Each year, about 4 million Americans are treated in intensive care units. And according to some studies, nearly all of them will be exposed to potentially harmful adverse events. These events range from central line associated bloodstream infections and ventilator-associated pneumonia, to medication errors and poorly coordinated care that results from imperfect systems of delivering care.
Our Approach to ICU Safety
At Johns Hopkins, we have developed a suite of tools and strategies for improving ICU safety. Our efforts include:
- Adopting CUSP—the Comprehensive Unit-based Safety Program—to foster a culture of safety and engage frontline caregivers in developing solutions for improving care
- Staffing ICUs with intensivists, an approach that research has found to produce better outcomes
- Creating point-of-care pharmacists to help to properly manage patients medication regimens
- Adopting a daily goals sheet, a communication tool used by care teams during rounds to improve communication across disciplines and focus their attention on the patient’s goals for the day
- Developing dashboards to display performance on key measures and encourage frontline workers and managers to seek improvement
- Using checklists that guide caregivers to consistently follow evidence-based practice in such areas as reducing bloodstream infections and ventilator-associated pneumonia
- Introducing bundles of supplies that make it easier for caregivers to follow these recommended practices, such as bundles containing all that a provider will need to safely insert a central line
- Having providers shadow those of other disciplines to build teamwork and understanding of the challenges that ICU colleagues face
Our Track Record
- Lengths of stay were reduced by one day in two Hopkins Hospital ICUs after introduction of the daily goals sheet.
- In Johns Hopkins Hospital, bloodstream infections in some ICUs dropped by 90 percent over 18 months, and many have since have gone a year or two without a single bloodstream infection. This effort has since been rolled out in other states and countries.
- Cases of ventilator-associated pneumonia dropped by more than 70 percent in Michigan hospitals where clinicians adopted a checklist designed by Hopkins researchers. Read the Feb. 2011 press release.
- ICUs have initiated their own improvements based on staff members’ observations about safety hazards. For example, a critical care transport team was created at Johns Hopkins Hospital after clinicians expressed concern that ICU staffing levels became unsafe when they had to accompany patients to other parts of the hospital.