IHI Open School

Greetings. I just wanted to relay some observations of how we have improved care in the Intensive Care Unit at the hospital I am at. There are simple interventions you can implement in your own space or institution that will improve quality of care, communication, team dynamics, and patient safety. The unit is a very dynamic place and requires closer monitoring and attention.

In the Unit we have instituted afternoon rounds and midnight rounds where the resident and on-call intern will review the plan for the day and figure out which items have been completed. We will then evaluate the patient via vitals/physical exam/nurse input and discuss the plan for the late afternoon/evening. We then will create an assessment/plan for the next eight hours. During this time we also review medications and discontinue those that are no longer needed or require dose adjustment.

Another intervention is the creation of ventilator bundle set and sepsis bundle sets that are a checklist protocol based system that can be applied to a patient in situations where they need to intubated or taken care of when in sepsis. This allows us to make sure we have incorporated evidence based strategies in taking care of patients that require activation of these bundles.

We also are in the midst of creating Tuesday School (A 4 hour long protected time where residents/medical students participate in interactive medical education with application of numerous topics such as quality improvement and patient safety.

It would be fantastic to create opportunities for medical students in their curriculum during 3rd year with each rotation to spend 1 hour during the month learning basics of quality improvement. The idea would be to engage them to start thinking an observing in a way that may lead to ideas for interventions resulting in quality improvement.

I would be interested in hearing about other interventions and ideas folks have.

For those folks in Boston please make sure you attend the event on 4/23 at Harvard Medical School from 6:30 pm - 9:00 pm where we will go through a case discussion and network with other like minded faculty and students.

Also, Dr. David Nash from Jefferson Medical College will be discussing how to get quality improvement into your curriculum on 4/27 from 4:30-5:30 EST. It will also be a time for you to ask questions and learn some concrete skills.

Have a great weekend!
Jay