Quality improvement efforts in the intensive care unit: development of a new heparin protocol.

CONTEXT An ongoing process of identifying and implementing breakthrough projects to quickly improve patient outcomes and reduce costs in the intensive care unit. OBJECTIVE To develop and test a new protocol for heparin administration in the intensive care unit, replacing the 5 existing protocols and ensuring compliance with the recommendations of the Fifth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. DESIGN A pilot study comparing results of 58 patients on the 5 existing protocols with those of 10 patients on the new heparin protocol. SETTING Baylor University Medical Center, a large tertiary hospital in Dallas, Texas, with 115 adult intensive care unit beds. INTERVENTIONS Heparin dosing was based on a patient's weight, and anticoagulation was monitored through the heparin assay. MAIN OUTCOME MEASURES In the control group treated according to the existing protocols, 5 patients (8.6%) received optimal bolus doses, and 2 patients (3.4%) received optimal infusion doses. In the pilot group treated according to the new protocols, 9 patients (90%) received optimal bolus doses, and all received optimal infusion doses. RESULTS The implementation of the new heparin protocol resulted in better patient care, improved nursing efficiency, and reduced costs. CONCLUSIONS As shown in this example, a rapid breakthrough project following a plan-do-study-act cycle can apply best practices relatively quickly and lead to better patient outcomes.