Sentara Obici Hospital
Suffolk, Virginia
One Year.....One Team
Remarkable Steps Toward Excellence!
Sentara Obici Hospital is a 138-bed acute care medical center located in Suffolk, Virginia. The new state-of-the-art facility, opened in 2002, replaced a 50-year-old hospital structure incapable of supporting the change necessary to fully engage new technologies, improve efficiencies, and drive patient safety enhancements. In 2006, Obici became part of the Sentara Health System, an eight-hospital network serving Virginia and its surrounding area. Sentara Health System’s dedication to reliability and safety is recognized across the country. It was with great enthusiasm that coaches William A. Brock, MD, FCCM, and Sarah L. Darwin, RN, MSN, embarked on this journey.
Through the Paragon pre-assessment and site visit process, the Obici critical care team and Paragon coaches worked together to evaluate existing best practices and potential areas for improvement. Already advanced with intensivist coverage not frequently enjoyed in a smaller community-based hospital and a largely closed intensive care unit (ICU) embracing evidence-based care, the team was functioning at a very high level. A good structure for daily multiprofessional rounds and communication was in place, a new bar-coding medication safety system was implemented, and steps were being taken to integrate families more readily into the care plans for the patients. A wave of new equipment and technologies promised provision of real-time streamlined information to care providers, and these upgrades would enhance the ability for Obici to self-assess and benchmark against sister organizations.
Self-analysis became important as Obici staff looked carefully at hospital-acquired infections – a zero tolerance position within the Sentara system -- days with central lines in place, ventilator hours, and other critical care metrics that would enhance their ability to identify methods for safer, less costly care. Yet there were two areas that stood out as important critical care improvement opportunities: development of a critical care-based rapid response team, and better coordination of efforts between the emergency department (ED) and ICU in implementing the Surviving Sepsis Campaign sepsis bundles. Over the course of the next year, these would become the Obici Paragon focus.
The establishment of a rapid response team (RRT) had been a goal for sometime at Obici. The task of implementing this team was assigned to their new Vice President of Medical Affairs. The desired team composition included a critical care nurse and a respiratory therapist, led by the hospitalist on duty. The hospitalist program was also a new endeavor at Obici yet due to market conditions, physician recruitment was slow. As the implementation of the hospitalist program continued to stall, the group working on the RRT implementation decided to move forward without a physician team member. The critical care nurse would serve as the team leader. This is a model in place in many hospitals across the country so the team felt it would be a very important first step. In addition, the patient care supervisor was added to the team. After months of planning, protocol review, and medical staff review, the RRT was initiated in May 2008. A hospital-wide education blitz provided information about the team and its purpose. Use of the team started slowly and is still a work in progress, but its effectiveness is demonstrated in the reduced number of out-of-unit codes. The hospitalist program now is underway and these staff members have joined the RRT. The hospital is rewarding nurses for utilizing the system as a method for decreasing out-of-unit calls.
The implementation of Surviving Sepsis Campaign bundles has proven to be a bigger challenge, as is the case in many hospitals across the country. The ED and ICU staff members were educated, necessary supplies and equipment were made available, and other measures were put in place. Screening for sepsis patients has been effective with just a few glitches. The sepsis team made strides in the management of the database. After a discussion in a system-wide sepsis meeting about lessons learned with data and screening in a sister hospital, the Obici unit manager has started collecting daily screening forms and entering the data herself. The accuracy of data is better, and the staff follow-up is timely as concerns arise. The ED has done a great job in screening, although everyone worried they would miss key indicators. Sentara Health System now has all hospitals in various stages of bundle implementation, so there is support moving forward and a breadth of experience across multiprofessional teams from which to draw.
At the one year mark, the Obici team was resurveyed with SCCM’s ICU Index™ tool to ascertain how much overall unit improvement had taken place since the initiation of the pilot. The results are as follows:
Although improvement was not seen in physician management and only slight increases were realized in the multiprofessional team analysis, improvement (as expected) was noted in the quality processes area, increasing from 62% to 85% at the close of the pilot. This translates into better care for the patient, improves work processes for staff, and indicates a potential for enhancement in reliability. The Society thanks the Obici team and the hospital administration for participation in this important program. They are to be congratulated for their hard work on two very challenging projects. The Paragon coaches look forward to staying in touch and learning more about their journey as they strive to capitalize on their excellent staff, new systems and teamwork.
