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Rutgers develops new, more inclusive model for ICU care

<p>The new model for the intensive care unit at Robert Wood Johnson Hospital, located in New Brunswick, differed from the previous one because decision making does not rely entirely on the ICU physician.&nbsp;</p>

The new model for the intensive care unit at Robert Wood Johnson Hospital, located in New Brunswick, differed from the previous one because decision making does not rely entirely on the ICU physician. 


Rutgers, in collaboration with the RWJBarnabas Health System, has developed a new model for intensive care, which can potentially help to discover factors that send chronically ill patients to the intensive care unit (ICU), according to Rutgers Today.

In the new model, members of the ICU team, which include physicians, nurses, pharmacists, social workers and chaplains, must actively listen to patients as well as their families. This would help to ensure that their needs are being met, according to a recent study in the journal "Creative Nursing."

Named LOTUS (Leadership, Ownership, Transformation, Unity and Sustainability), the new model is different from previous models because all of the planning used to be led solely by the ICU physician, said Liza Barbarello Andrews, a clinical associate professor at Rutgers’ Ernest Mario School of Pharmacy and critical care pharmacy specialist at Robert Wood Johnson University Hospital.  

In the first year of the model's implementation, it worked to identify areas where the ICU was not properly evaluating the causes of the health issues that sent patients to hospitals. Andrews said these gaps were missed opportunities to decrease the amount of admissions. 

 “Many patients present with life-threatening complications due to failure to take their diabetes or blood pressure medications,” she said. “We would treat the resulting problem, but hadn’t been routinely investigating what led to the issue or designed a solution to prevent it from happening again in the future. Under the LOTUS model, by focusing on the patient perspective we discovered that some patients had received confusing, mixed messages about the medicine from their healthcare providers. Other patients were struggling with financial or emotional problems that made self-care difficult.” 

On the other hand, LOTUS would empower ICU workers and help to address the issues alongside the patients and their families, which would help to prevent them from being sent to the hospital again.

LOTUS was developed at Robert Wood Johnson University Hospital Hamilton, after it merged with RWJBarnabas Health System in 2016. The new ICU model immediately replaced the old one, where the ICU physician made the decisions on patient care and did not focus on the patient's own goals or input from other members of the ICU team.

With the old model, there was also no formal structure for rounds, which is the practice where all of the members of the ICU team evaluate the patient at intake and through treatment. According to the article, this lack of structure meant that individual team members were not at their full potential and did not give their full expertise. 

The logo for the model is a testament to its name — a flower with a patient at the center and petals representing the health care team overlapping to meet at the center. 

The LOTUS model has helped ICU team members to contribute to better safety of their patients, lesser mortality rates and less hospital stays. 

 “We took a model that was fragmented and sometimes strayed from keeping the patients’ own wishes central to the decision-making process – and developed one that is much more efficient, thoughtful and deliberative,” Andrews said. “The ICU team members feel a real sense of engagement and collaboration and patients and families say they feel listened to." 


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