Nurses at seven Washington hospitals developed initiatives that improved clinical outcomes and helped raise scores on patient and family satisfaction surveys, which are key indicators of a hospital's overall quality of care.
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.
‘Nurses developed initiatives that improved clinical outcomes and helped raise scores on patient and family satisfaction surveys.’
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.
The teams reported a variety of clinical successes from their initiatives: Decreased catheter-associated urinary tract infections (CAUTIs) at two hospitals, with results ranging from a 64 percent to 92 percent decline over the project period. Decreased medication errors related to communication 80 percent. Increased progressive mobility of patients in the neuroscience intensive care unit 11 percent. Improved the Rapid Response Team (RRT) process, resulting in decreased average length of RRT calls and fewer patients requiring transfer to the intensive care unit. Eliminated patient falls related to communication issues during the project period
Three of the teams focused on improving communication between patients and care providers because of its far-reaching impact on clinical outcomes and patient satisfaction scores, which have become increasingly important for hospital reimbursement rates. The CSI team at Regional Hospital for Respiratory and Complex Care, Burien, focused on bedside shift reports, and how to best integrate the long-term acute care hospital's (LTACH's) new computerized charting system into patient care.
"Our nurses developed a process to quickly and efficiently review a patient's electronic health record together with the patient and their family. These conversations between family, patient and nursing staff led to a more collaborative approach to care," said Christi Sifri, RN, MN, Regional Hospital's chief nurse executive.
Through the nurses' CSI initiative, the patient's electronic health record became a tool to enhance communication at the bedside, not replace it. The team also found their efforts led to far fewer communication-related falls and medication errors, and greater patient, family and nurse satisfaction. The participating nurses at Island Hospital, Anacortes, also selected bedside shift reports as the focus of their CSI project. Denise Jones, RN, MN, the hospital's chief patient care executive, noted how using the program's structured process helped solidify acceptance of bedside shift reports as a best practice for patients at the 43-bed hospital.
"Handoff reports at the bedside allow our patients to see their nurses working as a team to provide around-the-clock high-quality care. The increased communication has led to greater continuity of care for our patients and improved how satisfied they are with the nursing care," Jones said. "Through CSI Academy, our nurses recognized that they can lead significant change at the point of care."
In addition to improving patient outcomes and raising patient satisfaction scores, the CSI Academy teams documented their initiatives' fiscal impact, with an anticipated combined savings of nearly $570,000.
Other Washington hospitals participating in the program: Harborview Medical Center, Seattle. Madigan Army Medical Center, Tacoma. Swedish Medical Center, Cherry Hill Campus, Seattle. Swedish Medical Center, First Hill Campus, Seattle. VA Puget Sound Healthcare System, Seattle.
The Washington nursing teams represent the seventh regional group to complete AACN CSI Academy, following cohorts in Indiana, Massachusetts, New York, North Carolina, Pennsylvania and Texas. Other groups are currently in progress in Arizona and California. Nationwide, more than 259 nurses at 68 hospitals have completed or are now participating in the program.
"Through CSI Academy, frontline nurses amplify their role as advocates for evidence-based clinical practice, frequently serving as resources for colleagues developing additional change initiatives," said Dana Woods, AACN CEO. "Their projects often take on a life of their own, expanding to other units and becoming the foundation for system-wide implementation efforts."
As part of its broader goal to inspire and empower all acute and critical care nurses to lead change that benefits their patients and improves the effectiveness of their organizations, AACN shares the CSI Academy team learnings, results and documentation by offering online access to CSI Academy innovation projects. These real-world project plans, clinical interventions, data collection tools, outcomes and references will continue to grow as more CSI teams complete the program.
With more than 25,000 unique downloads of project materials, the CSI innovation project library has quickly become a resource for hospitals throughout the United States and abroad, as healthcare administrators and clinical leaders seek solutions to improve patient outcomes and reduce costs.
AACN CSI Academy represents a substantial investment by AACN in the future of nursing, funding more than $2.25 million over the last four years to support national implementation of the program at partner hospitals across the country. This investment reflects AACN's 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.