Redesigning Intensive Care Unit Flow Using Variability Management to Improve Access and Safety

Ryckman, Frederick C.; Yelton, Paula A; Anneken, Amy; Kiessling, Pamela; Schoettker, Pamela J.; Kotagal, Uma R.

doi:10.1016/s1553-7250(09)35073-4

Cited by 41 publications

(25 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interventions to reduce perioperative SSEs included a list of expected safety behaviors specific to operating room safety developed by surgeons, embedding "time outs" and "debriefs" into standard surgical practice, providing visual cues in the operating room, standardized checklists, smoothing patient flow into the ICU, 38 parent review, real-time feedback, educational videos, and executive rounds.…”

Section: Tactical Interventions For High-risk Areasmentioning

confidence: 99%

Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

Muething

Goudie

Schoettker³

et al. 2012

Pediatrics

Self Cite

106

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVE: Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital. METHODS:A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture.RESULTS: SSEs per 10 000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P , .0001). The days between SSEs increased from a mean of 19.4 at baseline to 55.2 (P , .0001). After a worsening of patient safety culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009. CONCLUSIONS: Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions. Pediatrics 2012;130:e423-e431 AUTHORS:

show abstract

Section: Tactical Interventions For High-risk Areasmentioning

confidence: 99%

Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

Muething

Goudie

Schoettker³

et al. 2012

Pediatrics

Self Cite

106

View full text Add to dashboard Cite

show abstract

“…Our findings also suggest the need to respond acutely to perturbations in ICU bed availability, particularly accounting for MICU bed availability. During times of increased critical care strain, a flexible, system wide process may help to meet unpredictable surges in critical care demand (25) (26) (27) (28). In addition, the implementation of previously described quality improvement practices to reduce ICU length of stay may increase the number of available beds (29) (30) (31).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between ICU Bed Availability, ICU Readmission, and Cardiac Arrest in the General Wards

Town

Churpek

Yuen

et al. 2014

Critical Care Medicine

View full text Add to dashboard Cite

Objective The decision to admit a patient to the intensive care unit (ICU) is complex, reflecting patient factors and available resources. Previous work has shown that ICU census does not impact mortality of patients admitted to the ICU. However, the effect of ICU bed availability on patients outside the ICU is unknown. We sought to determine the association between ICU bed availability, ICU readmissions, and ward cardiac arrests. Design In this observational study using data collected between 2009 and 2011, rates of ICU readmission and ward cardiac arrest were determined per 12-hour shift. The relationship between these rates and the number of available ICU beds at the start of each shift (accounting for census and nursing capacity), were investigated. Grouped logistic regression was used to adjust for potential confounders. Setting Five specialized adult ICUs comprising 63 adult ICU beds in an academic medical center. Patients Any patient admitted to a non-ICU inpatient unit was counted in the ward census and considered at risk for ward cardiac arrest. Patients discharged from an ICU were considered at risk for ICU readmission. Measurements and Main Results Data were available for 2086 of 2190 shifts. The odds of ICU readmission increased with each decrease in the overall number of available ICU beds (OR=1.06 [95% CI, 1.00–1.12], p=0.03), with a similar but not statistically significant association demonstrated in ward cardiac arrest rate (OR= 1.06 [95% CI, 0.98–1.14], p=0.16). In subgroup analysis, the odds of ward cardiac arrest increased with each decrease in the number of medical ICU beds available (OR= 1.26 [95% CI, 1.06–1.49], p=0.01). Conclusions Reduced ICU bed availability is associated with increased rates of ICU readmission and ward cardiac arrest. This suggests that systemic factors are associated with patient outcomes and flexible critical care resources may be needed when demand is high.

show abstract

“…This matches our results. Ryckman et al (2009) report on a large-scale project undertaken at a pediatric hospital in Cincinnati whose goal was to match patient demand with available capacity in order to reduce waiting times for urgent care children and avoid the typical long lists of add-on patients at the end of the day. The availability of data was a big challenge to the team, and much of the baseline data for flow through the operating room and pediatric ICU had to be collected by hand.…”

Section: Saltzman Et Al: Discharge Holding Area's Impact On Pediatrimentioning

confidence: 99%

The Impact of a Discharge Holding Area on the Throughput of a Pediatric Unit

et al. 2017

View full text Add to dashboard Cite

Abstract. Hospital patients often move from one bed to another for both medical and nonmedical reasons. In a highly utilized quaternary inpatient pediatric unit we have studied, bed and nursing resources are stressed not only by frequent movement of patients but also by the unit's patient discharge policy. We present a discrete-event simulation model for examining how the unit's efficiency may be improved by a better discharge policy. In particular, we use the base version of the model to investigate the impact of sending various percentages of discharge-ready patients to a discharge holding area where they can safely wait for a few hours until being picked up by their parent or guardian. Doing so frees up inpatient beds, allowing the unit to serve many more pediatric patients per year. In a revised version of the model we quantify the benefits of helping some patients achieve discharge-ready status a few hours earlier than under current operations. In both cases, our cost analysis shows that the unit could realize hundreds of thousands of dollars more per year in net revenue. This argument can be used to help persuade decision makers, who have otherwise been skeptical of the idea of a discharge holding area.

show abstract

Redesigning Intensive Care Unit Flow Using Variability Management to Improve Access and Safety

Cited by 41 publications

References 13 publications

Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

Relationship Between ICU Bed Availability, ICU Readmission, and Cardiac Arrest in the General Wards

The Impact of a Discharge Holding Area on the Throughput of a Pediatric Unit

Contact Info

Product

Resources

About