Smart ICUs Transform Critical Care
Have you been in the intensive care unit (ICU) recently? If so, you might have noticed some changes. In ICUs around the country, nurses are at the forefront of revolutionizing quality of care by delivering a more personalized patient experience with the help of advanced technology.
Hildy Schell-Chaple, RN, PhD, CCNS, FAAN, is a clinical nurse specialist at the University of California, San Francisco (UCSF) Medical Center in San Francisco, Calif. who co-leads the Project Emerge initiative at her hospital. The UCSF Medical-Surgical ICU is one of the first in the country to implement programs and new technologies to create a “smart” ICU.
Project Emerge is a pilot quality improvement initiative with three main goals: to eliminate preventable harms in the ICU, engage patients and families in their care through collaborative interprofessional efforts and to increase proficiency and personalize patient care through an advanced technological “smart” component.
Project Emerge was created with a team of frontline clinicians (nurses, physicians, physical therapists, respiratory therapists, advance practice nurses and pharmacists) as well as informatics/IT specialists from the UCSF Center for Digital Health Innovation in collaboration with Johns Hopkins University Applied Physics Lab and Armstrong Institute for Patient Safety and Quality. It aims to improve the ICU’s culture of safety and continuous learning. According to Schell-Chaple, the comprehensive unit safety program program “taps into the wisdom of frontline nurses, physicians and all team members and is proactive rather than reactive to serious safety events to prevent harm.” So far, the program has trained more than 200 clinicians/staff and has identified more than 150 defects or conditions that pose potential risks to patient and staff safety.
One of the forward-thinking abilities of Project Emerge includes an app with a portal for patients and a separate portal for clinicians. The patient portal is a place for patients or families to input information about themselves and their preferences during the hospitalization. The goal of this portal is to add a layer of personalization to treatment. Via the information in the app, ICU staff are able to humanize the ICU environment.
“One patient really enjoyed listening to Van Morrison music,” said Schell-Chaple. “His daughter put this information into the portal and voila! Nurses found the Van Morrison station and began streaming it for the patient in his room.”
Another patient’s family member used the portal to share that her uncle did not like sports, and asked the healthcare team to avoid putting the TV on any sports channels in his room.
“That was important during the basketball playoff season in the Bay Area,” said Schell-Chaple.
On the clinician portal, the risk data from a patient’s electronic health record is transformed into an easy-to-visualize “harms wheel” graph.
“The harms wheel graph provides situational awareness of harmful risks and whether prevention interventions (bundles of care) are completed or in need of completion,” said Schell-Chaple. “When the harms section of the app is tapped, either on the computer or a portable device, it expands to show options to prevent risks for the patient.”
A study conducted by Schell-Chaple and her team found a reduction in time for evaluating patient harm with the use of the Emerge app. Also, the app proved to be a valuable training tool for new nurses and clinicians.
In addition to the patient/family portal on the Emerge app, another part of Project Emerge includes the Patient & Family Advisory Council at UCSF, the first ICU-specific, inpatient-focused advisory group. The group helped guide the development of content for family members of ICU patients on the website: Critical Care Innovations Group at UCSF. This website provides information about innovative approaches and interdisciplinary teamwork by hospital personnel. The website also has information for patients and families about the ICU and their care teams, treatments, resources, and procedures.
ICUs are one of the most fast-paced hospital units caring for a diverse population of critically ill patients, which can make the ICU nurse’s role in improving patient care all the more important.
“In an ICU like ours, where there are 140 nurses and 40 critical care physicians, today’s modern nurse is adaptable to change and contributes continuously to improve care and patient outcomes,” said Schell-Chaple. “Nurses are essential on every health care team. The leadership and advocacy skills of many nurses are keys to successful improvements in patient care in the ICU and beyond.”
*All images courtesy of Hildy Schell-Chaple, RN, PhD, CCNS, FAAN.