The intensive care unit can be one of the most intimidating areas of a hospital for patients. The rush of activity, the sounds, machines, tubes and monitors can all create an environment that fills people with foreboding, instead of inspiring feelings of calm and safety.
Now, healthcare leaders are taking steps to change that, through the use of novel and innovative approaches, the Wall Street Journal reports. Hospitals are redesigning intensive care units with safety in mind, focusing on removing dehumanizing aspects of current facilities and engaging patients and their families in decisions. Many ICU teams have adopted apps and devices to link up medical teams with family, and to request input from patients regarding goals for care.
According to the WSJ, evidence has shown that patient participation in care can improve safety and outcomes. Hospitals are putting failures to treat patients with respect on par with other preventable medical complications. This includes refusing to treat patients with compassion, ignoring or overlooking their concerns and brushing off patient contributions regarding their care.
"We are broadening the definition of harm to include disrespectful care, which is every bit as important as an infection in the ICU," says Peter Pronovost, a critical care physician and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore. John Hopkins is one of four centers whose top patient safety experts are working on ICU redesign projects.
More than five million Americans are treated in an ICU annually. There they face the highest risk of complications — such as infections, blood clots and pneumonia — of any hospital department. ICU's also tend to rob patients of their privacy and control.
"There are so many patients on life support, and ventilators, and there are IVs and bags everywhere and you just don't feel as if you have any control," Michelle Young, a UCSF advisory council member who provided feedback on the project, told WSJ. She added that patients needed transparency and access, and for families in the ICU regularly or long-term, education on how to navigate the ICU. Young's daughter was in and out of the ICU for several years as she struggled with autoimmune disorders. She passed away of complications from an infection at age 23.
Kenneth Sands, senior vice president of health care quality at Beth Israel Deaconess Medical Center in Boston, which is developing it's own ICU technology, also told the WSJ that many patients experience a severe loss of autonomy in the ICU. The hospital consulted with patients and families on its critical care advisory committee and found that beeping machines and monitors were not too difficult for patients to deal with. Instead most anxiety and stress was a result of being approached and touched without adequate explanation.
Understandably, doctors and nurses have been slow to adopt transparency or include patients and families in decision making, due to concerns that they might interfere as workers attempt to treat dire medical conditions. David Bates, chief innovation officer and principal investigator for the project known as Prospect at Brigham and Women's in Boston, told the WSJ that cheerleading was required to encourage ICU teams to become comfortable with the idea of patients and families posing questions and having full access to their plan of care, health reports and lab results via online portals. Overall, however, these steps prevent harm and improve patient engagement and outcomes, which is better for the hospital.
Healthcare workers can also introduce technology into their practice by partnering with applications such as Patient Approved, which allows patients to document feedback regarding hospital facilities and care online. Doctors and others can respond to concerns and work to improve areas that need it.