Nurse-Led Innovations Improve Patient Outcomes, Save More Than $28 Million Annually

Critical care nurses at 42 hospitals nationwide developed patient care initiatives that substantially improved clinical outcomes while demonstrating anticipated financial savings of more than $28 million annually. The results stem from the nurses’ participation in AACN Clinical Scene Investigator (CSI) Academy, a 16-month leadership and innovation training program for staff nurses delivered and funded by the American Association of Critical-Care Nurses (AACN).

Empowered as clinician leaders and catalysts for change, the 163 CSI Academy nurses created quality improvement initiatives focused on clinical challenges as diverse as healthcare-associated infections, pressure ulcers, delirium, early mobility, falls and patient handoffs.

The CSI Academy teams successfully addressed these clinical challenges, significantly reducing many unintended consequences of hospitalization. Among other outcomes, improvement projects from regional groups in Indiana, Massachusetts, New York, North Carolina, Pennsylvania and Texas on average have decreased:
• Intensive care unit (ICU) and progressive care unit (PCU) lengths of stay 1.0 day
• Days on mechanical ventilation 14 percent or approximately 1.0 day
• Healthcare-acquired infections and ICU complications 50 percent
• Patient falls 50 percent
• Pressure ulcers 40 percent
• Catheter-association urinary tract infections 70 percent
• Confusion Assessment Method for the ICU (CAM-ICU) positive scores 14 percent

“These outcomes solidly reaffirm the value of investing in bedside nurses’ leadership development,” says AACN CEO Dana Woods. “Our program evaluations confirm that dedicated time for nurses to apply their skills in leading organizational and behavioral change was vital to achieving the program’s impressive results. This challenges traditional healthcare measurement systems, which often call this ‘non-productive time.’”

Indiana University (IU) Health, Indianapolis, had teams of nurses from three of its hospitals participate in AACN CSI Academy. Those frontline nurses continue to drive innovation and culture change in their units and throughout the organization, according to Linda Everett, RN, PhD, NEA-BC, FAAN, former IU Health executive vice president and chief nurse executive.

“It’s one thing to develop a new policy, a new protocol or a new gizmo; sustaining and spreading the change is the true challenge,” she says. “Through CSI Academy, frontline nurses became the champions for patient care innovations and improved clinical practice.”

Speaking to the broader implications of empowering bedside nurses as leaders of change and innovation, Everett says, “Hospitals need to understand that nursing is a strategic imperative and not just an operational necessity. That, to me, is the cornerstone of how you bring the organization along to support these types of patient-care innovations.”

Many other CSI Academy teams sustained or expanded their initiatives since completing the program.

In a recent survey completed by Indiana and North Carolina program participants, nearly 50 percent reported their projects have been implemented in other units, divisions or hospitals within and outside their system. About 75 percent of survey respondents also reported sustaining their initiatives – or key aspects of them – and being contacted by others for more information about their project.

CSI Academy nurses in Massachusetts established a delirium-focused consortium of Boston-area hospitals to benchmark best practices and improve care in the region. In Texas, a CSI team extended the impact of their project by collaborating with hospital pharmacists to implement a new medication protocol that further reduces delirium incidence.

CSI graduates are also speaking to hospital executives and nursing school classes, and presenting their work at regional and national healthcare conferences. More than half of the 42 teams will either lead a concurrent session or host a poster presentation about their initiatives at AACN’s National Teaching Institute & Critical Care Exposition, the premier annual event for critical care nursing to be held May 18-21, 2015, in San Diego.

As part of its broader mission to share clinical solutions and inspire industry-wide patient care innovations, AACN makes available project materials from each team, including plans, data collection tools, practice resources and references in a searchable online database. Access the Innovation Database from the AACN CSI Academy Web page or www.aacn.org/csiprojects.

With more than 15,000 unique project material downloads, the database has quickly become a resource for hospitals throughout the United States and abroad as healthcare administrators and clinical leaders seek practice-based solutions to improve patient outcomes and reduce costs.

During the past three years, AACN has invested more than $1.25 million to fund national implementation of the CSI Academy program at partner hospitals across the country. It reflects AACN’s high-level strategic response to the Institute of Medicine’s landmark “Future of Nursing” report and represents the national expansion of a pilot program developed by Children’s Mercy Hospital in Kansas City, Missouri.

Source: American Association of Critical-Care Nurses

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