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North Mountain Hospital ICU Honored with National Award for Reducing Risk, Enhancing Care Quality

Premier Insurance Management Services Presents $10,000 Risk Management Grant

Premier Insurance Management Services Inc. recognized John C. Lincoln North Mountain Hospital's Intensive Care Unit with a $10,000 American Excess Insurance Exchange (AEIX) Risk Management award.

The award recognizes their work in measurably improving the quality of care for patients with delirium.

"Older adults who are hospitalized are more vulnerable to change in cognitive and functional decline," said Robbi Johnson, RN, MN, CCRN, clinical director of the North Mountain Intensive Care Unit.

"The irony," she said, "is that national statistics show this group has the highest rate of delirium, placing them at risk for falls, but more than half of the older patients who experience delirium in the ICU setting are not recognized as having delirium."

This is no small issue, Johnson points out. Delirium increases intensive care unit stays, hospital length of stays, length of time on mechanical ventilation, mortality, and long term neuropsychological impairment, costing $4 to $20.4 billion annually in the United States.

Part of the problem, Johnson explained, was the lack of processes in place to prevent common complications that, when undetected or untreated in older hospitalized adults, lead to delirium. "We didn't have a validated assessment tool to identify delirium in our ICU patients," she said. "That meant patients were not being assessed and were not getting appropriate follow-up care to prevent the onset of delirium."

One of the steps in recognizing delirium is conducting a thorough cognitive assessment with a clinically tested and approved evaluation process. "Our evaluation tool, the CAM-ICU helps identify delirium in trauma patients. We also measured the nurse's attitudes, beliefs, and knowledge of delirium and then provided education to improve their understanding of how to assess and treat delirium when we found it," Johnson said.

Once the patient's delirium is diagnosed, appropriate care can be determined and put into effect, thereby creating a safer environment. Delirium-related falls in the ICU have decreased by 85 percent since this assessment process and follow-up care plans have been put into effect.

One additional and unexpected benefit of this new process is that the ICU is focusing on quality of care to improve long-term recovery, rather than limiting itself to its historical focus on acute care treatment modalities for optimal short term outcomes.

North Mountain Hospital was one of six Premier health care alliance member hospitals and health systems honored this year with AEIX awards and grants. Ninety-three hospitals and associated entities within AEIX, an excess liability risk retention group managed by PIMS, were eligible to apply.

Criteria for selection included whether or not the project demonstrably reduced cost and enhanced patient safety, as well as whether clear metrics were established to track and sustain success. Another criterion is scoring "spreadability," or how replicable the approach is for other health systems, and is also essential in the selection process.

The recipients were honored on June 12 at Premier's 2013 Breakthroughs Conference and Exhibition in San Antonio. Award winners shared best practices that were the basis for their awards in concurrent sessions during the conference.

"These organizations are making impactful changes in care as they collaborate to reduce liability and enhance patient safety," said Les Meredith, senior vice president and general counsel, PIMS. "They are furthering the goal of AEIX to combine risk management with quality improvement initiatives that deliver the best clinical outcomes."

In addition, John C. Lincoln Health Network also received recognition as a winner of the Sylvia Moss Brown Award for Excellence, given annually to the project receiving the most votes from the AEIX Award and Grant Sub-committee. This award is named for PIMS' former risk management colleague, Sylvia Brown, who helped initiate the awards and grants program and made significant contributions to both ASHRM and the profession of risk management prior to her death in 2011.

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