Coming together, improving care: One unit’s story of triumph

February 15, 2022  //  FOUND IN: Our Employees,

A unique unit and an exceptional team that works as a family — that’s the Cardiac Intensive Care Unit (CICU), which strives for quality and excellence every day.

The CICU is unique at Michigan Medicine because it is jointly led by a medical director and a clinical nurse manager. A 10-bed adult unit with specialized care for patients with all forms of cardiac disease, the CICU is managed within the Frankel Cardiovascular Center on 7DN.

In 2020, the CICU initiated several projects to standardize rounding procedures, improve communication across shifts and improve quality of care.

A primary focus was creating a positive team culture to facilitate the best care for patients.

With an eye on safety and quality, initiatives such as round robin meetings, consistent CICU updates and Joy in Work projects were implemented, leading to the team being more cohesive and bettering certain metrics. By improving safety and quality, the team’s experience was enhanced in line with U-M Health’s Build our BASE strategic priority.

Looking at themselves critically

Emily Walker, R.N., the educational nurse coordinator for the unit since 2018, said the CICU’s success started by identifying where it could be better.

As part of Quality Month in October 2021, the CICU’s quality improvement (QI) committee identified Spontaneous Awakening Trial (SAT) compliance as an opportunity for improvement.

That committee developed a CICU-specific “Nurse-Led SAT Protocol,” which led to an educational period for nurses and physicians and a three-month audit period. It was one of several ways the CICU improved its quality metrics for the betterment of patients and its team members, all while working amid a pandemic.

“While difficult to measure,” Walker said, “I am confident the most impactful thing our team has done this year is maintaining fantastic patient care and a true sense of teamwork in the face of unprecedented circumstances and hardships. Our patients are sicker than ever and their families are often limited in their time with their loved ones. The strain on intensive care nurses to maintain excellence through increasingly difficult circumstances is extraordinary. Our CICU team has been phenomenal.”

Joy in Work

Other projects that the CICU worked on were standardizing rounding procedures, enhancing communication, and decreasing certain medicine dosage parameters for patients. Finally, they created the “Joy in Work” program for better fellow-nurse relationships.

The last of those is where the unit truly came together. The program promoted open dialogue among all disciplines, surveys and more. The goal is to further positive interactions and continue forging a culture of inclusivity and respect.

“We love this unit,” said Walker. “And we want others to love it as well.”

The unit also participates in several volunteer experiences. The QI committee has organized opportunities for staff to serve food to the underprivileged and provide gifts to families in need during the holiday season.

A small family

As mentioned previously, the unit is tiny — just 10 beds. It’s the smallest ICU in the hospital, which adds to the sense of camaraderie.

“We have been successful for many reasons but mostly because we function as a team,” Walker said. “You are never alone on this unit. Our nurses are fearless advocates for our patients and for each other.”

Walker credited Ariel Toews-Ricotta, R.N., and Corbyn Dach-Butler, R.N., in aiding the CICU’s effort at lifting care and team morale. Toews-Ricotta recently stepped into a supervisor role, taking on overnight shifts to aid the unit, while Dach-Butler has been working to keep staff engaged in fun activities such as a kudos board and gift card rewards.

Walker and her colleagues are proud of their accomplishments.

“Seeing to critically ill patients is stressful,” Walker said. “Nevertheless, we’ve banded together and found ways to stay motivated, positive, and keep our patients safe.”