Achieve Remarkable Excellence In the ICU

We Coach • You Transform • Patients Improve
Paragon Critical Care Quality Implementation Program Highlights

• 33 critical care expert, multiprofessional coaches
• Webcasts featuring case studies on quality improvement strategies
• Evaluations using the ICU REPORT® and other assessment tools
• Experience in a variety of improvement areas and strategies
• Much more!

Visit SCCM.org/paragon or contact Lori Harmon, Paragon Program Manager, at +1 847 493-6403 or lharmon@sccm.org.

Every member of the intensive care unit (ICU) multiprofessional team strives for the same goal: improved outcomes for patients. Practitioners on the front lines of care want to achieve this as much as hospital administrators focused on financial well-being.

The Society of Critical Care Medicine’s Paragon Critical Care Quality Implementation Program™ peer-coaching initiative has delivered on its promise to help ICU teams make significant improvements in self-set goal achievement.

The data are in, and the results are clear: Paragon helps hospitals realize results reflecting clinical improvement, enhanced patient safety, improved teamwork and communication, and cost savings.

Reducing VAP
Ventilator-associated pneumonia (VAP) and central line infections are expensive: one case of VAP costs an average of $37,000 for early onset to $61,000 for late onset.(1) One ICU team worked with Paragon coaches to reduce VAP cases from an average of six to zero, saving the hospital more $200,000 and reducing patient risk in the unit. How did they accomplish this? Through a methodical and systematic review of processes that resulted in the development of carefully chosen methods to ensure high reliability.

Retaining Staff
Cultivating healthy, highly skilled critical care teams is crucial to safe care. According to the Robert Wood Johnson Foundation (RWJF),(2) the cost of replacing a specialty registered nurse (considering such costs as recruitment, training and lost productivity) can be as high as two times a nurse’s average salary. These costs can grow exponentially when additional members of the multiprofessional team, such as physicians, pharmacists and respiratory therapists, become dissatisfied and opt to leave in search of better work conditions.

One Paragon hospital estimated it spends up to $120,000 to replace one critical care nurse. According to RWJF, costs can be as high as $145,000.

Retaining critical care providers requires the creation of a healthy work environment. Paragon coaches worked with team members to improve the ICU culture and, after one year, employee satisfaction surveys reflected positive outcomes.

In 2008, several survey respondents indicated that they definitely desired new employment. In 2009, after initiating steps to improve communication and teamwork, staff satisfaction increased dramatically. Survey responses showed employees were now less likely to leave the community hospital. The data indicated a potential cost savings of $435,000 related to staff retention.

Improving End-of-Life Care
Improving palliative and end-of-life (EOL) care cultivates a better family experience and can produce cost savings by reducing ICU lengths of stay and avoiding futile care situations.

Paragon coaches helped one hospital improve its EOL program by including palliative and pastoral staff in multiprofessional critical care rounds. Paragon coaches also worked with the team to enhance family involvement, and the hospital added an ICU patient/family advocate.

After eight months, the hospital reported a 145% increase in palliative care and hospice consultations with a 188% increase in patients transferred to hospice, reducing ICU deaths, lengths of stay and costs related to futile care cases. Pastoral care staff indicated a very high level of satisfaction with their inclusion as an integral component of intensive care.

In addition, staff surveys administered as part of a Paragon assessment revealed improvements in open communication, decision making, planning and shared responsibility among multiprofessional team members and between families. Results improved across the board from an average of 60% to 66% reporting moderate or strong satisfaction with palliative and EOL care to 82% to 91%. This accelerated improvement contributes to a reduction in staff turnover and associated high staff cost replacement.

Improving Team Outlooks
The multiprofessional team is an integral component in providing quality care, as each member brings various skills, responsibilities and viewpoints. Without a high-functioning, cohesive team, quality and patient safety are at risk. The same hospital that achieved the results related to palliative care and employee satisfaction also saw significant changes among ICU staff in attitudes about the performance of the multiprofessional team (see Figure 1). When asked if they would choose the institution for the care of their own loved ones, positive responses jumped from 82% to 96%, a telling indication reflecting the improving cohesiveness of the team and pride in their hospital’s care. Other hospitals have seen similar improvement in physician management. One ICU REPORT® IndexTM score showed only 19% reported positive responses related to physician management. One year later, after Paragon, the score rose to 74%.

Results from the SCCM ICU Index also reflect widespread improvement related to physician management, quality processes and the performance of the team (see Figure 2). The ICU REPORT is a tool used by Paragon coaches to assess functions of critical care areas; it generates radar diagrams and bar charts, providing a snapshot of ICU performance that allows coaches and teams to identify areas of improvement. Most significantly, those surveyed realized increased satisfaction related to the function of the multiprofessional team, which includes many factors, such as staffing, training, teamwork and daily rounds.

Paragon’s unique philosophy – We Coach, You Transform, Patients Improve – pairs seasoned SCCM adult and pediatric critical care experts with hospital staff. The program aims to establish lasting relationships that generate ongoing, deep-seated changes as hospitals strive for remarkable excellence. These success stories reflect a model that works in helping to achieve this level of excellence in teamwork, fiscal responsibility and – most importantly – patient outcomes.

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