Hospitals try to make ICUs less chaotic for patients, families

Custom apps and a focus on families can improve outcomes, experts argue

Some hospitals are redesigning their ICUs—where complex care can seem stressful and dehumanizing—to improve care, the patient experience, and coordination with families, Laura Landro writes in the Wall Street Journal.

Peter Pronovost, a critical care physician and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, says, "We are broadening the definition of harm to include disrespectful care, which is every bit as important as an infection in the ICU."

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A new set of apps, devices, and quality assurance tools are helping ICUs lessen the psychological toll of intensive treatment and improve medical outcomes.

For example, Hopkins has started providing patients and their families in the ICU with a tablet that allows them to set care goals, ask questions, and for the families, sign up to assist providers in activities like washing the patient's hair. Similarly, Brigham and Women's Hospital in Boston has developed a web-portal called Patient-Centered Toolkit that lets patients view their care plan, lab results, and medication information.

Hopkins is also developing surveys to identify instances in which patients and families feel disrespected by the care team. Rhonda Wyskiel, a nurse researcher on the project, says examples can include failing to schedule a family meeting before important clinical decisions or not closing a privacy curtain when undressing a patient.

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Meanwhile, Hopkins' Project Emerge uses software to gather data from records systems and monitoring equipment, and then recommends preventive actions ahead of potential issues or complications, such as over-sedation. The system is color coded, with red indicating urgent action is required and yellow signaling a preventative intervention is advised. Green means all recommended measures have been taken.

Pronovost says the reminders for preventative care can have a big clinical impact. For example, his research has shown that catheter bloodstream infections can be reduced by 66% when a checklist of preventative steps is followed.

Growing pains

However, the push to innovate in the ICU can be difficult, says David Bates, Brigham's chief innovation officer. For instance, some families may want to see more aggressive care than is safe.  It has taken "a lot of cheerleading" to integrate Brigham's new systems into the ICU, he says.

Deb Rivkin, the wife of a patient who stayed in Brigham's ICU for over two weeks, says the patient-centered innovations are helpful—even if they occasionally lead to conflict. For instance, she thought a sleeping medication being administered to her husband was giving him nightmares. Ultimately, the nurses insisted it he needed rest, but Rivkin says she felt respected and appreciated having the opportunity to discuss her concerns. "I had to trust them," she says (Landro, Wall Street Journal, 3/16).

The takeaway: Some ICUs are working to more proactively coordinate with families and provide valuable preventative care.

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