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

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: RecommendationsThe recommendations of the committee are presented to the medical center president and leadership council, who look to the committee for decision-making guidance where critical care is involved. Link
Although the medical directors of each unit shown in Figure 1 still primarily report to the chairs of their respective clinical departments, the days of silo building (ie, noninterdisciplinary, isolationist decision-making behavior) are gone. The critical care community as a whole now monitors and manages all critical care activities and budgetary matters. Activities, results, and/or behavior that fall outside what is expected are monitored in real time and are managed by relying on data-driven peer pressure in collaboration with division chiefs and department chairs. UMass Memorial Medical Center has been able to achieve impressive culture transformation and has begun to note measurable improvements in patients’ outcomes through this innovative reorganization of critical care delivery. The model works because it was intentionally designed to support the clinical, teaching, and research missions of the medical center. Through the model, clinicians, faculty members, and researchers collaborate to deliver accessible, excellent, patient-focused care, constantly evaluating and improving processes and services with the goal of achieving evidence-based practice and high levels of satisfaction among patients, patients’ families, and the health-care team. Since September 2004, the following structural and process changes have been implemented at UMass Memorial Medical Center:
• Nurse managers and medical directors of the ICUs are considered to be peers with equal accountability for clinical outcomes and the performance of the professional teams of each group.
•    A policy applied to the entire medical center requires that the care of every ICU patient be supervised by a critical care specialist.
•    The care of all critically ill patients will be managed around the clock by a critical care specialist whether on site or via telemedicine. Phasing in of electronic monitoring (eICU; VISICU, Inc; Baltimore, MD) began June 27, 2006; full implementation by February 2007 is anticipated.

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