Nursing leaders say a program that fosters innovation among critical care nurses so they can improve patient care and reduce costs has been a success at seven Philadelphia area hospitals.
We reduced total hospital length of stay for patients who were being readmitted back to the SICU by 1.3 days, said James Ballinghoff, MSN, MBA, RN, NEA-BC, CNO and associate executive director at Penn Presbyterian Medical Center in Philadelphia.
The hospital was among seven in Pennsylvania selected to send a team of four nurses to the American Association of Critical-Care Nurses Clinical Scene Investigator Academy to work on nurse-led projects. Funded and delivered by the AACN, CSI faculty meet with the nurse teams seven times over 16 months in daylong workshops on quality improvement projects and each team has an internal coach assigned to guide the nurses work within their hospitals.
Reduced readmissionsJames Ballinghoff, RN
They gave us $10,000 and provided guidance, oversight and education on what the nurses approaches should be, Ballinghoff said.
That support helped the nurses develop a risk assessment tool and revise the daily rounding process to reduce ICU readmissions changes that could potentially save Penn Presbyterian Medical Center between $33,250 to $199,500, according to hospital estimates.
Typically, we would identify these problems at the administrative level and we would get frontline involvement in resolving the issues, but this [academy] allowed nurses to say what they think the issues are and what to do to make an impact, Ballinghoff said.
Preventing delirium and improving teamwork and communication were among the positive outcomes produced by the academy nurses. Not only did nurses improve patient outcomes at all seven participating hospitals, but also their projects will save the organizations an estimated $2.7 million, according to AACN officials. The other participating hospitals were Hospital of the University of Pennsylvania, Philadelphia; Abington Memorial Hospital, Abington; Fox Chase Cancer Center, Philadelphia; Lankenau Medical Center, Wynnewood; Lehigh Valley HospitalMuhlenberg, Bethlehem; and Pennsylvania Hospital, Philadelphia.
Anne Jadwin, MSN, RN, AOCN, NE-BC, vice president of nursing and CNO at Fox Chase Cancer Center, said the timing of the academy could not have been better.
The hospitals critical care committee had concerns about the lack of standardized delirium assessments and interventions and that some patients with delirium were injuring nurses in the ICU unit, among other issues.
Ive been thrilled with the results of this not only because [the academy] improved patient care, but it also improved the nurses ability to care for their patients and screen for their condition earlier, she said.
As a result of their efforts, academy nurses have developed standardized ways to assess delirium with evidence-based nursing interventions and have an increased comfort and competence caring for delirium patients. There also has been a 50% reduction in the use of the antipsychotic drug Haldol and a 12-hour reduction in the length of stay in the ICU.
Cost savingsAnne Jadwin, RN
We anticipate that over time reducing the length of stay could save the hospital significant dollars because you can accommodate other patients, Jadwin said. That amount could be a half million dollars a year.
At Abington Health, academy nurses focused on improving early mobility for stroke patients, said Terry Reilly, DNP, RN, NEA-BC, senior vice president for patient care services and CNO. The program took a year to establish, but preliminary results found that patients were out of bed earlier and faced fewer complications.
A real benefit of the program was the nurses working together, Reilly said. It was a lot of work. They had to buy equipment, apply for another grant, get the pamphlets all done and educate the staff. They learned a lot about organization and how to influence the outcomes of the patients. I think they left feeling much richer than before.
Nationwide, the AACN academy has been completed by 163 nurses at 49 hospitals in six regions. Its goal is to inspire nursing innovation and empower critical care nurses to become change agents, according to Caryl Goodyear-Bruch, PhD, RN, NEA-BC, AACN senior director.
Robin Farmer is a freelance writer.