians, allowing for insulin doses to be adjusted, and for blood sugars to achieve the best range possible. The entire protocol is documented in the electronic medical record.

Results

Joint Commission Codman AwardThe program has achieved excellent results for ICU patients, and was recognized by the Joint Commission, the nation's largest accreditor of hospitals, with its Codman Award for excellence in healthcare quality.

Figure 1 shows the percent of all blood sugars in various ranges among ICU patients at Stamford Hospital. In this chart, you'll see that the percent of ideal blood sugars has increased while the percent of undesirable blood sugars have decreased substantially.

Click Image to Enlarge (Fig. 1)

For more information on the Program’s quality improvement program and approach to care, contact us.

For more information on quality improvement in the field of Critical Care Medicine, visit the Society of Critical Care Medicine.

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