Parkland SICU Takes Part In Groundbreaking Quality Improvement Project

Aims to reduce debilitating impact of intensive care on patients

DALLAS — When you think of a hospital intensive care unit, you probably envision bedridden, highly sedated patients breathing with the assistance of a ventilator and connected to a maze of tubes. But at Parkland Memorial Hospital, that picture is changing.

A new quality improvement project at Parkland called “ICU Liberation” hopes to free intensive care patients from serious, often permanent declines in physical and cognitive function resulting from the intensive care experience

The 18-month initiative sponsored by The Society of Critical Care Medicine selected 77 U.S. intensive care units to participate in the “A-F Bundle Improvement Collaborative” aimed at eliminating negative outcomes resulting from ICU care. The Parkland Surgical Intensive Care Unit (SICU) is one of only two ICUs in Texas selected to participate.

Every year 5.7 million people are admitted to ICUs in the U.S. for life-saving care. Thanks to advances in critical care medicine, most recover, but nearly one-half of these patients end up with permanent impairments in their physical, mental or psychiatric health due to Post-Intensive Care Syndrome, or PICS. PICS can cause serious, irreversible health problems including muscle weakness, cognitive or brain dysfunction, loss of memory, depression, severe anxiety and even PTSD symptoms.

“Pain, agitation, delirium, immobility and interruption of normal day-night cycles have been considered ‘normal’ for ICU patients. Actually, they all contribute to PICS. These are not normal or healthy and we need to eliminate them in ICU settings,” Dr. Williams said.

The A-F Bundle project focuses on the following aspects of ICU care to minimize PICS:

A – Assess, prevent and manage pain
B – Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT)
C – Choice of analgesia and sedation
D – Delirium: assess, prevent and manage
E – Early mobility and exercise
F – Family engagement and empowerment

Parkland’s multidisciplinary SICU team includes critical care physicians and nurses, respiratory therapists and physical, occupational and speech therapists, among others. All are collaboratively engaged in transforming ICU care to meet the goals of the A-F Bundle project. Dr. Williams decided to place the greatest emphasis at the beginning of the project on the Early Mobility (E) bundle.

To learn more about the ICU Liberation A-F Bundles project, visit www.iculiberation.org/bundles.  For more information about services available at Parkland, visit www.parklandhospital.com