Ideal care in the Intensive Care Unit: You sleep well

Dr. Peter Pronovost's vision of care in the Intensive Care Unit:

Imagine your loved one is admitted to the ICU after cancer surgery, you are actively involved in his or her care at a level comfortable to you, providing information about symptoms and concerns, knowing what is going on and actively participating in decisions.  

Clinicians are using technology to predict what harms your loved one is at risk of suffering.  Using technology the clinicians have a checklist of the 200 therapies your loved one may need to receive on any given day, to prevent harm. You can see when they are due, when they have been done. And most are automated because the devices monitoring care are connected.  

You sleep well knowing the infusion pump would alert staff and shut off if your loved ones breathing slowed. You are confident that staff will have time to provide comfort for your loved one, listening to their concerns, holding their hand. You attend clinical rounds daily, or whenever you choose–sometimes by video conference sometimes in person.  

You are provided a daily report on how well your loved one’s symptoms were managed, how well the team performed those 200 things and the results it achieved. The staff continuously works to learn and improve. You can feel that the staff work as a team, and are joyful. You can feel you and your loved one are treated with respect and dignity. And amazingly, care is much less expensive.

All of this is possible today, technology is not a barrier. The engineers can do this now. The question is–do we believe and will we collaborate?

See another story about Dr. Pronovost.  Thanks to Dr. Pronovost for this excerpt from his speech on August 28 at the launch of the Gordon and Betty Moore Foundation's Patient Care Program. 

Permanent, pervasive and beyond their control: Non-use of hospital checklists

David Maxfield, Linda Groah, and their research team at VitalSmarts and the Association of periOperative Registered Nurses (AORN) surveyed 2,383 registered nurses about communication breakdowns. For each breakdown, the nurses said whether it had been part of a continuing ["permanent"] pattern, was widespread ["pervasive"], or was within the nurse's control. Here are two of the 50 or so "triple-negative" [permanent, pervasive, and beyond their control] incidents the researchers collected:

"A special graft was ordered and due to arrive at 10:00. The surgeon insisted the day before he had to have this particular graft. The day of surgery the graft was not yet physically in the building but the surgeon insisted we put the patient to sleep. My stand was that unless you were prepared to use something else we should wait until it arrived. All of our checklists and protocols require that all implants and necessary items are available before the case begins. The surgeon said he would [get the graft] if necessary. I felt we were jeopardizing patient care, setting a poor example to the staff and why do we go through all these things in the first place?"

"Inserting central line at bedside in ICU. Used checklist but surgeon refused maximal sterile barrier and in fact, ridiculed me and hospital staff for instituting (this precaution) when there is no 'proof' it works. Hospital does not allow RN to stop procedure so it was inserted without maximal sterile barrier."

Unfortunately, there are times when well-intentioned staff can't speak truth to power.

Advice: A professional patient advocate can help in these situations.

Read about finding and working with a professional patient advocate in Chapter 12 of Getting Your Best Health Care: Real-World Stories for Patient Empowerment.

Thank God she did: Night shift in the hospital’s intensive care unit

Melinda Henneberger tells the story of her recovery from breast cancer surgery:

My husband wanted to come with me, but I finally persuaded him to stay home, thinking how much scarier it would be for our two kids if we were both gone. But my best friend, Mary, did fly in from Oregon and thank God she did. I was on the table for 12 hours and when I came out, they put me on a morphine drip. Nauseated, I’d start to vomit, then choke. I was thirstier than I’d ever been, but I couldn’t drink anything. Mary was there to feed me ice chips and hold me up when I choked. A few times, we pushed the button for help, but no one responded for quite a while Sometimes they never came at all. If I’d been on my own and choking, I’m not sure how I would have made it through the night.

The night shift staffers were kind and caring, but appeared to be overwhelmed by patients needing attention. I could hear other patients crying out for help that didn’t seem to come. It was horrible listening to them.

Later in the week, when I was able to move around, I fed ice chips to another patient. I stayed up all night with them. It took me half an hour just to get across the room. I was still in a great deal of pain and moving pretty slowly.

The whole thing was Dante-esque.

A spokesperson for the medical center says the hospital assigns one nurse for at least every two patients in the ICU, both night and day.

Melinda’s advice to people having inpatient surgery: By all means, get somebody to stay with you through the night.

Read another of our night stories, or read Max Alexander’s source story in the June 2007 Readers Digest.