Regional Efforts to Advance Critical Care in Community Hospitals (REACHout): Implementation and Evaluation of a Complex, Multimodal Intervention
CCCF ePoster library. Sarti A. Oct 27, 2015; 114758; P96 Disclosure(s): This research was funded by The Ottawa Hospital Academic Medical Organization (TOHAMO).
Dr. Aimee Sarti
Dr. Aimee Sarti
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Abstract
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P96


Topic: Education Science


Regional Efforts to Advance Critical Care in Community Hospitals (REACHout): Implementation and Evaluation of a Complex, Multimodal Intervention



Angele Landriault, S. Sutherland, A. Landriault, F. Fothergill-Bourbonnais, J. Nesbitt, J. Kim, P. DeYoung, J. Mccormick, P. Cardinal

Critical Care, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada | Critical Care Education Scientist, The Ottawa Hospital, Ottawa, Canada | Practice, Performance and Innovation Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada | School of Nursing, University of Ottawa, Ottawa, Canada | Practice, Performance and Innovation Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada | Critical Care, The Ottawa Hospital, Ottawa, Canada | Critical Care, Cornwall Community Hospital, Cornwall, Canada | Critical Care, Cornwall Community Hospital, Cornwall, Canada | Medicine, The Ottawa Hospital, Ottawa, Canada

Introduction:

Literature supports that non-intensivist led intensive care unit models portend worse outcomes compared to intensivist led models. The basis for this benefit is unclear, but likely related to numerous factors. There is widespread use of these ‘open models’ and closing all of these units to be staffed by only intensivists is not feasible given current economic and manpower constraints. Strategies to support non-intensivist led ICUs and to promote organizational, team, and individual learning must be developed and evaluated.



Objectives:

Our primary goal was to develop, implement and evaluate a complex multimodal intervention aimed at improving the care of patients in the intensive care unit (ICU) of a community hospital (CH).



Methods:

Concurrent, mixed-method design. This project employed a systematic approach to design a needs assessment process, implement interventions, and evaluate the success of the entire initiative. Designing the intervention grew directly from the NA findings. The process involved collaboration with the CH to prioritize needs. The REACHout team strategically tailored the comprehensive interventions to include: multi-modal education delivery (e.g. phone, and skill workshops); tools (e.g., transfer tool, chart audit tool); and system changes. The system interventions were designed to facilitate the recognition of unstable high-risk patients (e.g., triggering criteria), to improve access to human resources (e.g., monitoring physician response time) and response to crises (e.g., medical directives), and to inform the administration thus providing ongoing capacity building at the CH (e.g., providing data to support changes in physician coverage models). The evaluation included both qualitative and quantitative measures.



Results:

The program increased awareness and organizational readiness for change and promoted the evolution of the model of care delivery. Physicians and nurses received multi-modal education and skills training using simulation. The program increased accessibility to physicians in the ICU, whose performance managing crises significantly improved with training. A chart audit tools proved reliable in identifying unstable patients at greater risk of death and documenting the health care team response. The multi-method evaluation data indicate that REACHout has been successful in attaining its primary goal in six inter-related domains:

1. Improved education & expertise
2. Increased access to human resources
3. Enhanced communication
4. Effective inter professional teamwork
5. Efficient inter hospital network
6. Strategic capacity building.



Conclusion:

REACHout demonstrated positive outcomes in the delivery of critical care, leading to capacity building at the individual, team and organizational levels, producing measurable results. The next step is to perform a multicenter investigation to evaluate the feasibility and the impact of the ‘bundle’ of interventions in different CHs. To support this phase, we would like to create a network of health care professionals CHs, equipped with the necessary tools to conduct NAs, implement solutions and evaluate outcomes. We suspect this approach is also transportable to other areas of acute care, including, but not limited to, Emergency Departments and step down units.



References:

Marik, P. E. (2010). What Defines an Intensive Care Unit? Implications for Organizational Structure. ICU Director.

Sarti, A. J., Sutherland, S., Landriault, A., Fothergill-Bourbonnais, F., Bouali, R., Willett, T., et al. (2014). Comprehensive assessment of critical care needs in a community hospital. Critical Care Medicine, 42(4), 831–840.


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