Keck Hospital of USC is among 77 leading hospitals selected nationwide to participate in a campaign that aims to make the improvement of intensive care unit (ICU) outcomes as easy as A, B, C.

The Society of Critical Care Medicine, a nonprofit medical organization that promotes excellence and consistency in the practice of critical care, created the ICU Liberation Campaign to standardize and improve best practices in ICU’s across the nation. The program focuses on implementation of six best practice protocols designated as A, B, C, D, E, F (A: Assess and manage pain; B: Both awake and spontaneous breathing; C: Choice of sedation; D: Assess and manage delirium; E: Early mobilization and exercise; F: Family engage and empower). Despite global recognition that these protocols are ICU best practice, implementation nationally falls far short of expectations. The goal of the campaign is to determine barriers to implementation and how best to address them in each of the 77 participating hospitals.

The 7 West Surgical ICU in Keck Hospital was selected for the campaign, under the direction of J. Perren Cobb, MD, Director of Surgical Critical Care, Geoff Cariker, DPT, instructor of clinical physical therapy, and Kathrine Winnie, RN-BC, clinical nurse specialist. Cobb is collaborating with Keck Hospital’s departments of surgery, anesthesiology, medicine, nursing, physical therapy, respiratory therapy, pharmacy and social work. The team will monitor the first 30 patients admitted to the 7 West Surgical ICU every month, for 18 months, to determine how best to implement the six clinical protocols and the impact of these protocols on patient outcomes. The other 76 ICU’s in the campaign are similarly entering data from their patients.

“There is significant variance in how patients do in intensive care units, even after controlling for how sick somebody is,” Cobb explained. “There has been global acceptance that 100 percent compliance with A-F protocols dramatically improves the value of the care we provide. Our goal is to get our quality as high as possible and get our costs as low as possible, thereby optimizing value.”

Compliance with the six protocols are expected to lead to decreased ventilator time, decreased ICU length of stay, improved return to normal brain function, increased independent functional status, improved patient and family satisfaction, and an increased survival rates.

At the end of the 18-month period, the data from the 77 ICU’s will be analyzed. Cobb and his team will review the findings with other members of the campaign and report on lessons learned.

– L. Alexis Young