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December 7, 2017

This 'CSI Academy' for nurses led to $34 million in fiscal impact

Daily Briefing

    The Clinical Scene Investigator Academy, developed by the American Association of Critical-Care Nurses (AACN), teaches nurses to innovate and share their ideas, and hospitals that have implemented the nurses' proposals have seen better financial and clinical outcomes, three providers write in a Health Affairs Blog post.

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    The blog post was written by Caryl Goodyear-Bruch, a senior director for patient care services at Children's Mercy Hospital and a part time clinical practice specialist with AACN, Marian Altman clinical practice specialist with AACN, and Karen Cox, the current EVP and COO of Children's Mercy.

    What is CSI Academy?

    Formed in 2012 by AACN, the CSI Academy is a 16-month-long training program focused on promoting nurse leadership and innovation, the authors write. Specific topics covered include:

    • Change management;
    • Creativity and innovation;
    • Improvement science;
    • Project development; and
    • Sustainability.

    The program creates unit-based teams consisting of two to four nurses who work together, alongside a CSI Academy mentor and faculty members, throughout the 16 months the authors write. Together, they identify nursing challenges, create plans to improve practices, and implement and evaluate their ideas.

    Proven results

    The CSI Academy has been demonstrably effective, the authors write. At Duke Raleigh Hospital in Raleigh, North Carolina, for example, CSI Academy alumni worked on a program, called "Walk This Way," that aimed to improve mobility for ICU patients.

    As part of the program, the nurses created new mobility and charting protocols, emphasizing small wins while rewarding both staff and patients for their efforts. To add a layer of fun, nurses organized the program around an Olympic theme, giving patients a torch to carry while they walked.

    The program was a success on several metrics: It improved patient mobility, decreased length of stay and ventilator days, and reduced hospital-acquired conditions (HACs) to zero. In all, the program contributed to six-month savings of nearly $621,000.

    This is only one example of CSI Academy alums implementing what they've learned: According to the authors, 67 teams of nurses that have participated in the CSI Academy have had a fiscal impact of around $34 million. Outcomes achieved at institutions that have implemented the program include:

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    • More than a 50% reduction in HACs and patient falls;
    • Nearly a 50% reduction in pressure injuries;
    • Nearly a 40% reduction in Confusion Assessment Method for the ICU positive scores for delirium; and
    • A one-day decrease in both ventilator days and overall length of stay.

    The authors also note that CSI innovations have improved patient/family satisfaction and decreased errors during bedside reporting and patient handoffs.

    And the improvements appear to be sustainable: A one-year post-program survey showed that more than 50% of respondents said that the results of a CSI project were "fully sustained," while 28% said they were "somewhat sustained."

    "Based on participation, outcomes, and evaluation data from the first nine cohorts, the possibilities for the future of the CSI program appear limitless,"  the authors write, adding that "Confident, empowered nurses have demonstrated ability to lead change on their unit and diffuse this change to other units and hospitals—affecting patient outcomes and improving the fiscal health of their organizations" (Goodyear-Bruch et. al., Health Affairs Blog, 11/30).

    How to attract millennial nurses—and keep them happy

    In 2016, millennials surpassed Baby Boomers as the largest living generation in the United States. As more millennials have entered the nursing workforce, health care leaders have confronted a growing challenge: young nurses are turning over at higher rates than their older peers, especially early in their careers.

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