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Quality improvement in critical care

Quality improvement in critical care

What is critical care?

Critical care is provided for acutely unwell patients who require specialist nursing or medical care by our Intensive Care (ICU) and High Dependency (HDU) units based at North Shore Hospital. We also have a Critical Care Outreach Team (CCOT) who support other hospital services providing care for patients with serious medical conditions or with deteriorating health.


What are we trying to achieve?

Our aim is to provide high quality care for our patients and to strive for excellence in clinical practice with a focus on:

  • quality
  • safety
  • patient and family/whānau experience
  • staff experience

What have we done?

Quality and safety

We have developed a quality framework for our critical care services which includes the following:

  • audit schedule including monitoring, management, action planning of both local and organisational audits
  • policy review, development, updates and education
  • reportable events monitoring, investigation, action planning and education
  • quality dashboard to report on key performance indicators
  • Clinical governance group
  • clinical research and audit - active membership with Australia and New Zealand Intensive Care Society Clinical Trials (ANZICS) group

Our quality framework is supported by a multi-disciplinary quality team who meet regularly to coordinate and manage our quality activities.


Patient and family/whānau experience

Our number one priority is patient and family/whānau wellbeing and we have focused on four key areas:

Stream 1: Keeping patients and family/whānau informed

We know that providing appropriate, clear and compassionate information is vital – for both the patients and loved ones who may be participating in decisions about the patient who may not be able to speak for themselves. We have developed and implemented the following:

  • 'Welcome pack' with relevant information for new patients and their family/whānau
  • ICU/HDU information booklet covering what to expect while in critical care
  • Visitors' room information board
  • Transfer to the ward information booklet covering the transition process

'Welcome pack' for new patients and family/whānau
'Welcome pack' for new patients and family/whānau

Visitors' room information board
Visitors' room information board

Stream 2: Learning from patient and family/whānau feedback

We collate and review feedback from our patient and family/whānau to identify areas for improvement through the following means:

  • compliments and complaints
  • friends and family test (real-time patient feedback)
  • face-to-face interviews with family members
  • patient and whānau centred care standards [link]

Stream 3: Improving transition to the ward

Feedback from our face-to-face interviews have often highlighted the period of transitioning from ICU/HDU to a ward, with many patients and families experiencing fear and anxiety through this transition. Evidence also shows that the transition to ward is a time when patients are most at risk with an increased likelihood of an adverse event during this period.

To address these issues we have introduced a number of new activities:

  • multi-disciplinary team meetings to review complex or longer-term patients to plan their transition to ward level care
  • visits by our outreach team to more vulnerable patients before and after discharge from ICU/HDU
  • development of a new ward transfer form

Critical care multi-disciplinary team
Critical care multi-disciplinary team

Stream 4: Support following bereavement

Sometimes our patients do die as a result of their illness and as such we continue to support the family/whānau through their grieving process. We have introduced bereavement cards which are sent to families to express our condolences and offer families an opportunity to come and meet with our team to discuss any lingering questions.

Did we make a difference?

  • Positive feedback from patients and families/whānau about the ‘Welcome Pack’ and visitor room poster
  • Approximately 10% of recipients of bereavement cards have attended a bereavement meeting with our critical care team – families who attend have been grateful for the opportunity and have praised the process
  • Stronger connections achieved with social work and speech language therapy colleagues since the introduction of our weekly Multi-Disciplinary team meeting with earlier referrals to these
  • Maintaining great standard of patient experience with our net promoter score from our Friends & Family Test increasing to 81 for 2015/16 up from 78 for 2014/15 (DHB target 65)

Patient feedback

Patient feedback about critical care services


Where to from here?

  • Our new stream of work is focussing on staff experience which includes the development of:
    • a peer support group
    • a daily staff huddle to promote effective teamwork with their care planning
    • a buddy programme to support new staff
    • team debrief sessions for complex situations
  • Other services are looking at adopting some of our initiatives, like our welcome pack and ward information booklet