Nurse-Led Initiatives Yield Positive Patient Outcomes, Financial Savings at NC Hospitals


Nurses from seven North Carolina hospitals recently shared results from their early progressive mobility and other patient-care initiatives that significantly improved patient outcomes while demonstrating anticipated financial savings of more than $2.5 million.

The results stem from the nurses participation in a 16-month experiential, hospital-based nurse leadership and innovation training program sponsored 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 generate quantifiable improvements in the quality of patient care and hospital bottom line.

Earlier this month, the North Carolina AACN CSI Academy teams presented the results of their initiatives at an Innovation Conference in Chapel Hill, reporting noteworthy clinical and fiscal outcomes. These results are available online in the free AACN CSI Academy Innovation Database.

Four of the teams focused on early progressive mobility. Growing evidence documents the benefits of integrating early and progressive mobility into patient care protocols, including a reduction in ventilator-associated pneumonia (VAP), pressure ulcers, deep-vein thrombosis and, potentially, length of stay.

Among the early mobility-related clinical successes achieved by the CSI nursing teams at Duke Raleigh Hospital, Rex Healthcare, UNC Health Care and WakeMed Cary Hospital:
Decreased intensive care unit (ICU) length of stay by more than one day
Reduced mechanical ventilation days up to 35 percent
Reduced VAP up to 60 percent
Decreased pressure ulcers up to 20 percent
Reduced readmission rates
Increased HCAHPS scores

The CSI nursing teams at Duke Regional Hospital, Duke University Hospital and WakeMed Raleigh Hospital reported similar positive outcomes from projects with other patient care focuses:
Reduced patient falls by 30 percent
Decreased catheter-associated urinary tract infections (CAUTIs) by more than half
Improved communication with patients and families, contributing to shorter average length of stay

Victoria Orto, chief nursing and patient care services officer at Duke Regional Hospital, acknowledges the substantial impact AACN CSI Academy has had at her hospital. Our associate chief safety and quality officer for Duke University Health System was impressed when he learned about our successful CSI-driven CAUTI decreases, Orto says, especially since this level of success had not been attained with CAUTI in the past.

According to Orto, Duke Regional is expanding the CSI teams CAUTI-prevention program to other units throughout the hospital about 360 beds in all.

The CSI program has empowered our nurses to innovate and were all very excited about what that means for our patients Orto adds. It also brings home for us that a relatively small investment in our nurses can translate into great returns for patients, staff and the hospital.

Open sharing of clinical solutions and patient care innovations is a keystone of AACN CSI Academys broader mission to empower and inspire all acute and critical care nurses to lead change that benefits their patients and organization.

The AACN CSI Academy Innovation Database supports this mission by providing access to a compilation of CSI team results and documentation. This searchable database of real-world project plans, clinical interventions, data collection tools, outcomes and references will grow as additional CSI teams complete the program. Access the database from the AACN CSI Academy Web page at

The North Carolina cohort is the second regional group to complete AACN CSI Academy, following Indianapolis last November. Groups continue at hospitals in Massachusetts, New York, Pennsylvania and Texas, where participants are undertaking projects to address prevention of delirium, VAP, central line-associated bloodstream infections and unplanned extubation, and improved communication, teamwork and patient handoffs.

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 of AACNs expertise and money in nursing practice innovation about $1.25 million during the programs three-year first phase.

The program reflects AACNs high-level strategic response to the Institute of Medicines landmark Future of Nursing report, confirming the vital role nursing can and should play in the transformation of healthcare.

Source: American Association of Critical-Care Nurses (AACN)

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