The service Dayton ICU Consulting provided was exceptional and above expectations. As an ICU medical director, I have had to unlearn what has been taught to us over the years and what we thought was right. When I started listening to the Walking Home From The ICU podcast, I felt profound sadness and guilt for what we did to other human beings thinking what we were doing was right.
I have changed my practice and we had Dayton ICU Consulting at our hospital in each of our intensive care units for multiple sessions. It was eye-opening for the staff, especially the bedside RNs. We have developed significant momentum, especially in our surgical and trauma ICUs where staff that were non-believers are now champions of this movement. We have done videos of patients’ experiences and plan to use them to educate new hires. I am very excited about where we have come from and expect great things.
I cannot thank Kali Dayton and our staff enough for helping us improve ICU care and experiences for our patients.
Lawrence Bistrong, MD, FCCP, Medical and Surgical Intensive Care Unit Medical Director at Mercy San Juan Medical Center
When patients are so ill that they require a ventilator in the ICU, the antiquated approach of heavy sedation and immobilization should be avoided in order to help prevent the immense burden of physical and cognitive disabilities suffered during survival.
Kali is leading ICU teams to become Awake and Walking ICUs through true mastery of the ABCDEF Bundle. I endorse her mission and look forward to the standardization of this evidence-based approach in ICUs all over the world.
Dr. Wes Ely, author of Every Deep Drawn Breath, leading founder of the ABCDEF Bundle and ICU CAM delirium screening tool, and Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center
One of the most striking aspects of this initiative has been the cultural shift among physicians and nurses, which has been largely influenced by the training led by Kali Dayton. These trainings emphasize the importance of collaboration and communication within the health care team, fostering a shared commitment to patient-centered care.
As a result, clinicians are more attuned to the value of keeping patients awake and engaged, which has proven to be critical in preventing the deconditioning and delirium often associated with prolonged sedation. Moreover, the dramatic improvements in patient outcomes are evident in the reduction of complications that frequently arise in the ICU setting. With fewer ventilator days, patients are less susceptible to ventilator-associated pneumonia and other respiratory complications.
The emphasis on mobility not only accelerates recovery but also contributes to improved psychological well-being, as patients are less disoriented and more connected to their surroundings. This holistic approach to care, driven by a cultural transformation among health care providers, underscores the profound impact of mobility-limited sedation protocols on patient health and safety.
Peter Murphy, MD, FCCP, MRCPI, Professor, Assistant Dean, and Chief of Medicine at California Northstate University College of Medicine
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.
Implementation has been challenged by pushback at the bedside, but knowing how most patients can be off sedation and comfortable allowed me to advocate for the patients. So far, four patients were successfully kept off of sedation after getting intubated, and two of them immediately smiled at me as they woke up from induction meds. Kali and the members of the Awake and Walking ICU have decades of experience in this approach.
Mikita Fuchita, MD
Kali Dayton’s consultancy energized our ICU to adopt the very latest evidence-based therapies to identify, prevent, and treat delirium with the ultimate goal being to eliminate preventable delirium by leveraging lessons shared by Kali to get our ICU patients awake, mobile, and walking.
The advice and tier-one support by Dayton ICU Consulting is a critical component of any ICU leader who wants to do better and make the greatest impact possible for patients so that they survive the ICU and go home to continue their livelihoods free of post-intensive care syndrome or PTSD.
Kali offers a powerful vector to ensure ICU care is state of the art.
Brian Delmonaco, MD, FACEP, Medical Director, Pulmonology and Critical Care Medicine, Samaritan Health Services