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Critical Care Nutrition at the Clinical Evaluation Research Unit (CERU)

is dedicated to improving nutrition therapies in the critically ill through knowledge generation, synthesis, and translation. We engage in a broad range of research activities and promote a culture of best practices in critical care nutrition. Ultimately, this will result in improved clinical outcomes for critically ill patients and increased efficiencies to our health care systems.

What is the Best of the Best Award?

blue-ribbonTo be considered for the Best of the Best award, ICUs must:
  • Finalize a minimum of 20 patients in the International Nutrition Survey by the data finalization deadline
  • Be willing to send us source documentation for purposes of verification
 
Eligible sites are ranked based on their performance on the following 5 criteria:
  • Adequacy of provision of energy
  • Use of enteral nutrition (EN)
  • Early initiation of EN
  • Use of promotility drugs and small bowel feeding tubes
  • Adequate glycemic control

The top site receives a $1000 reimbursement to an educational session. The top 10 sites receive a Best of Best plaque.

For more information on the creation of the award and its scoring system, please read "Creating a Culture of Clinical Excellence in Critical Care Nutrition: The 2008 ‘Best of the Best' Award" published in JPEN (2010) by Dr. Daren Heyland et al.

Congratulations to the Top 10 best performing sites from the INS 2014!

Continue to read below on what makes the Best of the Best sites successful. More to come soon.

PlaceSite
1st The Alfred ICU, Australia
2nd
Sunnybrook Health Sciences Centre Ross Tilley Burn Centre, Canada            
1st place among burn sites
3rd
Milpark Hospital Burns Unit, South Africa
2nd place among burn sites
4th St. Vincent's Hospital Melbourne ICU, Australia
5th Redcliffe Hospital ICU, Australia
6th
The Ohio State University Wexner Medical Center Surgical ICU, USA
3rd place among burn sites
7th G. Kuppuswamy Naidu Memorial Hospital MICU, India
8th Royal North Shore Hospital ICU, Australia
9th Groote Shuur Hospital Neuro ICU, South Africa
10th Milpark Hospital Trauma ICU, South Africa
 

The Alfred ICU

The Alfred photo 2015

From left to right: Prof Jamie Cooper, Dr Susannah King, RD, Dr Andrew Udy, Emma Ridley, RD, PhD candidate, Dr Owen Roodenburg, Prof Carlos Scheinkestel, Dr Daren Heyland, Emily Dynon, RD, A/Prof Ibolya Nyulasi, Liz Purcell, RD, Louise Becroft, RD, Ana Monteiro, RD (missing: Kate Moore, RD)


Sunybrook Health Sciences Ross Tilley Burn Centre

Sunnybrook

From left to right: Dr. Marc Jeschke (Director), Suna Girn (RN), Rosemary Hayhoe (RD), Karen Smith (Patient Care Manager), Dr. Darren Heyland, Gary Ackerman (RT), Katelynn Maniatis (RD), Claudia Cocco (RN), Michelle Cornelio (RN), Wei Zhang (RN)

"Our success in enteral feeding is related to a combined effort amongst the entire interprofessional team.  We have implemented a number of protocols and standards that have contributed towards improved nutrition practices.  These include the use of a volume-based feeding protocol to make up missed feeds; minimizing perioperative NPO times, NJ tube insertion by nurses at the bedside, and standardized admission order sets that include early initiation of feeds and the prompt implementation of micronutrient delivery.  The clinical dietitian is an active member of the team and regularly re-assesses nutrient requirements, and the physicians, nurses and respiratory therapists play a critical role in ensuring nutritional goals are met on a daily basis."


St. Vincent's Hospital Melbourne ICU

photo
 From left to right: Cynthia Dowell (Chief Nursing Officer), Jamee Barugh (Dietitian), Dr. Antony Tobin (Deputy Director ICU), Dr Daren Heyland, Catherine Carbery (Nurse Unit Manager), Katherine Hastie (Dietitian), Belinda Smith (Acting General Manager Speciality Services ), Jennifer Holmes (Research Nurse ICU), Dr. John Santamaria (Director ICU).
 
“Our whole Intensive Care team contributes to our consecutive success. We have a feeding algorithm so enteral tube feeding is commenced promptly, including after hours, and rates increased to target following clear guidelines. Our nurses play a vital role in initiating feeding and reducing interruptions. Many of our Intensivists have a keen interest in Nutrition and are highly supportive of the Dietitian role in the Intensive Care setting. Nutrition is included on the Doctor's checklist for morning and evening ward rounds which is a prompt to confirm if feeds have been commenced and for nurses to report if feeds are at target rate. A Dietitian visits the ICU six days per week (Monday – Saturday). Any Dietitian covering the ICU has completed competency based training, so optimal nutrition care is maintained. Participation in regular nutrition audits and nutrition in-services from the Dietitian has helped keep motivation and enthusiasm levels high for ongoing success.”

Wexner Medical Centre Surgical ICU
Not only did this ICU place well among all sites and burn sites in the INS 2014, they are the first American site to place in the top 10 of the Best of the Best. Click here to read a local Columbus Ohio newspaper article on the ICU's nutrition success.
SICU award July2015
Picture left to right: Dr. Larry M Jones, Director of the Burn Center; Sheela Thomas, RD for the SICU and Burn Center; Dr. Daren Heyland; Andrea Bidley, Burn Program Manager

G. Kuppuswamy Naidu Memorial Hospital ICU
 
DSC08348
 
Chief Dietitian Mrs. J Vidhya pictured above with Dean Dr. Ramkumar Raghupathy and Medical Superintendent Dr. (Col.) T.B. Ramakrishnan.

"Our success is attributed to the strong leadership in the ICU. There is a real sense of team work in the ICU with great collaboration and communication. Our dedicated ICU team has complete awareness and appreciation of the importance of nutrition in patient care. Our clinical team head provides continued medical education to the critical care staff nurses and dietitians. We use a protocol and pre-printed nutrition prescription so that nutrition is initiated and maintained based on the need of the patient. The algorithm includes standing orders for nurses and dietitians and each day it is prescribed and reviewed based on the need of each patient in Critical Care. This is a big boost for our department where the practice was previously to keep all patients fasting overnight and that was changed 2 years ago to a 24/7 fully functional critical care nutrition therapy. We also have a state of the art formula preparation room where formulas are prepared under a laminar flow with full sterile precautions by a trained dietary personal every 4 hours for all patients on Critical Care. We have definitely grown and learnt through this journey over the last years and this award is such an encouragement for our work culture and colleagues. We always thank our administration for their ongoing support and new set ups they provide us on an ongoing basis." 


Royal North Shore Hospital ICU
site visit
From left to right: Deirdre Mathai, RD, Dr Daren Heyland, Gwen Hickey, RD, Dr Roger Harris, Dr Ray Raper
 
"We have a strong culture of early feeding, which is supported by the multi-disciplinary team."
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