UW Health's Neurocritical Intensive Care Unit (ICU) at UW Hospital and Clinics in Madison, Wisconsin, provides value in the care of neurologically-ill patients by improving outcomes and reducing costs.
Joshua Medow, MD, founded the neurocritical care program in 2008. Our state-of-the-art, 16-bed, dedicated neurocritical care unit provides value by following best practices and identifying quality improvement initiatives in our ICU. Our efforts have reduced mortality in the sickest patients by 43 percent and costs by about $3 million.
Neurocritical ICU Projects
- Deep Vein Thrombosis (DVT) Prophylaxis: Deep vein thrombosis is a blood clot that forms in a vein, usually in the lower limbs, that blocks blood circulation. All neurocritical ICU patients receive TED Hose - tight-fitting stockings that reduce the possibility of blood clots - and Venodynes - compression boots that do the same - in an effort to reduce blood clots. Many patients with intracranial hemorrhage or traumatic brain injury have been getting dalteparin or SubQ heparin to slow intracranial hemorrhage.
- Nutrition: The percentage of goal tube feeds has increased since the program's inception, as our staff has established a uniform approach for how and when the tube feeds should get started, including placement of feeding tubes, and devised new protocol feed rate increases.
- Reduction of Ventilator-associated Pneumonia (VAP): We have addressed VAP by implementing national standards such as maintaining endotracheal tube cuff pressures and by using chlorhexidine mouthwashes in addition to the standard, every two-hour mouthwash that is being performed. We also ensure that our patient’s head-of-bed is greater than 30 degrees. Additionally, we change the ventilator suction system every 24 hours, which seems to reduce infection rates and we now only use quantitative bronchoalveolar lavages (BAL) to assess for infections.
- Reduction in Drug Costs: The Neurocritical ICU pharmacy staff evaluated the use of a number of drugs, and their work has helped us reduce our per-patient drug costs from more than $700 per patient to less than $500 per patient.
- Patient Length of Stay: Most patients admitted to our neurocritical ICU do not have a health care power-of-attorney, which made post-care placement difficult. Our staff began an initiative to ascertain patient power-of-attorney privileges and involve patient families, when necessary and appropriate. The initiative helped us place patients in rehabilitation, skilled nursing or long-term care facilities.
- Discharge Planning: Our staff created and implemented a real-time discharge status board in our electronic medical record which significantly reduced the number of pages between physicians, pharmacists, therapists and nurses. Patients now understand all that goes into the discharge process and physicians use the software to see their patients' discharge status from the moment they are admitted.
The sum total of our clinical and educational projects is improved patient care, including:
- A reduction in mortality rates
- Reduced length of stay in our unit
- Reduced costs