Staff from one ICU describe how they integrated the ICU Liberation Bundle (A-F) into the electronic health record to improve patient care.
The Society of Critical Care Medicine’s (SCCM) ICU Liberation Campaign is an ongoing initiative that aims to liberate patients from the harmful effects of an intensive care unit (ICU) stay by providing a comprehensive bundle of strategies for the entire multiprofessional critical care team. The bundle’s evidence-based practices enhance patient care in both adult and pediatric patients and are now at the fingertips of critical care clinicians.
Anne Marie O. Martland, DNP, ACNP-BC, and D. Scott McCaul, MD, describe how they integrated the bundle into the electronic health record (EHR) to improve patient care in their ICU at Scripps Memorial Hospital in La Jolla, California.
The 59-bed ICU at Scripps, a tertiary medical center, has a unique heterogenous population. Spanning two floors, it carries the designations of level 1 trauma center, advanced circulatory mechanical support referral center, shock referral center, and neurocomprehensive referral center. At any given time, we have six to eight intensivists rounding at the same time, creating a difficult landscape for finding a dedicated multidisciplinary team for each rounder.
In the aftermath of the COVID-19 pandemic and the Great Resignation that followed, we tried to create some normalcy in our ICU. We had struggled to find a working solution to implement the ICU Liberation Bundle (A-F) even before the pandemic. After the pandemic and mass resignations, we had a greater disadvantage in finding a solution.
Our greatest learning from the pandemic was that we can leverage technology to augment our ICU workflow and processes. Building on this premise, we created a hybrid approach to multidisciplinary rounds using synchronous (in-person) and asynchronous (store-and-forward) strategies. The asynchronous platform tool is embedded within the Epic EHR.
The EHR tool is organized by discipline and is structured to include all ICU Liberation Bundle elements in addition to objective data for daily evaluation of usual quality metrics, such as duration of lines and drains. The tool also allows all disciplines to enter free-text recommendations in a store-and-forward fashion to be reviewed by the in-person team at the time of daily rounds. We saw that the asynchronous EHR tool broadened the engagement of disciplines who could contribute to daily rounds. After the first iteration of the EHR tool, the infection control and wound care teams requested dedicated space within the tool to allow for their input for rounds.
With this approach, we have seen decreased ventilator days, ICU stays, and central line-associated bloodstream infections, either equal to or lower than pre-COVID-19 rates. We have continued our new approach to rounds, solving challenges that many of us experienced in coordinating our care team members to participate in daily synchronous multidisciplinary rounds.
The SCCM ICU Liberation Committee has partnered with Epic and Oracle (formerly Cerner) to easily incorporate the ICU Liberation Bundle (A-F) for adult and pediatric patients into clinicians’ workflows. Learn how to customize the EHR tool to fit your needs.
Below are images showing how each discipline at the Scripps Memorial Hospital ICU used the EHR ICU Liberation Bundle (A-F) tool. Images reproduced with permission. © 2024 Epic Systems Corporation.
