Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Acute Care

Appropriately educated and certified acute care nurse practitioners and physician assistants have been recruited to join the clinical teams and work with intensivists, house staff, and nurses to ensure that standards are consistently applied to achieve expert and rapid responses to patients’ short-term needs. In order to facilitate the entry of these care providers into the system in the future, a close collaborative educational and research partnership has been established with the University of Massachusetts Graduate School of Nursing, and a nurse practitioner/physician assistant critical care mentorship program has been established. comments
The need for additional ICU and progressive care beds has been identified, and all disciplines are involved in planning for these expanded services.
All disciplines are involved in developing, implementing, and expanding an ever-growing list of clinical practice guidelines so that the care that critically ill patients receive becomes uniformly evidence-based. Frontline providers of patient care give their feedback about the implementation of clinical practice guidelines to the leaders of the critical care operations committee during weekly interdisciplinary bedside rounds. Electronic documentation will be used throughout all ICUs and in the electronic monitoring (eICU) to support and improve communication and adherence to clinical practice guidelines.
A tiered process for responding to the need for critical care beds has been developed and has greatly improved collaboration between the emergency and critical care departments, proactively managing patient throughput on the basis of the census and acuity levels of patients in all areas.
A scorecard for monitoring critical care data is used to track progress and to indicate needed improvements in case mix, outcomes, care processes, and staffing.

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