1329: SAFETY OF INTRAVENOUS PUSH THIAMINE ADMINISTRATION AT A TERTIARY ACADEMIC MEDICAL CENTER

Abstract

Learning Objectives: At a large federal tertiary care facility, nurses of two intensive care units (ICU) were time-challenged to conduct discharge education. With a 50% monthly 30-day readmission rate among two ICUs, an opportunity arose to conduct root cause analysis to determine and understand causes of patient readmissions. Project Red model was determined to be the model of choice to support successful transitions home and reduce readmission rates using transition coordinators. Methods: Root cause analysis was conducted with all stakeholders to examine the discharge process including nurse time constraints and discharge teaching. Transition coordinators were used to directly observe patient discharges, totaling 267, daily over 30 days. Project Red stakeholders met consistently the first year to review individual readmissions and establish best practices. Results: 2014 readmission rates in two ICUs varied monthly from 10% to 55%. In 2015, readmission goals were reset to 8% and utilization of transition coordinators was implemented. Real-time data was collected. Monthly rates decreased reaching the 8% goal. By 2016, with a total of 511 discharges, annual average readmission rate for ICU-1 was 9.8% (down from 2014 rate of 26%) and ICU-2 3% (down from 16%). 2017 data demonstrated further decreases in readmissions in ICU-1 to 7.5% and stabilization from ICU-2 at 4%, with a total of 568 discharges. Conclusions:Transitioning from critical care unit to home is complex. Reduction of readmission rates amongst this population requires transitional care experts. Project RED transition coordinators successfully supported reduced ICU readmission rates to under the 8% goal. These rates remain consistently low; 2018 six-month average of 5.8% in ICU-1 (n=237) and 4% in ICU-2 (n=88). Project RED is now being considered a best practice across the health care system to sustain low level readmission rates.