Nurse-led initiatives in Indiana improve patient outcomes

Nurse-led initiatives in Indiana measurably improved patient outcomes while demonstrating anticipated financial savings of more than $5.2 million to their organizations, according to initial results from a hospital-based nurse leadership and innovation training program launched last year by the American Association of Critical-Care Nurses (AACN).

AACN developed this team-oriented and hands-on educational experience, AACN Clinical Scene Investigator (CSI) Academy, to empower bedside nurses as clinician leaders and change agents whose initiatives generate quantifiable improvements in the quality of patient care and hospital bottom line.

Forty-two hospitals in six U.S. regions are participating in the program's preliminary national rollout. The first of these initial cohorts presented its results at AACN CSI Academy's first Innovation Conference, held in Indianapolis in mid-November.

At the conference, nurses from six Indianapolis hospitals reported noteworthy clinical and financial outcomes based on initiatives they developed and implemented during their CSI Academy training.

Among the teams' clinical successes:
•Decreased length of stay in the pediatric intensive care unit (ICU) by 0.5 days
•Improved parent satisfaction scores by up to 20 percent
•Sustained zero rate of new infection-related ventilator-associated complications
•Reduced hospital-acquired device-related pressure ulcers of the nose and mouth by 50 percent
•Decreased mechanical ventilation days for ICU patients by 0.44 days
•Reduced patient falls by more than half
•Decreased overall pressure ulcers by greater than 60 percent

Linda Q. Everett, RN, PhD, NEA-BC, FAAN, executive vice president and chief nurse executive at Indiana University (IU) Health, said skill-building among participating nurses and other program benefits have already been translated across other units at IU Health hospitals.

"Direct care nurses at IU Health serve as evidence-based lean change agents, and our AACN CSI Academy participants have become expert in designing, implementing and evaluating nursing and patient care innovations," she said. "They gained confidence and competence to articulate the value of nursing and demonstrate its impact."

Indianapolis hospitals participating in AACN CSI Academy:
•Franciscan St. Francis Health
•Indiana University Health Methodist Hospital
•Indiana University Health University Hospital
•Riley Hospital for Children at Indiana University Health
•St. Vincent Indianapolis Hospital
•Wishard-Eskenazi Health (Eskenazi Health)

For the past 16 months, the Indianapolis teams have worked with CSI faculty, an internal mentor and a chief nursing officer to address some of patient care's most costly challenges, including healthcare-associated infections, pressure ulcers, patient falls and more.

In tandem with the conclusion of CSI initiatives in Indianapolis, AACN launches the AACN CSI Academy Innovation Database, a free online compilation of CSI team project outcomes and documentation.

"The CSI Innovation Database offers practical approaches to combating common clinical challenges that we hope will inspire bedside nurses and other leaders to embark on similar value-based improvement efforts," said Dana Woods, AACN senior director. "These results reinforce that bedside nurses are essential catalysts in driving excellence in patient care."

The searchable database of real-world project plans, clinical interventions, data collection tools, outcomes and references will grow as additional CSI teams complete the program. Access the database from the AACN CSI Academy Web page at www.aacn.org/csi.

Open sharing of clinical solutions and patient care innovations is a keystone of AACN CSI Academy's broader mission to empower and inspire all acute and critical care nurses to lead change that benefits their patients and organization.

As the only nursing excellence and leadership skill-building program that provides hospitals with both educational programming and grant funds to support project implementation, AACN CSI Academy represents a substantial investment of AACN's expertise and money in nursing practice innovation.

It also reflects a high-level strategic response by AACN to the Institute of Medicine's landmark "Future of Nursing" report, confirming the vital role nursing can and should play in the transformation of healthcare.

AACN CSI Academy continues at hospitals in Massachusetts, New York, North Carolina, Pennsylvania and Texas. Nurse participants in these regions are undertaking projects such as preventing ventilator-associated pneumonia, catheter-associated urinary tract infections, central line-associated bloodstream infections, pressure ulcers, falls, delirium and unplanned extubation, and improving communication and teamwork.

During the program's three-year first phase, AACN is investing $1.25 million to fund implementation at partner hospitals across the country. This investment supports program administration and provides a $10,000 implementation grant to each participating hospital.