1. Using VPS to address staffing needs in the PICU Katie Nielsen BSN, RN, CPN

2. Small but Mighty! Smallest freestanding Children’s hospital (CHA/PHIS) 19 bed PICU & 145 total beds Specialty Pediatric Center, Heart transplant program, FCC, ECMO, Transport

3. Comparative Database Outcomes Coordinator Who am I? “Nurse Nerd” What do I do? Where are all those tubes going? When June 2010 Why Bigger picture, bigger impact

4. Let me paint you a picture… Annual data July 2013-June 2014 Mixed unit - 35% cardiac 37% direct from OR to ICU = higher resource utilization (18% VPS ref group) 4 th highest PRISM 3 SMR of 47 in VPS ref group Longer LOS of 5.1 days (3.9 days VPS ref group)

5. VPS data June to July of each year 20142013201220112010* (*VPS June) Admissions831819843746769 Deaths282527 33 PICU closed28%5%0%6%0% ADC (midnight snapshot)13.512.710.511.39.2 ECMO run hours21072461 +572 VAD 177614401704 Current state of affairs RNs work 12 hour shifts, 7p, 7a 1 CCP per shift 24/7 PICU Attending in house

6. Census Data July 2013-June 2014 Peak admission times 11a-7p Discharge peaks at 3p Proved that the midnight ADC does not reflect peak activity

7. Stat Nurse Developed 11a-11p stat nurse based on influx of patients during the day Job responsibilities Admits & Discharges Quality & Safety Nurse –Education –Coaching –Audits –Quality measures

8. Acuity Trend VPS ref group – 24.7%

9. Started using multiple VPS data points instead of the ADC at midnight, and the PICU added 11.53 RN FTE’s since 2013 People make the world go ‘round

10. Other additional staff Same data set used to add additional staff: MD FTEs- high acuity and census data 2013: 9 MD FTEs 2014: +1 MD FTE 2015: +1 MD FTE Total: 11 MD FTEs (-0.5 CMQO) Child Care Partner (CNA) added during the day shift as well (2 total) Maintain 24/7 PICU attending coverage- Unplanned readmits to PICU (within 24 hrs) rate- 1% Comparison data for 24/7 coverage and cardiac LOS and outcomes

11. Challenges EMR (EPIC) in August 2013 Cardiac transplant program May 2013 Staff vacancy rate Nursing management reorganization

12. Outcomes for 2013 and 2014 10 of 12 months with no VAPS 7 of 12 months with no central line infections Beacon Award for Critical Care Excellence (2013) ELSO Award for Excellence in Life Support from the Extracorporeal Life Support Organization (2013-ELSO) US News & World Report Best Children's Hospitals Cardiology and Heart Surgery- 4 consecutive years (2011) Excellence through Insight award from HealthStream for having the highest patient satisfaction ratings among all inpatient pediatric units (57 hospitals-excludes NICU)

13. Outcomes continued 20142013201220112010* (*VPS June) SMR0.660.950.730.911.49 New building! We used VPS census and growth data in the design process of a new tower at Children’s that will take our 19 bed PICU to a 28 bed PICU with 12 flex IMC/PICU beds that could potentially hold 40 PICU patients

14. Why use VPS data? VPS data is well accepted by critical care physicians PICU specific focus Standard to which PICUs across the country strive and are judged by MyReports allows excellent data analysis-even for the novice VPS staff are knowledgeable resources and provide excellent user support

15. Summary We used VPS data to: Increase RN FTEs by 11.53 Created STAT Nurse position Added 2 MD FTEs Maintain 24/7 in house PICU attending coverage Add a CCP Display positive outcomes to staff