Beth Israel aims for ICU harm reduction

Project to deploy technology, personal input to better ensure 'dignity and respect in the ICU'
By Mike Miliard
05:47 AM
Beth Israel Deaconess Medical Center in Boston launches ICU initiative.

With help from a $5.3 million grant from the Gordon and Betty Moore Foundation, Beth Israel Deaconess Medical Center will explore ways to put IT and patient engagement to work eliminating preventable harm in the ICU.

BIDMC officials say the grant will help them better define the burden of harm in the intensive care unit – including the loss of dignity and respect – as the hospital moves to a systems-based approach to eliminating preventable harm.

As it works to develop tools to support safer interventions, BIDMC will focus on giving more timely and informative information to intensive care patients, families and providers. The hope is to develop new IT applications that can better involve people in the care process while reducing risk in the ICU.

"Beth Israel Deaconess Medical Center has a long and distinguished history in patient and family engagement, starting with the nation’s first Patient Bill of Rights in 1972 to its commitment in 2008 to eliminate preventable harms in its medical center," said Steve McCormick, president of the Gordon and Betty Moore Foundation, in a press statement.

A team of BIDMC clinicians, working with MIT system scientists, are developing a model for measuring and managing the leading indicators of risk for harm in the ICU, officials say, including a dashboard system to raise clinicians’ awareness of conditions that may threaten patient safety.

During the 30-month project funded by the Moore Foundation grant, BIDMC will work with its ICU providers to build upon and improve current practice with IT tools that provide nurses and physicians with the right information for the decisions immediately at hand for each patient.

"While checklists applied to critical care processes may be spectacularly effective, when scaled to try to prevent all harms, they may actually cause harm by overwhelming providers," said Kenneth Sands, MD, senior vice president of healthcare quality and chief quality officer at BIDMC.

The lack of systematic engagement of patients and families in understanding and identifying risks in ICUs is potentially harmful, say hospital officials. That failure may result in loss of dignity and respect, particularly when clinicians are not aware of the wishes of patients and their families in terms of how they would like to be involved and how much or how little effort is desired.

"Critical care scorecards almost never include quantitative measures of patient’s perceptions of dignity and respect in the ICU," said Daniel Talmor, MD, vice chair of BIDMC's department of anesthesia, critical care and pain medicine, in a statement.

That's why two key components of the project are to create checklists that will provide patient-specific information to clinicians, allowing them to make the right preventative-care decisions at the right time, officials say. The information would be available to clinicians in real-time through a provider-facing interface.

Another interface – one that relies on easy-to-understand language that facilitates communication between patients and families and providers in the ICU will also be developed.

"These innovations would enable open, real-time discussions between care providers, patients and family members in a critical care environment where, due to its complexity, this type of information has traditionally been available only to providers," said Talmor.

The project also hopes to take the lessons learned here to drive patient engagement in other, smaller settings that aren't urban academic medical centers. As such, certain projects from the BIDMC study will innovations will be piloted at satellite hospitals in Milton, Mass. and Plymouth, Mass.

"Until there are clear models for spreading safety innovations from large hospitals into community hospitals the national impact of patient safety will continue to be minimal," said Sands.

With this grant from the Moore Foundation, BIDMC joins nearby Brigham & Women’s Hospital, as well as Johns Hopkins Medicine and the University of California San Francisco as part of the ICU Consortium.

[See also: Beth Israel Deaconess docs to measure clinical performance]