Nurses Spearhead Quality Initiatives to Reduce Infection Rates, Improve Patient Outcomes

Critical care nurses at seven New York hospitals developed initiatives that substantially reduced healthcare-associated infections and improved other patient outcomes while demonstrating anticipated financial savings of nearly $4.5 million.

The results stem from the nurses’ participation in a 16-month, hospital-based nurse leadership and innovation training program delivered and funded by the American Association of Critical-Care Nurses (AACN).

Known as AACN Clinical Scene Investigator (CSI) Academy, the team-oriented program empowers bedside nurses as clinician leaders and change agents whose initiatives measurably improve the quality of patient care with bottom-line impact to the hospital. As the only nursing excellence and leadership skill-building program that provides hospitals with both educational programming and grant funds to support project implementation, AACN CSI Academy represents a substantial investment by AACN in the future of nursing.

During a recent Innovation Conference in New York City, the teams presented the results of their projects, reporting noteworthy clinical and fiscal outcomes. These results and supporting materials are available online in the AACN CSI Academy Innovation Database.

Among the New York teams’ clinical successes:
• Decreased catheter-associated urinary tract infections (CAUTIs) at three hospitals, with results ranging from 26 percent to 67 percent fewer cases
• Reduced central line-associated bloodstream infections (CLABSIs) 25 percent
• Decreased ventilator days up to 33 percent
• Reduced tracheostomy breathing tubes needed by 91 percent
• Decreased average length of stay in the intensive care unit (ICU) 19 percent and outside the ICU 32 percent
• Decreased mean number of loud occurrences (> 50 dB) in the ICU 24 percent

Diana Mason, RN, PhD, FAAN, president of the American Academy of Nursing and a national leader in nursing health policy and media, presented the keynote address and moderated a chief nursing officer (CNO) panel discussion at the New York Innovation Conference. A past editor-in-chief of the American Journal of Nursing, she is the Rudin professor of nursing at the Hunter College-Bellevue School of Nursing of the City University of New York.

“AACN CSI Academy provides frontline nurses with the knowledge and tools for improving the quality and cost of care,” she says. “It teaches nurses how to make the business case for specific approaches to improving patients’ experiences with care, improving clinical outcomes and reducing costs – the ‘Triple Aim’ that is guiding reforms in healthcare today.”

According to Mason, a key success factor in the CSI Academy model is engaging CNOs in support of developing staff nurses as change agents.

One such CNO, Thomas Smith, RN, DNP, NEA-BC, FAAN, chief nursing officer and senior vice president at Maimonides Medical Center (MMC), already sees a substantial impact from the initiative developed by the CSI participants at his hospital.

Their nurse-driven protocol decreased the average length of stay for patients in alcohol/substance withdrawal in both the ICU and the hospital overall, reduced the need for tracheostomy breathing tubes and improved other patient outcomes, while saving MMC an estimated $1.85 million annually.

“The nurse-led initiatives developed by AACN CSI Academy participants are an outstanding example of how we can advance our work and practice environments to support improvements in patient care,” he says. “Empowering clinical nurses at the bedside will drive innovation across the healthcare system.”

The seven New York hospitals participating in AACN CSI Academy were:
• Long Island Jewish Medical Center, New Hyde Park
• Maimonides Medical Center, Brooklyn
• New York-Presbyterian/Columbia University Medical Center, New York City
• New York-Presbyterian/Morgan Stanley Children’s Hospital, New York City
• New York-Presbyterian/Weill Cornell Medical Center, New York City
• NYU Langone Medical Center, New York City
• North Shore University Hospital, Manhasset

The New York nursing teams represent the sixth regional group to complete AACN CSI Academy, following Indiana, Massachusetts, North Carolina, Pennsylvania and Texas. A seventh cohort is in progress in Seattle. Nationwide, nearly 200 nurses at 49 hospitals have completed or are now participating in the program.

“Through AACN CSI Academy, we are addressing some of critical care’s most pressing challenges while offering tremendous benefits for nurses, patients and hospitals,” says AACN CEO Dana Woods. “These initiatives clearly demonstrate the impact of direct care nurses as leaders in efforts to enhance patient care while decreasing costs — to the tune of $29 million in anticipated savings from project initiatives thus far.”

During the past three years, AACN has invested more than $1.25 million to fund national implementation of the 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, Mo.

Source: American Association of Critical-Care Nurses

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