(1270) Standardization and Adaptation: A Resilience Framework Approach to Improving ICU Outcomes

Introduction: Institutions are expanding to satellite sites to improve access to inpatient and ICU care. The varying clinical scope of multiple sites requires a customized approach to identify and promote resiliency while retaining highly reliable patient-centered care. We hypothesized that a standardized sharing of real-time data on activity, acuity, and outcomes thru all ICU sites using the resilience framework of respond, monitor, learn, and anticipate, could minimize unnecessary variation, and recognize necessary adaptations.

Methods: A multidisciplinary team (physicians, advance practice providers, nursing, administrative and quality) identified and reviewed regularly, 6 activity, 8 acuity variables and 16 patient-centered outcomes using real-time data acquired from five sources. We qualitatively analyzed how we responded, what we monitored, how learning guided responses, and how adaptations directed future needs. Unnecessary variation in monitored metrics received directed interventions and necessary adaptations informed anticipatory plans. Data pre- and post-intervention were compared using student’s t-test, *p < 0.05.

Results: Sustainable data review engaged all five ICUs across three sites for over 14 months. Example data driven response and impact of actions include: 1) Two community ICUs with similar scope had differing length of stay (LOS) for bronchiolitis patients with one ICU having internal variation in respiratory wean practices. Standardized weaning resulted in decreases in median times of noninvasive ventilation by 41% [27 to 16 hours*], NPO status by 34% [39 to 26 hours*] and LOS by 15% [41 to 35 hours] with no change in intubations or readmissions. 2) Weekly device stewardship rounds reduced Foley days [Mean/month: 64 to 39*] within 6 months. Adaptations included managing: 1) increased unplanned extubation rates with overflow of respiratory patients to cardiac ICU and 2) winter rise in rapid response calls. Anticipatory responses planned for future patient overflow and seasonal demands are just-in-time training and modified resource allocation.

Conclusions: A resilience framework allows optimization of variation, both necessary and unnecessary, within the complex socio-technical environments of multisite ICUs.