Thomas Jefferson UniversitySidney Kimmel Medical College

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Reducing ICU-acquired infections:

The Jefferson MICU staff is dedicated to reducing the infectious complications of critical care. Multidisciplinary working groups made up of physicians, nursing staff, infection control specialists and other interested parties work continuously to reduce common ICU-acquired infections such as catheter-related bloodstream infections (CLASBIs), catheter-associated urinary tract infections (CAUTIs) and clostridium-difficile colitis.

Improving sepsis care:

Jefferson’s MICU is leading the way in improving the care of patients with sepsis.  An electronic protocol streamlines the recognition and treatment of sepsis and creates standards for all providers in the care team.  Innovations include automatic electronic alerts based on vital signs, First Line Orders (FLOs) for emergency department triage nurses, easy-to-use treatment order sets, and intranet based resources allowing all staff to easily access the protocol.  An interdisciplinary committee of physicians, nurses, pharmacists, administrators, and support staff from the Emergency Department (ED), the Medical Intensive Care Unit (MICU), Infectious Diseases (ID), and Information Services (IS) reviews each phase of sepsis recognition and treatment from first contact in the ED to eventual MICU transfer. The effect of these efforts have been dramatic with marked improvement in compliance with evidence-based standards for sepsis care and reductions in sepsis-related mortality

Improving the care of mechanically-ventilated patients:

More and more attention is now being paid to the long-term outcomes of patients surviving critical illness. A key part of improving these outcomes is optimizing the management of mechanically-ventilated patients.  Reducing exposure to unnecessary sedation, identifying patients early for extubation readiness and facilitating early exercise and progressive mobility are the cornerstones of this effort. The Jefferson ABCDE (Awakening and Breathing Trial Coordination, Delirium Assessment, Early Exercise and Mobility) Working Group is a multidisciplinary group of critical care professionals dedicated to developing and using evidence-based protocols to reduce the duration of mechanical ventilation and the incidence of delirium, and get mechanically ventilated patients moving and out of bed quicker.

Making critical care more patient and family-centered

The Jefferson MICU is focused on improving the patient and family centeredness of ICU care.  Current efforts include improving the conduct and documentation of multidisciplinary family meetings in the ICU and closely integrating palliative care services with the critical care team.