NY Nurses Help Hospitals Realize Better Outcomes, Lower Health Care Costs Through AACN CSI Program

Small teams of nurses at seven New York hospitals have improved patient care and saved their hospitals millions of dollars by participating in a training program conducted by the American Association of Critical-Care Nurses (AACN).

The New York hospitals were the sixth cohort in the program. So far 42 hospitals nationwide have participated in the AACN Clinical Scene Investigator (CSI) Academy, a 16-month nursing leadership and innovation training project that has improved patient outcomes and saved hospitals more than $28 million annually.

In the New York cohort, groups of four nurses from each hospital chose a treatment area they wanted to address, such as preventing hospital-acquired infections and falls or standardizing protocols to assessing delirium or mobilizing ventilated patients, reports Nurse.com.

At North Shore University Hospital, nurses focused on reducing catheter-associated urinary tract infections (CAUTIs) in the intensive care unit (ICU), because their unit had the highest rate in the state’s health system. Interventions included education efforts for patients, staff, and families on the importance of earlier removal of the catheter, and a focus on hygiene practices. After implementing the changes, the hospital achieved more than six months without a CAUTI, a significant improvement from not having a single CAUTI-free month before the academy. The reduction in infections saved $112,000 for the hospital.

At NYU Langone Medical Center nurses wanted to establish a consistent approach to treating and assessing delirium in the medical ICU. They collaborated with the care team, including the IT department, which developed a way to incorporate delirium assessment into electronic health records. Innovations also included an assessment checklist for delirium printed on mousepads, which eliminated the need to search for the tool. The Center estimates it will save between $3.3 million and $5.5 million as a result of the changes.

Nationwide, the CSI Academy has trained 163 nurses to address clinical challenges such as hospital-associated infections, pressure ulcers, delirium, early mobility, falls, and patient handoffs. Project materials developed by each team, including plans, data collection tools, practice resources and references in a searchable online database, are available on the AACN website at www.aacn.org/csiprojects.

The INQRI Blog featured previously released data from the Academy from regional groups working in Massachusetts and North Carolina and overall progress in the program.

National Nurse Leadership Training Program Yields Results in Boston

A nursing team from Boston that took part in a national leadership training program has shown measurably improved patient outcomes and a combined $8 million in anticipated annual savings for their hospitals. The Boston initiative is part of a broader training program conducted by the American Association of Critical-Care Nurses (AACN).

AACN directs and funds the AACN Clinical Scene Investigator (CSI) Academy, a 16-month, hospital-based nurse leadership and innovation training program. The program empowers bedside nurses as clinician leaders whose initiatives generate quantifiable improvements in patient care and cost savings, according to an AACN media statement. Teams of staff nurses from participating hospitals take part in the training.

The Massachusetts AACN CSI Academy teams recently presented the results of their projects at an Innovation Conference in Boston, reporting successes such as:

• Decreased the average length of stay in the intensive care unit (ICU) for ventilated patients by nearly eight days using an early mobility program;
• Reduced incidence of pressure ulcers acquired while in the ICU by 50 percent;
• Improved communication between units, leading to a 100 percent decrease in patient handoff incident reports;
• Decreased the average number of mechanical ventilation days for ICU patients; and
• Improved assessment of ICU-related delirium in critical care patients, leading to improved cognitive scores and decreased benzodiazepine use in patients with documented delirium.

The Massachusetts team is the third group to complete the Academy, after Indiana and North Carolina. Hospitals in New York, Pennsylvania, and Texas are currently participating and nursing teams from 42 hospitals will have completed the program by the end of 2014, according to AACN.

AACN’s searchable Innovation Database provides access to a compilation of CSI team results and documentation, including real-world project plans, clinical interventions, data collection tools, outcomes and references.

Nurse-Led Initiatives Benefit Patients and Finances at North Carolina Hospitals

Nurse-led initiatives at several North Carolina hospitals significantly improved patient outcomes and could result in savings of more than $2.5 million, according to the American Association of Critical-Care Nurses (AACN), which funded the program.

The 16-month hospital-based nurse leadership and innovation training program, known as the AACN Clinical Scene Investigator (CSI) Academy, seeks to empower bedside nurses as clinician leaders and agents of change. The nurses’ initiatives must seek to generate quantifiable improvements in quality of care and hospital finances. The North Carolina cohort is the most recently completed project. An Indianapolis academy was completed last year and work continues at hospitals in Massachusetts, New York, Pennsylvania, and Texas

Four of the North Carolina Academy’s teams focused on early progressive mobility, which can help reduce ventilator-associated pneumonia (VAP), pressure ulcers, and deep-vein thrombosis. Among the outcomes, early progressive mobility: 

• Decreased intensive care unit length of stay by more than one day;
• Reduced mechanical ventilation days up to 35 percent;
• Reduced VAP up to 60 percent;
• Decreased pressure ulcers up to 20 percent; and
• Reduced readmission rates.

The AACN CSI Academy Innovation Database includes a compilation of CSI team results and documentation.

The program is part of AACN’s response to the Institute of Medicine’s landmark The Future of Nursing: Leading Change, Advancing Health  report, which explored the vital role that nurses can and should play in transforming health care.

Critical Care Nursing Group Helps to Identify Potentially Harmful Practices

The American Association of Critical-Care Nurses (AACN), as part of the Critical Care Societies Collaborative, has helped to identify five routine critical care practices, which it says should be questioned because they may not always be necessary and could be harmful to patients. The recommendations are part of Choosing Wisely, an initiative of the ABIM Foundation that seeks to initiate conversations between patients and health care providers on tests and procedures.

The Collaborative is made up of four professional associations, which put together a 10-member interdisciplinary team representing critical care nursing, internal medicine, surgery, anesthesiology, and emergency medicine, to develop the Choosing Wisely list, Nurse.com reports.

The Collaborative recommendations are:

• Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.
• Don’t transfuse red blood cells in hemodynamically stable, non-bleeding critically ill patients with a hemoglobin concentration greater than 7 mg/dL.
• Don’t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of a stay in an ICU.
• Don’t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation.
• Don’t continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.

A detailed breakdown of the five recommendations is available here.

Launched in April 2012, the Choosing Wisely campaign provides a listing of more than 220 tests and procedures that have been identified by national health care and consumer groups as being possibly unnecessary and potentially harmful. The lists were first published in Archives of Internal Medicine and are available at: http://www.choosingwisely.org/

In addition to AACN, CCSC includes: the American College of Chest Physicians, the American Thoracic Society and the Society of Critical Care Medicine.

New Sepsis Guidelines Put Nurses at the Center

Hospital-acquired infections can be deadly and nurses can play a key role in preventing or ameliorating those infections. New guidelines for helping hospital patients survive sepsis, through early recognition and timely interventions recognize and capitalize on nurses' interaction with and proximity to patients. The guidelines, published in Critical Care Medicine and Intensive Medicine, highlight the role of critical care nurses in identifying patients with sepsis, initiating treatment and collecting data. That role was the focus of a presentation at the American Association of Critical-Care Nurses 2013 National Teaching Institute and Critical Care Exposition in Boston earlier this month, covered in MedScape Medical News.

Reducing central line-associated bloodstream infections was the focus of an INQRI-funded study led by David Thompson and Jill Marsteller. Their study, involving 45 intensive care units in 35 hospitals in 12 states tested a nurse-led intervention that used a bundle of evidence-based practices to reduce infections. The intervention was successful in significantly reducing infections and also highlighted the importance of promoting a culture of safety and communication. It also established that nurses should play a central role in quality improvement interventions.

Implementation Research Program Focuses on Hospital Staff Nurses

Leadership development is important at all levels of nursing, especially when it can contribute directly to improved patient care. The American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator Academy (CSI) gives critical care nurses the opportunity to learn leadership skills and become change agents by developing, managing, and sharing quality improvement initiatives in their hospitals.

NurseZone.com reports that seven Pennsylvania hospitals were recently selected to participate in this important initiative that is an expansion of a project funded by the Robert Wood Johnson Foundation: the Bi-State Nursing Innovation Center in Kansas City, Mo. 

The seven Pennsylvania hospitals will each receive a $10,000 grant from AACN. They are: Abington Memorial Hospital; Fox Chase Cancer Center; Hospital of the University of Pennsylvania; Lankenau Medical Center; Lehigh Valley Health Network; Penn Medicine-Pennsylvania Hospital; and Penn Presbyterian Medical Center.

The AACN CSI Academy also has projects in Indiana, Massachusetts, North Carolina and Texas. Over the next three years, AACN will invest $1.25 million to fund implementation of the program.