The second blog from Claire, a Critical Care Outreach Sister, and Patient Safety Learning's Associate Director, on her visit to Rush University Hospital, Chicago.
Day 2 – Visit to the medical ICU and medical ward
Today started off with a 10-minute meeting with the medical emergency and cardiac arrest team at RUSH University Hospital, Chicago. This team consisted of a critical care outreach nurse, the medical intensive care unit (ICU) doctor, a respiratory therapist and a pharmacist – "yes, a pharmacist!" This is so drugs can be sent up to the ward without delay, pre-prepared and appropriate for the patient. Respiratory therapists assist with intubation and oxygenation of the patient.
Unfortunately, the meeting was cut short due to a ‘code blue’, a cardiac arrest. I’m not sure what I was expecting; a bunch of doctors and nurses calmly following the protocol while dramatic music was playing in the background maybe? Seems I must watch too much drama on TV. It was nothing like that. For all those who work in a hospital and are aware of what a cardiac arrest is like where you work… it was like that. Lots of people in a room, some initial disorganisation, lots of voices, equipment being sought, people walking in and out of the room trying to find stuff, sounds familiar? It was like that.
Nurse patient ratio is 1:2 on the medical ICU. In the UK our ratio is 1:1 for ventilated patients; they require close observation as they may pull out their breathing tube. The patients here at RUSH are cared for in single rooms and to ensure they do not pull their tubes out they physically restrain their patients using straps on the wrists. This practice is unheard of in the UK. When questioning the ICU team they were shocked that we chemically restrained our patients, as they don’t use as much sedation as the UK. "One of the intubated patients was sat up comfortably watching TV, a sight we had not seen before!"
Family members play a large part in care here. They allow 24-hour visiting and encourage them to stay with the patient overnight on the sofa bed in the room. Family members play an active role in the ward round, they are able to voice their concerns and make suggestions.
At RUSH hospital there are around 700 beds, 100 of these beds are ICU beds. The ICU beds are not as much as a premium as they are in the UK. If a patient on the ward or ED needs a bed there is minimum waiting time.
The whole hospital is paperless: documentation, doctors notes, pharmacy, drug charting… everything. "Imagine an IT system that talks to pathology, imaging and pharmacy." By having everything computerised it allows for more robust patient safety solutions by using a forcible function. For example, nephrotoxic drugs cannot be prescribed to a patient who has an acute kidney injury (AKI) showing up on their blood results; the computer will not allow it until certain checks have been completed. Some hospitals use this technology; however, it is not yet standard practice.
That morning we also attended a ‘town hall meeting’. This was a meeting where the Chief Operating Officer (Cynthia) informed staff of what new plans there were for the hospital, strategies and updates. Questions from the floor were actively encouraged from an audience of over 200 people! Questions ranged from parking problems to staff safety. The town hall meeting is held four times a year and is a chance for staff to engage with the senior leader team. "Conversations were honest and non-hierarchical."
In the afternoon we observed on an acute medical ward. Processes such as patient escalation, end of life care, track and trigger scoring, and patient observations were different to the UK. Critical care outreach teams (CCOT) are in their infancy here, while the UK has established CCOTs since the early 2000s. Granted, the UK CCOTs are not standardised; however, this is something that the National Outreach Forum are working towards.
Today was enlightening; it highlighted the importance of collaboration of the RUSH CCOT and the UK CCOT. We can learn so much from each other, building lasting relationships that will, in-turn, improve outcomes for our patients.
About the Author
Claire is an experienced nurse of over 20 years. She has worked in numerous specialities in the NHS and in different places around the world, from being a repatriation nurse to volunteering in refugee camps and striking up collaborations with nurses in the USA. Since 2011, Claire has worked as a Critical Care Outreach Sister where her desire for patient safety was ignited.