Public Health: The Intensive Care Units

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Table of Contents

Introduction
Summary of the Project
Purpose of the Program
The Target Population
The Benefits of the Program
The Cost or Budget Justification
Basis of the Project Evaluated
Conclusion
References

Introduction

The intensive care units (ICU) their preoperative settings are multifaceted environment that requires cautious administration. The settings comprise not only of a variety of teams of caregivers but also the adaptation of care processes (Michigan Health & Hospital Association’s, 2013). Notably, communication breakdowns coupled with poor teamwork normally results in damaging medical errors, inefficient operating rooms, and longer hospital stays. Therefore, such dangers call for the implementation of a quality improvement program with multidisciplinary approaches that involves the hospital critical illness team and the surgery team.

Therefore, the imminent objectives should be to look beyond the patient mortality and to focus on the effect of critical illness towards the ICU patient long-term effects. Hospitals require to redesign how it conveys care within the ICU since there are accounts of critical illness in which physical therapy and occupational therapy consultations have not been considered with the result being detrimental to the patient health outcomes. Thus, the problems arise to some extent from the typical practice include maintaining the hospital in critical-care patients intensely sedated and extensively under bed rest. However, latest studies reveal that early rehabilitation along with minimal application of sedation is not just reasonable but also safe.

Summary of the Project

This program contains five phases that aim at transforming the ICU into an effective and efficient unit of the hospital. To achieve this, the program will transform the work culture within the ICU to be more rigorous and goal oriented. In so doing, it produces considerable safety improvements (Johns Hopkins Health System, 2013). The program entails empowering ICU personnel to take on responsibility for safety within their environment. Such a move utilizes education, responsiveness, the right to use organizational resources as well as a toolkit comprising every intervention. This program targets numerous problems including patient falls, the ICU-acquired infections, and medication administration slip-ups. Furthermore, the program calls for the hiring of a full-time physical therapist and an occupational therapist specialists since the preoperative patients have a high record of muscle weaknesses, damaged physical function, and impairments in their cognition. Such problems have been induced and made worse due to the hospital policy of maintaining critical care as a part-time program with the lack of a full-time rehabilitation assistant (Johns Hopkins Health System, 2013).

Moreover, the program calls for the implementation of current sedation practices. This entails moving away from the application of existing incessant intravenous combinations of benzodiazepines with narcotics, to only of necessity bolus doses (Johns Hopkins Health System, 2013). The approach of this project focuses on endorsing a culture of safety through the use of daily basis patient goals-sheets. Currently, the ICU labor force of the hospital comprise of a combination of steady, recurring, and impermanent or temporary clinicians. Consequently, this program offers a modern category of permanent providers using a standardized approach of care. To achieve this, there will always be a unit of nurses and physicians who will be working around the clock within the ICU (Johns Hopkins Health System, 2013).

Purpose of the Program

The intention of this program is to decrease the mortality of ICU patients arising from septic shock from the present 38% to 20% (Johns Hopkins Health System, 2013). This program seeks to harmonize guidelines on physical and occupational therapy consultations. Consequently, it will determine the safest time for ICU patients to acquire such therapies. Therefore, this program will focus on weaning ICU survivors off sedation and ventilators. This will minimize the ventilator-related pneumonia in addition to cutting down on ICU and overall lengths of stay. This program will also seek to minimize central line-connected bloodstream infections as well as VAP. Furthermore, it will aim at enhancing clinician-to-clinician contact and communication using a checklist to ascertain observance to infection-management practices ( American Hospital Association , 2012).

The Target Population

This program will primarily target ICU survivors, the ICU workforce, and the hospital physical and occupational therapy staff.

The Benefits of the Program

This project will reduce healthcare-linked infections, which then eradicates deadly and expensive infections. Through this program, the hospital ICU can survive over a year without an infection.

The Cost or Budget Justification

It is estimated that $200,000 will be required to set up this project since the project will focus on training the existing ICU staff, hiring temporary personnel into permanent positions, acquiring facilities for the physical and occupational therapy, and then implementing the uniform standardization of medicine. In addition to the above, supplementary qualified but permanent physical occupational therapists are required. This will result in additional salary expenses. Thus, the hospital seeks partial sponsorship for this project and the remaining amount will be repaid partially on a monthly basis from the revenues generated from the hospital. The client relations department of the hospital will handle the cyclic maintenance of the critical-care physical medicine and the rehabilitation facility.

Basis of the Project Evaluated

The ICU survivors’ satisfaction- survey questionnaire will form the basis for assessing the program performance. Secondly, performance indicators which derive the length of stay of preoperative patients prior to this program and afterwards will be evaluated using the Donabedian Q1 Model is a process improvement methodology which is used to identify quality and safety issues in the ICU, as it also comprises a systematic means of implementing the changes (Curtis, 2006).

Conclusion

It is important that all of the hospital critical-care stakeholders to distinguish and enforce imperative ICU attribute. The most important attributes include quality, value, and most importantly access. Thus, the Comprehensive Unit-based Safety Program fundamental strategy is to push progress in changing ICU care to a highly reliable model that entails enforcing reliable clinical practices through predictable outcomes.

References

American Hospital Association. (2012). Pioneering Hospitals Are Reinventing Intensive Care Units. Web.

Curtis, J. R. (2006). Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team. Crit Care Med , 34(2), 2111–2118.

Johns Hopkins Health System. (2013). The Comprehensive Unit-based Safety Program (CUSP). Web.

Michigan Health & Hospital Association’s. (2013). Keystone project. Web.

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