Monday, January 24, 2005. Teams of health providers and managers from seven Saskatchewan hospitals are working together over the next year to improve quality of care and patient safety within their adult intensive care units (ICU). Participating ICUs will use a method of quality improvement called a Collaborative to address two care processes: control of sedation and agitation, and prevention of venous thromboembolism in critically ill patients.
Hospitals involved in the improvement project are Victoria Hospital (Prince Albert); Union Hospital (Moose Jaw); Regina General (2 units) and Pasqua Hospital in Regina; and City Hospital, St. Paul’s Hospital, and Royal University Hospital in Saskatoon. The Health Quality Council is providing funding and web-based IT infrastructure for the project, and will also evaluate the results.
A Collaborative is a systematic way to rapidly spread major changes: teams will meet three times for learning sessions; in between these sessions they will apply and test the evidence-based strategies they’ve learned about. The participating teams work under the guidance of expert faculty.
Laurie Gander, HQC project manager for the Saskatchewan Adult ICU Collaborative, says the care provided in ICUs is very complex, requiring coordination of many different services and health providers. “Because this is such a challenging care environment, applying and sharing knowledge is key to improving outcomes,” says Gander. “Given what other Collaboratives have accomplished, we are optimistic that participating Saskatchewan units will achieve significant improvements.”
Through its participation in a Canada-wide Collaborative in 2003-04, the ICU team at Saskatoon's Royal University Hospital reduced to zero the number of incidents where patients' blood sugar is too high (hyperglycemia) and to nearly zero the number of incidents where patients' blood sugar is too low (hypoglycemia). ICUs elsewhere in Canada addressed different topics:
- Calgary Health Region increased appropriate use of red blood cell transfusions from 50 per cent to 100 per cent in eight months;
- Calgary also reduced unnecessary blood withdrawals (e.g., for lab tests) by 50 per cent in eight months;
- St. Paul's Hospital in Vancouver reduced incidence of ventilator-associated pneumonia by 35 per cent over 12 months.
Dr. Jaime Pinilla, Director of Quality Improvement for the ICU at Royal University Hospital, will lead the Saskatchewan Adult ICU Collaborative. He says his team’s experience with the Canadian Collaborative has helped promote interdisciplinary teamwork and learning, increased enthusiasm for and commitment to continuous improvement among unit staff, and enhanced the culture of safety. “The Saskatchewan Adult ICU Collaborative will help improve communication and learning among the participating ICUs, and lead to important changes that improve care and safety of critically ill patients,” says Pinilla.
Control of Sedation and Agitation
Finding the optimal level of sedation is a balancing act: patients who are over-sedated run the risk of side effects caused by the medication, while patients who are under-sedated may become agitated and pull out their IV lines or ventilator tube, increasing the risk of complications. The literature suggests that better control of sedation—through ongoing assessment—improves outcomes, including getting patients off ventilator sooner. There is a proven scale available for determining appropriate levels of sedation.
Preventing Venous Thromboembolism (VTE)
VTE occurs when blood clots that form in large veins of the body (primarily pelvis and legs) travel to the lungs. These clots lead to breathing difficulty, chest pain, and in about 20 per cent of cases, death. Preventing VTE is a quality issue for all ICUs regardless of size. Research suggests that there is wide variation in how well different units prevent this condition. ICU patients are particularly susceptible to VTE since bed rest, trauma, or surgery can increase the risk of blood clots. New evidence-based “best practice” guidelines on preventing VTE were recently published.
For more information about the Saskatchewan Adult ICU Collaborative or to arrange interviews with Laurie Gander, contact:
Greg Basky
Director of Communications
Ph: 306-668-8814 (cell: 220-5075)
To arrange interviews with spokepeople in participating sites, please contact:
Participating RHA/Hospitals Media Contact Telephone #
Five Hills:
Victoria Hospital Craig Beesley
Program Director 694-0300
Prince Albert Parkland:
Union Hospital Betty Skarpinsky
Nursing Unit Manager, Intensive Care 765-6231
Regina Qu’Appelle:
Regina General
Pasqua Mark Torjusen
Public Affairs 766-5332
Saskatoon:
City Hospital
Royal University
St. Paul’s Leanne Nyirfa
Corporate and Public Affairs 655-1095
Saskatoon Health Region
"Healthiest people, healthiest communities, exceptional service."
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