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Nurse Leadership Program Helps Hospitals Cut Costs, Improve Outcomes

Nurse-led innovations save more than $28 million annually nationwide, association says

Critical care nurses at 42 hospitals in the U.S. have developed patient-care initiatives that substantially improved clinical outcomes while demonstrating anticipated financial savings of more than $28 million annually, according to a report from the American Association of Critical Care Nurses (AACCN).

The results stem from the nurses’ participation in the AACCN Clinical Scene Investigator (CSI) Academy, a 16-month leadership and innovation training program for staff nurses.

The 163 CSI Academy nurses created quality-improvement initiatives focused on clinical challenges such as health care-associated infections, pressure ulcers, delirium, early mobility, falls, and patient handoffs.

The CSI Academy teams successfully addressed these clinical challenges, significantly reducing many unintended consequences of hospitalization, the report says. Among other outcomes, improvement projects from regional groups in Indiana, Massachusetts, New York, North Carolina, Pennsylvania, and Texas on average have decreased:

  • Intensive care unit (ICU) and progressive care unit (PCU) lengths of stay by 1 day
  • Days on mechanical ventilation by 14% or approximately 1 day
  • Healthcare-acquired infections and ICU complications by 50%
  • Patient falls by 50%
  • Pressure ulcers by 40%
  • Catheter-associated urinary-tract infections by 70%
  • Confusion Assessment Method for the ICU (CAM-ICU) positive scores by 14%

Indiana University (IU) Health, Indianapolis, had teams of nurses from three of its hospitals participate in the AACN CSI Academy. Those frontline nurses continue to drive innovation and culture change in their units and throughout the organization, according to Linda Everett, RN, PhD, NEA-BC, FAAN, former IU Health executive vice president and chief nurse executive.

Speaking to the broader implications of empowering bedside nurses as leaders of change and innovation, Everett said, “Hospitals need to understand that nursing is a strategic imperative and not just an operational necessity. That, to me, is the cornerstone of how you bring the organization along to support these types of patient-care innovations.”

Many other CSI Academy teams sustained or expanded their initiatives since completing the program, according to the report.

In a recent survey completed by participants from Indiana and North Carolina, nearly 50% reported that their projects have been implemented in other units, divisions, or hospitals within and outside their systems. About 75% of survey respondents also reported sustaining their initiatives –– or key aspects of them –– and being contacted by others for more information about their projects.

CSI Academy nurses in Massachusetts established a delirium-focused consortium of Boston-area hospitals to benchmark best practices and to improve care in the region. In Texas, a CSI team extended the impact of their project by collaborating with hospital pharmacists to implement a new medication protocol that further reduces the incidence of delirium.

CSI graduates are also speaking to hospital executives and nursing school classes, and presenting their work at regional and national health care conferences. More than half of the 42 teams will either lead a concurrent session or host a poster presentation about their initiatives at the AACN’s National Teaching Institute & Critical Care Exposition, to be held May 18–21, 2015, in San Diego, California.

As part of its broader mission to share clinical solutions and to inspire industry-wide patient-care innovations, the AACN makes available project materials from each team, including plans, data collection tools, practice resources, and references, in a searchable online database. This information may be accessed from the AACCN CSI Academy web page.

Source: AACCN; April 14, 2015.

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