Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study

Robyn Clay-Williams, Brette Blakely, Paul Lane, Siva Senthuran, Andrew Johnson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. Design: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data. Setting: ICU in a 700-bed regional tertiary care hospital in Australia. Participants: 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: Bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: Staff from surgery and emergency departments. Intervention: Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan. Main outcome measures: Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds. Results: Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ21 =24.9, p<0.0001. Conclusions: By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.

LanguageEnglish
Article numbere025041
Pages1-9
Number of pages9
JournalBMJ Open
Volume9
Issue number3
DOIs
Publication statusPublished - 1 Mar 2019

Fingerprint

Intensive Care Units
Decision Making
Delivery of Health Care
Interviews
Amber
Nursing Staff
Hospital Departments
Tertiary Healthcare
Tertiary Care Centers
Workplace
Hospital Emergency Service

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • intensive care
  • organisation of health services

Cite this

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title = "Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study",
abstract = "Objective: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. Design: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data. Setting: ICU in a 700-bed regional tertiary care hospital in Australia. Participants: 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: Bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: Staff from surgery and emergency departments. Intervention: Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan. Main outcome measures: Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds. Results: Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ21 =24.9, p<0.0001. Conclusions: By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.",
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Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia : a multimethod study. / Clay-Williams, Robyn; Blakely, Brette; Lane, Paul; Senthuran, Siva; Johnson, Andrew.

In: BMJ Open, Vol. 9, No. 3, e025041, 01.03.2019, p. 1-9.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia

T2 - BMJ Open

AU - Clay-Williams, Robyn

AU - Blakely, Brette

AU - Lane, Paul

AU - Senthuran, Siva

AU - Johnson, Andrew

N1 - Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objective: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. Design: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data. Setting: ICU in a 700-bed regional tertiary care hospital in Australia. Participants: 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: Bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: Staff from surgery and emergency departments. Intervention: Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan. Main outcome measures: Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds. Results: Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ21 =24.9, p<0.0001. Conclusions: By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.

AB - Objective: To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds. Design: Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data. Setting: ICU in a 700-bed regional tertiary care hospital in Australia. Participants: 31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: Bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: Staff from surgery and emergency departments. Intervention: Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan. Main outcome measures: Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds. Results: Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ21 =24.9, p<0.0001. Conclusions: By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.

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