Monday, January 26, 2009
ICU, but do I feel for you?
We've been thinking a lot about our intensive care units (ICUs) and how we could make them more comfortable, welcoming, and friendly -- not only for the patients, but more for their families. Last week, the three people here (Wendy McHugh, RN; Dr. Michael Howell; and Barbara Sarnoff Lee, our chief of Social Work) presented a report on this work in progress to our Board of Directors.
We serve 5500 adult ICU patients each year, in 9 separate units with 77 beds. Staff for these units comprise dozens of types of specialists and virtually every department in the hospital. The theory of the case for our working group is that the patient and family experience is an outcome that must be managed and improved. Thus, this is not a project. It is an attempt to understand the experience to great depth, looking at both quantitative and qualitative factors. We are aided in this process by a volunteer advisory group of patients and family members who have had ICU experiences.
A symbol of the "old way" is seen in the picture above: Hardly a welcome greeting! Another symbol was the existence of visiting hours in the ICUs. Why do they exist? Well, our working group decided to eliminate them. They decided that allowing loved ones to be in the ICU at all hours would actually be helpful to all parties. Since the patient is often unable to communicate well, who better to explain things to the medical staff and hear from the doctors during their rounds than a family member?
The group is also focusing on how to improve communication in this environment, making it more predictable and consistent. Another area of attention is how to improve the transition from the ICU to the regular floors, often a stressful period as the patient goes from continuous nursing care to more episodic care.
Since the usual patient satisfaction surveys don't really address the ICU experience, the team is also working with a survey designed for this audience of patients and families. In addition, Wendy engages families in real time to get their reactions to the environment and other issues.
I am sure the team would welcome thoughts from readers about your experiences in this kind of process improvement. Please post them here.
Posted by Paul Levy at 1/26/2009 05:02:00 PM