Institute for Healthcare Improvement: Learning and Innovation Community: Improving Outcomes for High-Risk and Critically Ill Patients

Available through the IMPACT network or on a direct-enroll basis, IHI’s most intensive front-line improvement work happens in Learning and Innovation Communities. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area.

Listen to an informational call on this topic.

Download a brief description of this Community.

Improving Outcomes for High-Risk and Critically Ill Patients is available either through membership in the IMPACT network or through direct enrollment in the Community. Learn more about IMPACT.

The Challenge

The Solution

Every day, in every hospital, critically ill and high-risk patients count on their health care providers for care that is reliable, timely, and error free. Their chances of recovery depend on it. They rely on their medical caregivers to communicate effectively with one another and with them and their families, to respect their wishes and meet their needs with compassion. Unfortunately, current care often falls short of these expectations. In its landmark 2001 report "Crossing the Quality Chasm: A New Health System for the 21st Century," the Institute of Medicine describes serious quality gaps in US health care. The report highlights the need for new delivery system designs to enhance system performance.

The Improving Outcomes for High-Risk and Critically Ill Patients Learning and Innovation Community is designed to close the gap between what is known and what is practiced, and to establish new systems of care throughout the hospital aimed specifically to provide better support to the most vulnerable patients.

With mounting evidence that reliable, timely and compassionate care for high-risk and critically ill people is achievable, more and more hospitals are seeing the opportunity for fewer deaths, fewer complications, and shorter patient stays. These achievements will bring improved patient well-being, cost savings, and increased pride and hope to the workforce. Several hospitals working with the Institute for Healthcare Improvement through the IMPACT network and the 100,000 Lives Campaign have demonstrated that achieving these aims for high-risk and critically ill patients is within reach. There is tremendous opportunity for hospitals to make these improvements by focusing on specific units in the hospital and also addressing the entire system of care for high-risk and critically ill patients in the hospital.

Areas of Focus

Participants may focus on changes for high-risk and critically ill patients in specific units or throughout the hospital:

Prevention of Complications
Early Identification and Intervention
Communication and Collaboration
Integration of Patient and Family
Management and Flow of High-Risk and Critically Ill Patients
Culture and Infrastructure for Care of High-Risk and Critically Ill Patients
Standardization
Care at the End of Life

Specific interventions:

Ventilator Bundle
Central Line Bundle
Rapid Response Team
Glucose control inside and outside of the ICU
Sepsis Resuscitation and Management Bundles
Using Reducing Mortality Rates Diagnostic to guide action
Multidisciplinary rounds and daily goals
Handoffs/SBAR
Advanced Care Planning/Palliative Care

Aims

Participants will be asked to establish aims using these goals:

20 point reduction of overall HSMR
Greater than 25% reduction in raw mortality
Decrease ICU mortality by 20%
Decrease ICU length of stay by 20%

Examples of other measures for which hospitals can set specific goals based on organizational priorities and starting points:

Ventilator-associated pneumonia rate
Central line bloodstream infection rate
Sepsis mortality
Pulseless (cardiac) code rate
Rapid Response Team utilization
Glycemic control (within appropriate range, depending on patient condition)