Resisting the Status Quo to Reduce Hospital-Acquired Conditions

As a health system that is dedicated to continuous improvement, GBMC is consistently exploring ways to minimize the risk of hospital-acquired conditions, which are conditions that can occur during a hospital stay but were not initially present upon admission. In fact, within our aim of Better Health, we have embedded goals to decrease the number of these conditions to keep our patients safe and provide the best outcomes.

Today, I want to highlight the work being done in our medical and surgical intensive care units (MICU and SICU) to reduce the number of catheter-associated urinary tract infections (CAUTI). While indwelling catheters can be helpful in certain situations, they also come with risks because they can introduce bacteria into the urinary tract and lead to infection. Preventing unnecessary catheter placements reduces infection risk. 

Too often in the emergency and ICU settings, there is a tendency to catheterize because that’s the way it’s always been done rather than pausing and considering alternatives. David Vitberg, MD, Director of our Medical and Surgical ICU, and his team reflected on this trend, analyzed data, and recognized the following opportunities for improvement in our own ICUs. 

• Shift of culture and critical thinking: The team noted that indwelling catheterization was part of the standardized order set for many conditions within our electronic health record system, when it actually wasn’t always necessary. They got out of the habit of following the status quo and implemented a “questioning attitude” to assess the need for catheterization on a case-by-case basis. As part of each assessment, they consider questions like, “Does this patient truly need an indwelling catheter?” and “Is there a lower-risk alternative to measure urine output for this patient?”
• Education: Nurse leaders have educated staff about alternative strategies to placing indwelling catheters to measure urine output, such as using external catheters instead.
• Continuous communication: Questions about catheterization have been built into discussions and checklists around the care of each patient to prompt critical thinking. Dr. Vitberg and Temitope Oseromi, MSN, RN, CCRN-K, Nurse Manager of the Medical and Surgical ICU, round the units and ask questions when they see patients have been catheterized to encourage staff discussion and identify educational opportunities.

With these enhancements, our ICU teams have significantly reduced their placement of indwelling catheters, with an expected result of fewer CAUTIs.

Thank you to Dr. Vitberg and Temi for leading this important patient safety work, as well as the entire MICU and SICU teams for working to improve outcomes for patients!

Celebrating Juneteenth

On Monday, June 19, our Black Alliance Employee Resource Group (ERG) hosted an excellent Juneteenth event to commemorate the emancipation of enslaved people in the US. This year’s theme was “Educating, Empowering, Entertaining” and was a wonderful celebration of history, culture and art and food. Thank you to our Black Alliance ERG for planning this thoughtful event!