Traditionally, nurses have been the “face of healthcare” to the patient. According to the American Nurses Association (ANA), the nursing profession involves the “protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering, and advocacy in the care of individuals, families, communities, and populations.”
Unfortunately, due to the culture of the healthcare industry, nurses have usually taken a back seat to physicians and administrators when it comes to changing the policies and practices of optimizing care. However, there is a wealth of evidence that points to the vital and increasing leadership role nurses are taking in healthcare practices around the country. According to Teri Lynn Kiss, President of the American Association of Critical-Care Nurses (AACN), “Studies confirm that empowered nurses provide the best patient care.”
Bolstering the case for that claim, in 2012, AACN began a national rollout of their Clinical Scene Investigator (CSI) Academy, a 16-month, hospital-based nurse leadership and innovation training program with teams of staff nurses from 42 hospitals in six regions. The program’s goal is to empower bedside nurses as clinician leaders and change agents whose initiatives quantifiably improve the quality of patient care and hospital bottom lines. Teams in Texas, North Carolina, Indiana, and Massachusetts have completed the program, and initial results point to anticipated savings of $21 million. (Teams in Pennsylvania and New York will finish by the end of 2014.)
Kiss summarized results from the four regions so far, saying that “on average, their nurse-driven initiatives decreased patient length of stay in ICUs and progressive care units by up to a full day. They decreased by one day the time patients needed support from a mechanical ventilator. And they cut in half ICU complications and infections.” To achieve these improvements, the CSI teams have taken on three challenges that often elude hospital staff: reducing skin pressure ulcers, preventing falls, and helping patients become mobile sooner.
The CSI Academy team at Brigham and Women’s Hospital in Boston implemented an evidence-based, pressure ulcer prevention program, adding a two-person, head-to-toe skin assessment when a patient is admitted, and testing new products for dressings and incontinence. They reduced pressure ulcers at the lower back by 63% and anticipate hospital savings of nearly $2 million a year.
The team at St. Francis Health in Indianapolis developed a “No Fall Zone” initiative that combined staff education about the how to’s of fall prevention with a patient-family fall prevention contract. They decreased patient falls by 35%, with anticipated annual savings of more than $120,000.
Seven of the CSI Academy teams have taken on the challenge of helping ICU patients become mobile sooner. The projected annual hospital savings from these initiatives is more than $6 million. Early mobility is important because it reduces the risk of unintended and costly consequences of severe illness such as hospital acquired infections (HAI).
Some of the most impressive and comprehensive results so far are from the team at Duke Raleigh Hospital. They engaged the entire patient care team — doctors, nurses, administrators, and respiratory, physical, and occupational therapists — to reframe how they approached mobilizing severely ill patients. They developed a protocol that decreased by one day the average length of stay for ICU postoperative patients and those requiring mechanical ventilation. The results had a favorable impact on patient satisfaction scores and saved the hospital more than $1.2 million a year.
Each team's project materials are available via a free, searchable online database that’s already being used as a resource by non-participating hospitals developing their own initiatives. For example, nurses at Inova Fairfax Medical Campus in Falls Church, Virginia, applied project plans from the database to achieve an 80 percent reduction in central line-associated bloodstream infections (CLABSIs) in ICUs, and $962,000 in savings.
The message to hospital administrators should be clear - if you’re looking to improve the quality of care and reduce costs, try talking to the people working on the front lines every day – talk to a nurse.
