Conference to Teach Clinicians to Provide Better, Safer Care for ICU Patients

SALT LAKE CITY, UT (3/28/2011) – Thirty healthcare providers from around the country will arrive at LDS Hospital on Tuesday for a unique hands-on class to learn how the hospital’s innovative approach to patient care, which includes getting patients off sedatives as quickly as possible in the intensive care unit, can benefit their patients.

“Reducing Patient Harm from Immobility, Sedation, and Delirium,” is the title of the class, which is sponsored by the Institute for Healthcare Improvement (IHI), a Massachusetts-based nonprofit organization dedicated to improving healthcare in the United States.

Clinicians from around the country will learn about LDS Hospital’s use of unique protocols that are designed to get patients off heavy sedatives as quickly as possible — and then getting them back on their feet. Healthcare professionals from Seattle, Toronto, North Carolina and elsewhere will take the methods back home to their hospitals after this week’s two-day class.

In most hospitals across the United States, intubated ICU patients are kept in a heavily sedated “twilight state” where they’re not quite awake and not fully asleep, according to Dr. Terry Clemmer, MD, director of critical care medicine at LDS Hospital.

But the consequences of using these sedatives can be profound: The drugs cause delirium in up to 80 percent of ICU patients who are breathing with the assistance of a ventilator. Often these patients will suffer from post traumatic stress disorder and nightmares months and even years after their stay.

The drugs also keep patients immobilized, which means that patients begin to lose muscle strength within days. Many lose the ability to care for themselves and must move from the hospital to a nursing home. Studies show that among patients who have experienced a critical illness, more than half are unable to return to work within a year of ICU hospitalization.

Heavy sedation, immobility, and delirium can also lead to longer hospital stays, increased risk of death, and higher medical costs, says Dr. Clemmer.

For several years, Intermountain Healthcare’s LDS Hospital has taken a nontraditional approach to caring for ICU patients.

“We get them off sedatives the day they arrive in the ICU and manage their symptoms with pain medication,” says Dr. Clemmer. “When you remove the sedatives, patients are able to think more clearly and they’re not as fearful.”

That means they’re less likely to try to pull out an IV or a breathing tube, which is the reason most ICUs keep patients heavily sedated.

Withdrawing the sedatives also allows the ICU team at LDS Hospital to get patients moving again very quickly — often the same day they arrive. The team will begin by helping the patient sit on the edge of the bed, then move to a chair, then take a few steps.

“More of our patients go home after their stay in the ICU than patients in ICUs across the country. That’s because we’ve been able to help them maintain their strength and ability to function,” says Dr. Clemmer.

The ICU team at LDS Hospital and the respiratory ICU at Intermountain Medical Center have published on their successes with ending sedation and getting patients moving; several other centers, including the prestigious Johns Hopkins, have adopted their strategies. However, the approach is still novel for most hospitals.

Clinicians from Seattle, Toronto, North Carolina and elsewhere will take the methods back home to their hospitals after this week’s two-day class, which is sponsored by the Institute for Healthcare Improvement (IHI), a Massachusetts-based nonprofit organization dedicated to improving healthcare in the United States.

The class will be taught at LDS Hospital by Dr. Clemmer and other members of the ICU team at LDS Hospital and the respiratory ICU at Intermountain Medical Center. They will be joined by Wes Ely, MD, a physician from Vanderbilt University, which has also adopted some of the sedative strategies.

“Intermountain and Vanderbilt have achieved exceptional outcomes and substantial reductions in complications and length of stay for their ICU patients via novel screening tools, early removal of heavy sedation, and aggressive mobility,” says IHI in an announcement for the course.