SICU People Movers. IU Health University Hospital

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2 SICU People Movers IU Health University Hospital

3 IU Health University Hospital Melissa Trees RN, BSN Megan Confer RN, BSN

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5 SICU University Hospital 18-bed Intensive Care Unit Simon Cancer Center Indianapolis Primarily cancer diagnosis following surgical intervention Gastroenterology Thoracic Gynecological Oncology ENT General Surgery

6 Purpose The purpose of this project is to increase mobility utilizing the mobility protocol thereby decreasing ICU length of stay. To implement mobility protocol on unit To collaborate with staff RNs to educate and utilize protocol

7 SICU Retrospective Data From 6-month retrospective data collection, our patients were meeting physician activity orders only 20% of the time.

8 People got to talking about the CSIs At first SICU Professional Practice Council University Evidence-Based Practice Council University Professional Practice Council University Leadership Advisory Forum SICU Physician Journal Club

9 People got to talking about the CSIs Before we knew it System-wide Professional Practice Council (17 IU Health facilities) CSI Academy participants present to all central Indiana chief nursing officers Drafting our work for Magnet submission Presenting at Critical Care Conference

10 Mobility Protocol

11 Mobility Protocol

12 Attempting to Engage SICU RNs

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14 Purpose and Goals The purpose of this project is to increase mobility utilizing the mobility protocol thereby decreasing ICU length of stay. Our Goals: Short Term (3 months): 100% of RNs educated and familiar with utilizing mobility protocol Intermediate (6 months): RNs utilizing mobility protocol to progress 40% of patients to the next mobility level Long Term (1 year): RNs utilizing mobility protocol to progress 65% of patients to the next mobility level

15 Budget $1,000 $2,000 $5,000 CSI Team Education/Launch Party Mobility Contest "People Mover" logo $1,000 $1,000 Unexpected Cost

16 University SICU Length of Stay (LOS) Data ,686 days/1,065 total cases = 5.34 days/case ,625 days/1,091 total cases = 5.16 days/case

17 Data Collection MONTHS Mobility Level 4 Mobility Level 5 Average LOS January 83% 39% 4.49 Days February* 87% 58% 6.42 Days March 82% 29% 5.07 Days April 72% 21% 4.57 Days May 79% 30% 4.23 Days June 60% 27% 3.71 Days July 77% 39% 5.20 Days *February included 4 outlier cases that included 129 days. If we subtract those days and cases our average LOS would be 4.88.

18 Average Length of Stay for AVERAGE DAYS

19 Percentage of Patients Achieving Mobility Levels 100% 80% 60% 40% 20% 0% LEVEL 4 LEVEL 5

20 How has the Mobility Protocol impacted the SICU? January-July ,872 days/606 total cases = 4.74 days/case ON TARGET AVERAGE LENGTH OF STAY GOAL OF 4.65 DAYS WITH AT LEAST 1,000 PATIENTS!

21 How is this going to translate? Approximate average cost of an ICU stay is $2,179/day Decreasing the LOS by 0.5 day saves $1, With projected cases of 1,000 patients for 2013, total savings would be $1,089,500 for the YEAR! YES, THAT S CORRECT MORE THAN 1 MILLION DOLLARS IN SAVINGS!

22 National Average Cost Savings Average cost of an ICU stay is $3,500/day. 1 Decreasing the LOS by 0.5 day saves $1,750 per patient With projected cases of 1,000 patients for 2013, the projected annual savings using the national average would be $1,750,000.

23 Key Challenges Manpower/Helping Hands Staff Resistance Behavior change Time constraints for staff Data Collection/Time Management Navigating electronic health record (no available report) Unable to easily collect data, extremely time consuming

24 Unintended Positive Outcomes Committee Involvement Mobility Protocol MDs Reaction Staff Responsiveness Pioneers of Mobility Tracking

25 What We Have Learned About Our Team and Ourselves Learning that we as staff RNs can have dominance and influence in motivating change, which was not in our comfort zone in the beginning.

26 How Do We Plan to Maintain Momentum and Sustain the Project When Funding Is Over Become the new norm Expectations of staff

27 References 1. Dasta J, Mclaughlin T, Moody S, Piech C. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):