R W Baird1. 1. Division of Pulmonary Diseases, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
Abstract
CONTEXT: An ongoing process of identifying and implementing breakthrough projects to quickly improve patient outcomes and reduce costs in the intensive care unit. OBJECTIVE: To develop and test a new protocol for heparin administration in the intensive care unit, replacing the 5 existing protocols and ensuring compliance with the recommendations of the Fifth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. DESIGN: A pilot study comparing results of 58 patients on the 5 existing protocols with those of 10 patients on the new heparin protocol. SETTING: Baylor University Medical Center, a large tertiary hospital in Dallas, Texas, with 115 adult intensive care unit beds. INTERVENTIONS: Heparin dosing was based on a patient's weight, and anticoagulation was monitored through the heparin assay. MAIN OUTCOME MEASURES: In the control group treated according to the existing protocols, 5 patients (8.6%) received optimal bolus doses, and 2 patients (3.4%) received optimal infusion doses. In the pilot group treated according to the new protocols, 9 patients (90%) received optimal bolus doses, and all received optimal infusion doses. RESULTS: The implementation of the new heparin protocol resulted in better patient care, improved nursing efficiency, and reduced costs. CONCLUSIONS: As shown in this example, a rapid breakthrough project following a plan-do-study-act cycle can apply best practices relatively quickly and lead to better patient outcomes.
CONTEXT: An ongoing process of identifying and implementing breakthrough projects to quickly improve patient outcomes and reduce costs in the intensive care unit. OBJECTIVE: To develop and test a new protocol for heparin administration in the intensive care unit, replacing the 5 existing protocols and ensuring compliance with the recommendations of the Fifth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. DESIGN: A pilot study comparing results of 58 patients on the 5 existing protocols with those of 10 patients on the new heparin protocol. SETTING: Baylor University Medical Center, a large tertiary hospital in Dallas, Texas, with 115 adult intensive care unit beds. INTERVENTIONS:Heparin dosing was based on a patient's weight, and anticoagulation was monitored through the heparin assay. MAIN OUTCOME MEASURES: In the control group treated according to the existing protocols, 5 patients (8.6%) received optimal bolus doses, and 2 patients (3.4%) received optimal infusion doses. In the pilot group treated according to the new protocols, 9 patients (90%) received optimal bolus doses, and all received optimal infusion doses. RESULTS: The implementation of the new heparin protocol resulted in better patient care, improved nursing efficiency, and reduced costs. CONCLUSIONS: As shown in this example, a rapid breakthrough project following a plan-do-study-act cycle can apply best practices relatively quickly and lead to better patient outcomes.