Episode 217: Leaders- DON’T Mess it Up!
Revolution in sedation, delirium, and mobility culture in the ICU requires more than a memo, grand rounds, or a weekend symposium. Leaders who provide minimal support without teaching teams the how and why but expect a drastic change in care and outcomes risk a mutiny. Leadership and implementation strategy can inspire innovation, humanity, and transformation
Why ICU Champions Alone Cannot Create Lasting ICU Culture Change
Most ICU culture change begins with someone who sees that patients could receive better care. It may be a nurse who understands the consequences of deep sedation, a physical therapist who sees patients losing strength every day they remain immobile, or any other clinician who recognizes how the ABCDEF Bundle can improve survival and recovery.
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I stumbled upon Kali’s podcast midway through my anesthesia critical care fellowship in February 2021. At our institution, I got the impression that patients in the ICU either got better on their own or had a prolonged and complicated course to LTAC or death. In her podcast, Kali explained that LTAC was rarely the outcome for patients in the Awake and Walking ICU™ in Salt Lake City.
Their ICU survivors hardly ever got trached, PEGed, or sent to LTAC, and literally walked out of the hospital in condition as close to their previous health as they could be. Although the concept of using no sedation on ventilated patients was completely foreign to me, it made sense based on what I had read in the literature. I devoured all of the episodes from the beginning, many of them bringing tears and regret for my ignorance, followed by inspiration and hope in later episodes. Listening to her podcast has been one of the most profound experiences in my short, eight-year career in medicine.
After discovering the no sedation, early mobility practice at the Awake and Walking ICU™, my focus shifted to bringing it to my own institution. I visited Salt Lake City in March to witness it with my own eyes. Since then, I’ve been in touch closely with Kali and Louise to learn the practical approaches to sedation wean and sedation avoidance for newly intubated patients in the ICU.
Mikita Fuchita, MD
Colorado, USA
Perception Versus Reality: Debunking The Myths About Medically-Induced Comas
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