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Recommended Citation
Hartley NM, Thompson L. Tele-critical care nurse initiative drives central line stewardship to improve quality of care. Quality Improvement podium presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Quality Improvement podium presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background
Central line-associated bloodstream infections (CLABSIs) lead to increased hospital length of stay, cost, morbidity, and mortality, and negatively impact patient experience with an average inpatient cost of $48,108 (AHRQ, n.d.). Critically ill patients are at increased risk for CLABSI.
Local Problem
Atrium Health’s Virtual Critical Care (VCC) standardizes and delivers care at 14 ICUs across the Advocate Health Southeast region utilizing evidence-based practice, Intensivist-managed care, and multidisciplinary teamwork. VCC nurses also collaborate to support the units’ clinical quality goals. Atrium Health Union’s Critical Care Unit (CCU) experienced 8 CLABSIs in the first 3 quarters of 2022, and CL utilization was identified as an opportunity.
Method (PDSA)
A multidisciplinary team identified opportunities for VCC and AH Union CCU to partner on CLABSI prevention processes. Leveraging telecritical care technology, the collaborative relationship with bedside RNs, and the multidisciplinary rounding team, our project used PDSA Methodology to focus on central line necessity and decreasing the Central Line Standardized Utilization Ratio (SUR). The VCC nurse proactively reviewed patients with central lines (CL), evaluated necessity, and discussed during daily multidisciplinary rounds to facilitate CL removal and promote alternatives. Process and outcome measures were monitored, and adaptations made based on feedback to optimize efficiency and impact.
Results/Conclusions
Monthly Central Line days decreased more than 20%. SUR goal exceeded the target reduction 3 of 5 months and demonstrates a continued downward trend. There were zero CLABSI events Dec 2022-Mar 2023, far exceeding the 20% reduction targeted. With between 2-4 CLABSI per quarter in 2022 prior to this program, a conservative estimate is nearly $100,000 of cost avoidance based on AHRQ estimates.
Implications for Practice
This process has now spread to additional critical care units covered by the VCC, yielding nearly 90 CL removals across the region since November 2022. Similar processes are being developed to support urinary catheter stewardship across VCC units.
Document Type
Oral/Podium Presentation
Publication Date
11-15-2023
Tele-critical care nurse initiative drives central line stewardship to improve quality of care
Background
Central line-associated bloodstream infections (CLABSIs) lead to increased hospital length of stay, cost, morbidity, and mortality, and negatively impact patient experience with an average inpatient cost of $48,108 (AHRQ, n.d.). Critically ill patients are at increased risk for CLABSI.
Local Problem
Atrium Health’s Virtual Critical Care (VCC) standardizes and delivers care at 14 ICUs across the Advocate Health Southeast region utilizing evidence-based practice, Intensivist-managed care, and multidisciplinary teamwork. VCC nurses also collaborate to support the units’ clinical quality goals. Atrium Health Union’s Critical Care Unit (CCU) experienced 8 CLABSIs in the first 3 quarters of 2022, and CL utilization was identified as an opportunity.
Method (PDSA)
A multidisciplinary team identified opportunities for VCC and AH Union CCU to partner on CLABSI prevention processes. Leveraging telecritical care technology, the collaborative relationship with bedside RNs, and the multidisciplinary rounding team, our project used PDSA Methodology to focus on central line necessity and decreasing the Central Line Standardized Utilization Ratio (SUR). The VCC nurse proactively reviewed patients with central lines (CL), evaluated necessity, and discussed during daily multidisciplinary rounds to facilitate CL removal and promote alternatives. Process and outcome measures were monitored, and adaptations made based on feedback to optimize efficiency and impact.
Results/Conclusions
Monthly Central Line days decreased more than 20%. SUR goal exceeded the target reduction 3 of 5 months and demonstrates a continued downward trend. There were zero CLABSI events Dec 2022-Mar 2023, far exceeding the 20% reduction targeted. With between 2-4 CLABSI per quarter in 2022 prior to this program, a conservative estimate is nearly $100,000 of cost avoidance based on AHRQ estimates.
Implications for Practice
This process has now spread to additional critical care units covered by the VCC, yielding nearly 90 CL removals across the region since November 2022. Similar processes are being developed to support urinary catheter stewardship across VCC units.