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Biomedical subjects

Carol Haraden

Publications and source records attributed to Carol Haraden.

5 recordsLinked to original sources
PubMed2005

Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia.

BACKGROUND: A "bundle" of ventilator care processes (peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, elevation of the head of the bed, and a sedation vacation), which may also reduce ventilator-associated pneumonia (VAP) rates, can serve as a focus for improvement strategies in intensive care units (ICUs). Between July 2002 and January 2004, teams of critical care clinicians from 61 health care organizations participated in a collaborative on improving care in the ICU. METHODS: ICU team members posted data monthly on a Web-based extranet and submitted narrative descriptions describing the changes tested and the strategies implemented. RESULTS: For the 35 units that consistently collected data on ventilator bundle element adherence and VAP rates, an average 44.5% reduction of VAP was observed. DISCUSSION: The goal-oriented nature of the bundle appears to demand development of the teamwork necessary to improve reliability. The observations seem sufficiently robust to support implementing the ventilator bundles to provide a focus for additional change in ICUs.

Canada↗
PubMed2004

Patient flow in hospitals: understanding and controlling it better.

Because waits, delays, and cancellations are so common in healthcare, patients and providers assume that waiting is an inevitable, but regrettable, part of the care process. For years, hospitals responded to delays by adding resources--more beds and buildings or more staff--as the only way to deal with an increasingly needy population. Furthermore, as long as payment for services covered the costs, more construction and more staff allowed for continued inefficiencies in the system. Today, few organizations can afford this solution. Moreover, recent work on assessing the reasons for delays suggests that adding resources is not the answer. In many cases, delays are not a resource problem; they are a flow problem. The Institute for Healthcare Improvement has worked with more than 60 hospitals in the United States and the United Kingdom to evaluate what influences the smooth and timely flow of patients through hospital departments and to develop and implement methods for improving flow. Specific areas of focus include smoothing the flow of elective surgery, reducing waits for inpatient admission through emergency departments, achieving timely and efficient transfer of patients from the intensive care unit to medical/surgical units, and improving flow from the inpatient setting to long-term-care facilities.

Academies and Institutes↗
PubMed2003

Developing and pilot testing quality indicators in the intensive care unit.

PURPOSE: To develop and implement a set of valid and reliable yet practical measures of intensive care units (ICU) quality of care in a cohort of ICUs and to estimate, based on current performance, the potential opportunity to improve quality. METHODS: We included 13 adult medical and surgical ICUs in urban community teaching and community hospitals. To monitor performance on previously identified quality measures, we developed 3 data collection tools: the Team Leader, Daily Rounding, and Infection Control forms. These tools were pilot tested, validated, and modified before implementation. We used published estimates of efficacy to estimate the clinical and economic effect of our current performance for each of the process measures: appropriate sedation, prevention of ventilator-associated pneumonia, appropriate peptic ulcer disease (PUD) prophylaxis, appropriate deep venous thrombosis (DVT) prophylaxis, and appropriate use of blood transfusions. RESULTS: Performance varied widely among the 13 ICUs and within ICUs. The median percentage of days in which ventilated patients received therapies that ought to was 64% for appropriate sedation, 67% for elevating head of bed, 89% for PUD prophylaxis, and 87% for DVT prophylaxis. The median rate of appropriate transfusion was 33%. The failure to use these therapies may lead to excess morbidity, mortality, and ICU length of stay. CONCLUSION: To improve quality of care, we must measure our performance. This pilot study suggests that it is feasible to implement a broad set of ICU quality measures in a cohort of hospitals. By improving performance on these measures, we may realize reduced mortality, morbidity, and ICU length of stay.

Cohort Studies↗
PubMed2003

Improving communication in the ICU using daily goals.

BACKGROUND: Clear communication is imperative if teams in any industry expect to make improvements. An estimated 85% of errors across industries result from communication failures. PURPOSE: The purpose of this study was to evaluate and improve the effectiveness of communication during patient care rounds in the intensive care unit (ICU) using a daily goals form. DESIGN: We conducted a prospective cohort study in collaboration with the Volunteer Hospital Association (VHA), Institute for Healthcare Improvement (IHI), and Johns Hopkins Hospital's (JHH) 16-bed surgical oncology ICU. All patients admitted to the ICU were eligible. Main outcome variables were ICU length of stay (LOS) and percent of ICU residents and nurses who understood the goals of care for patients in the ICU. Baseline measurements were compared with measurements of understanding after implementation of a daily goals form. RESULTS: At baseline, less than 10% of residents and nurses understood the goals of care for the day. After implementing the daily goals form, greater than 95% of nurses and residents understood the goals of care for the day. After implementation of the daily goals form, ICU LOS decreased from a mean of 2.2 days to 1.1 days. CONCLUSION: Implementing the daily goals form resulted in a significant improvement in the percent of residents and nurses who understood the goals of care for the day and a reduction in ICU LOS. The use of the daily goals form has broad applicability in acute care medicine.

Cohort Studies↗