What makes a great ICU? Just ask our intensivists.

By Steve Matchett, MD | CEO, Sound Critical Care 

Today’s hospitals are treating sicker patients — critically ill patients with more complex conditions — because circumstance demands it. With fewer patients coming to the hospital for low-acuity conditions and with procedures like routine hip replacements moving to outpatient, hospitals must find new ways to stay viable. Growing their high-acuity surgical subspecialties — such as cardiovascular, neurologic, and oncologic services — is one path to success. But to support those complex specialties, you need equally complex care in the form of a high-performing ICU program. I’m not talking about simply staffing your ICU with talented individual intensivists; rather, I’m talking about a well-designed and cohesive critical care program that brings the level of sophistication and understanding needed to support critically ill and complex patients.  

Sound Critical Care has earned its reputation as that kind of program. With 70 practices across the country that cared for more than 150,000 patients in 2023, we understand what it takes to run a high-performing ICU.

Building blocks for a better ICU 

Throughout medical school, residency, and fellowship, intensivists learn how to take exceptional care of patients. Nowhere in that education, however — but equally important — is how to run a successful ICU. You need a strong physician leader anchoring your ICU who can ensure a healthy team culture and know where to effect change.  

Over the past two decades, we’ve developed a robust and reproducible curriculum to teach the best and brightest intensivists with the right blend of IQ and EQ to lead our ICUs. And with solid leadership in place, our intensivists and critical care advanced practice providers can focus on the key components of our program that are the building blocks to success no matter where in the country we practice. 

We know you need a team-based quality improvement program with consistent, evidence-based practice and minimal variation in day-to-day care. You also need to create an environment that values and operates within a space of psychological safety. We develop and nurture our ICU leaders as clinicians who lead by example and model best practices while creating that space of psychological safety for their fellow teammates. And we focus on understanding our why — challenging the status quo of critical care medicine and delivering something better to our patients in each community we serve.  

Education is an essential and ongoing part of how we run our critical care practices. We support more than 25 residency programs and three critical care fellowship programs and regularly engage and train all our critical care teams around our why. 

Measuring success 

Measuring our performance is all about looking at how we can be better — aligning with our hospital partners’ key quality initiatives, identifying priorities, reviewing data, and putting what we’ve learned into action at the individual practice level and, if successful, across all our critical care practices. 

Most hospital data comes from the entirety of a patient’s stay. As such, it’s hard to carve out what success looks like specific to their time in the ICU, which is only part of their overall stay. Further complicating how to measure success is that data isn’t consistent across hospitals: patients in a university medical center ICU aren’t the same as patients in a rural community hospital ICU. And while there have been efforts to benchmark certain aspects of critical care — ICU length of stay and mortality, for example — most hospitals are constrained by time and resources to do this. 

We’ve found our own ways to track and measure success. 

When severity-adjusted data is not available, we look at the hospital ICU’s data before and after we arrive. We look at outcomes and performance quarterly to compare where the hospital was before we got there, and how our critical care program is progressing. We also look at ICU length of stay, time on a ventilator, and occurrence of complications, such as an infection from a catheter.  

We have our goals-of-care conversation with a patient’s loved ones early in their ICU stay, and we make sure to document their wishes within 72 hours of admission to the hospital. In most programs, we can document compliance with this best practice in more than 85 percent of all patients. 

Finally, we ask the nurses we work with day in and out to let us know how they think we’re doing. For more than a decade we’ve given a nursing satisfaction survey to approximately 5,000 bedside nurses to assess their level of satisfaction before we start our program, six months into our practice, and then a year out. In general, we see a 20 percent increase in nursing satisfaction after the implementation of a Sound Critical Care program, which translates into the recruitment and retention of ICU nurses.  

We take our practice and the feedback we get on it seriously — and it shows.  

As the leading critical care program in the U.S., our Net Promoter Score of 72 continues to be on the level with the best of American businesses, including Apple and Costco, for customer satisfaction.

Shared purpose, clinical excellence 

From the culture of clinical teams to their care at the bedside, we put deliberate focus on implementing evidence-based practices that drive consistency day to day and patient to patient, and developing a highly functional team that can achieve that consistent level of care no matter the circumstances.  

The healthcare landscape offers many models of critical care. Some boast efficiency but they’re working toward their own goals rather than the hospital’s goals, and they’re more focused on financial — rather than patient — outcomes.  

Sound doesn’t operate a staffing model. Far from it, in fact.  

As I’ve shared here, we put our stock in team unity, shared purpose, clinical excellence and consistency, and ensuring our ICU leaders can wrangle everything it takes to keep our practice operating not just efficiently but meaningfully. Our critical care program continues to place a premium on intentionality and values-driven care: What we do in the ICU first and foremost must benefit the patients we serve. And we all operate from the same playbook, honoring the physical and emotional intensity of what we do, and respecting the need to show up day in and out with compassion for our patients, their loved ones, and each other.