Processes and Procedures: Achieving Optimal Outcomes for ICU Patients

In our ICU units, the primary objective is clear: to ensure our patients survive, recover, and return to their owners in the best possible health.

Given the critical nature of their conditions, this goal is often challenging, but by adopting strategic approaches and effective management techniques, we can significantly optimize patient outcomes.

Collaboration among veterinarians, veterinary technicians, and pet owners is essential to this process.

Establishing Objectives

The initial step is to define the desired outcomes and set clear expectations for all parties involved.

This may include goals such as reducing patient mortality rates, accelerating mobility post-surgery, or enhancing data recording efficiency.

These professional aims will differ from the clients' priorities, which typically focus on the pet's quality of life.

Early in the case, it's crucial to engage with pet owners to understand their primary concerns and objectives.

Whether their goal is to get their dog back to running long distances, encourage their cat to eat again, or provide palliative care for a pet in its final days, understanding these aims is the first step toward achieving them.

Staffing Appropriately in Veterinary ICUs

Effective management of an ICU hinges on efficiency, both among staff and within care procedures. Ensuring that an ICU is appropriately staffed is crucial.

Each team member should understand their role and perform their duties to the best of their abilities. Additionally, staff should be ready to assist colleagues when needed and prioritize their own physical and mental well-being.

Research in human medicine has demonstrated that nurses significantly impact patient outcomes and survival rates in hospitals. We can draw a parallel in veterinary medicine, recognizing that the expertise and efficiency of veterinary technicians are vital to the success of any shift.

A 2020 study reinforced this, examining errors and patient outcomes in three U.S. veterinary hospitals. It found that variations in veterinary technician staffing levels and experience directly influenced the occurrence of errors.

This underscores the importance of appropriate staffing in maintaining high standards of care and improving patient outcomes in veterinary ICUs.

Communicating Effectively in a Veterinary ICU

Effective communication is crucial in any team environment, but it is especially vital in a busy, fast-paced, and stressful ICU setting.

ICU patients often have complex, multi-factorial needs, making thorough and precise communication essential.

This involves not only verbal communication, such as running 'rounds' at the start of each shift, but also ensuring that paperwork—including hospital charts, medication charts, and owner consent forms—is meticulously maintained.

Small details, like checking off when a medication has been administered or highlighting a known allergy, can significantly impact patient care.

Ensuring legible handwriting and clearly labeling any symbols used can enhance accuracy. Assigning one or two people to oversee each case can help minimize discrepancies caused by communication errors.

Rounds are beneficial for keeping the entire team updated on the critical aspects of each case. However, detailed handovers should ideally occur directly between team members responsible for the patient to avoid potential miscommunication.

Learning from mistakes

Veterinary medicine is a volatile business and despite everyone’s best efforts, things can and will go wrong.

In order for the system to continue to function positively, it is vital that mistakes are not ignored or shrugged off – this does absolutely not mean that a blame culture should be encouraged, but means that any mistakes, or even near-misses, should be documented and learned from in order to ensure they don’t happen again³.

It is worth noting that these shouldn’t be limited to drastic events such as the death of a patient, but could be as simple as a set of blood results going missing.

An anonymous system is one common way to achieve this, by which the information is fed back to senior staff who then can relay it and any solutions to the team, with or without a staff meeting.

If members of staff have been involved in a difficult case or one with a negative outcome, they should also be encouraged to attend ‘debrief’ meetings in order to process the situation, and to help support their mental health.

This is much more commonly done in human medicine but should also be promoted within the veterinary field.

Having checklists and SOPs in place for situations such as drawing up drugs or dispensing medications, which center around one person ‘doing’ and another person ‘checking’ can help to reduce errors in dosing.

It is vital that training is also kept up to date and any new members of staff are trained in these protocols as soon as possible. 

Auditing

Carrying out clinical audits can help bring to light any potential issues and areas in which patient care or outcomes could be compromised.

An example of a clinical audit could be evaluating ICU patient temperatures after they have undergone an operation, to ensure they are being managed appropriately and are consistently within expected limits. I

f this audit was to reveal that maybe temperatures in the post-operative period are below the recommended range, it should prompt changes to be made to improve the situation, such as implementing the use of active or passive warming devices.

However, probably the most important part of this process is to re-audit after a certain period of time, to ensure improvements have taken place.

One model that summarizes this is the PDSA model – Plan, Do, Study, Act⁴. 

• Plan to carry out a change 

• Do carry out a change

• Study the results of carrying out the change

• Act to make any further adjustments

Post-event audits can tie in nicely with evaluating mistakes or near-misses in the practice and provide a structure to learn from. But again, there should never be any blame placed on any individual or group of individuals. 

Looking at the bigger picture

Veterinary medicine is constantly evolving, and we are discovering new and exciting methods to aid in our diagnostics and treatment of our veterinary patients.

However, sometimes, we need to take a step back and look at how getting the basics right can form a stable foundation on which to build a patient’s recovery.

Although surgery and drug therapy will make up a large proportion of the treatment an animal may receive, they are not the only things we have in our armoury to improve outcomes. 

Nutrition: The Foundation of Your Pet's Recovery

Proper nutrition is essential for the recovery of your pet, whether a cat or dog. Without appropriate and sometimes specialized nutritional therapy, other medical or surgical treatments may not reach their full potential.

The Benefits of Complementary Therapies

In addition to nutrition, complementary therapies like physiotherapy, hydrotherapy, laser therapy, and acupuncture have shown significant benefits for your pet's recovery. These therapies are effective not only for mobility issues but also for a range of other conditions.

Adopting a Multi-Modal Approach

Utilizing a multi-modal approach in treatment increases the chances of achieving our primary goal: ensuring that the pet survives, recovers, and returns to you in the best possible health.

Maximizing ICU Potential

The ICU is a complex environment but also one that offers immense opportunities. By leveraging the full capabilities of veterinary staff and medicine, we can transform dire situations into positive outcomes for your beloved cat or dog.

References

1. Curtin LL. An integrated analysis of nurse staffing and related variables: effects on patient outcomes. Online J Issues Nurs. 2003;8(3):5. PMID: 14656199.

2. Hayes GM, Bersenas AM, Mathews K, Lane WG, LaLonde-Paul DF, Steele A, Avellaneda A. A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units. J Vet Emerg Crit Care (San Antonio). 2020 Sep;30(5):517-524. doi: 10.1111/vec.12991. Epub 2020 Sep 12. PMID: 32918379.

3. Quality improvement for patient safety and a better practice culture; Pam Mosedale and Mark Turner; The Veterinary Nurse 2022 13:4, 156-161 

4. https://todaysveterinarypractice.com/practice-management/measuring-patient-outcomes/