EVIDENCE-BASED NURSING INNOVATIONS

This issue of Critical Care Nurse Quarterly is dedicated to evidence-based innovations impacting intensive care nursing practices. Health care organizations are under pressure to improve quality while simultaneously reducing cost to provide evermore value for payers and patients.1 When one looks at the in-hospital setting, nurses provide the majority of direct patient care and nurse labor costs are a very large portion of a hospital's budget. Thus, nursing, by its very nature, is at the forefront of the demands for improved quality and reduced costs.2 But the question that is often asked is "How can we improve quality and reduce cost at the same time?" Clearly, the answer cannot be by doing things the way we have in the past, by working harder, or by being more careful. The goal of this issue is to provide the reader with several innovative approaches to achieve the seemingly disparate goals of reducing cost and improving quality.

There are common themes present in intensive care units (ICUs) that provide high-quality care reliably. First, practice is based on evidence. Leaders and staff value evidence-based practice and use research and other sources of evidence to determine where and how to change nursing practice to achieve desired patient outcomes. Change for the sake of change creates more work and accomplishes little. Second, data collection so that improvement can be accurately measured is critical to success. Third, although often led by nurses, many quality improvement initiatives require partnership with multidisciplinary teams.3 It is our belief that nursing's intimate familiarity with care delivery gives it a unique opportunity to go beyond participation to active leadership roles. Furthermore, the inclusion of the patient, the family, or both on these teams helps focus the work on what matters-the outcomes of our patients and families. It is within these teams that the largest gains are seen. Finally, standardization is prominently featured in many of the articles within this issue. The issue editors feel that standardization allows nurses to commit many more tasks to "muscle memory," thus reducing waste in nursing time and supply costs. Standardization helps ensure that care is provided in the same manner consistently, which makes for more reliable processes as well as making it easier to evaluate care processes. Moreover, standardization frees up the bedside nurse to focus on new quality improvement efforts and connecting evidence-based practice with the delivery of care.

In this issue, readers will see several innovative, evidence-based approaches used by a wide variety of ICUs (pediatric, adult, medical, and surgical) to improve bedside care. The issue editors feel that many of these approaches improve quality significantly by focusing on evidence-based practice, multidisciplinary teamwork, standardization, and using quality improvement data to inform care processes. The issue editors hope that readers will find something useful in each of the articles-whether it is a topic that is relevant to their practice or a process that they could apply in their setting.

-Sharon Dickinson, MSN, RN

Clinical Nurse Specialist, Surgical Intensive Care Unit, Rapid Response and Trauma/Burn, University of Michigan Health System, Ann Arbor

-Leah L. Shever, PhD, RN

Director, Nursing Research, Quality and Innovation,

University of Michigan Health System, Ann Arbor

REFERENCES