May 2023
Carolyn
Holder
,
MN, APRN-BC, CCRN, CCNS
Medical ICU
Emory University Hospital
Atlanta
,
GA
United States
Carolyn has created a practice environment encouraging nurses and their interdisciplinary partners to improve empirical outcomes. Carolyn’s interests are broad and impactful.
I would like to nominate Emory University Hospital’s (EUH) clinical nurse specialist for Complex Medicine and Emergency Services, Carolyn Holder, for a DAISY Lifetime Achievement Award. For more than 47 years, starting as a staff nurse and then as a clinical nurse specialist from 1984 forward, Carolyn has created a practice environment encouraging nurses and their interdisciplinary partners to improve empirical outcomes. Carolyn’s interests are broad and impactful.
Over the years, Carolyn led an interprofessional team to implement an educational intervention that decreased the ICU’s average glycemic index from 145 mg/dl to 137 mg/dl. Implementation of a chlorhexidine gluconate (CHG) oral care protocol decreased the MICU's ventilator-associated pneumonia rate by 33%. Carolyn led an initiative to improve antibiotic stewardship that decreased care costs by decreasing vancomycin use by 10%.
Carolyn advocates for resources to enhance care outcomes and improve the practice environment. Several years ago, she obtained additional APRN team members who then demonstrated the value of APRN-led Primary Palliative Care in the ICU. They decreased hospital costs by significantly decreasing the average length of stay (ALOS) from 15.5 to13.4 days and ventilator days from 11.5 to 4.1 for involved patients. These outcomes outperformed initial estimates of return on investment (ROI). Carolyn led a collaboration across the care continuum creating a program for adult patients with cystic fibrosis that decreased ALOS from 11.5 to 5.5 days in nine months of operation, delivering on its three-year ROI in a year and improving patient experience by 63 percent. She and a team demonstrated the impact of an expanded Vascular Access Team (VAT) in two Emory Healthcare (EHC) system hospitals that decreased Central Line-Associated Bloodstream Infection (CLABSI) rates, and increased nurse satisfaction and ROI. All of these impressive initiatives involved multiple interprofessional partners. Carolyn creates teams where each has complementary talents. She demonstrates respect for each member, and the teams reach their decisions by consensus.
The Medical Director of the MICU, Jon Sevransky, MD, states, "Carolyn convenes people from across the system to identify issues and solve problems that will benefit the patient.” He mentions that Pain Agitation and Delirium Guidelines implemented across the ICUs resulted in an 82% increase in patient days with controlled pain. This work brought Carolyn to Dr. Wes Ely's attention at the national level, who writes, “In leading the SCCM ICU Liberation Collaborative, I invited my colleague, Carolyn Holder, to collaborate with us. Carolyn’s work implementing the ABCDEF bundle enhanced the care of patients throughout EHC.”
In 2016, Carolyn became the EHC system co-chair of an interprofessional CLABSI prevention team due to prior work aimed at decreasing CLABSI. Carolyn previously reported decreased CLABSI rates with (CHG) treatments. As a co-principal investigator, Carolyn and the team demonstrated a significant 32% decrease in CLABSI rates with silver-coated needleless connectors. She and a team implemented CHG treatments to patients with central lines on three acute care oncology units, decreasing methicillin-resistant staphylococcus aureus BSI rates by 62% on one unit and rates of zero on the other units, representing a cost avoidance of $646,000. By September 2019, the EHC CLABSI prevention team decreased the EHC Standardized Infection Ratio (SIR) from 1.38 to 0.78 and the EUH SIR from 1.48 to 0.81. Carolyn’s collaborative work to establish a culture of safety, high reliability, and superior empirical outcomes embodies the best of DAISY. Thus far, in fiscal year 23, there is a 36% decrease in CLABSI and a 30% reduction in CLABSI across the system.
Carolyn is a proponent for specialty certification, with the MICU nurses often leading the system for professional certification. In the MICU, she expects each nurse to be ready to sit for the critical care specialty exam near the end of their residency. The certification rate in the MICU is routinely greater than 51% of nurses certified. She hand-writes notes of appreciation and has served as a mentor to many nurses and interdisciplinary colleagues. Carolyn’s support of pulmonary hypertension patients led to her supporting nurses in Women’s Services at Emory University Hospital Midtown in caring for this most vulnerable patient population during late pregnancy and childbirth. Several years ago, when the first pregnant patient with newly diagnosed pulmonary hypertension presented, Carolyn spent countless hours at the bedside and on the EUHM’s 71 ICU helping the interprofessional team manage the patient. In three short months, three pregnant patients with pulmonary hypertension successfully delivered very healthy babies.
When she retires, she will leave behind an interprofessional team that was mentored by Carolyn and will continue to achieve and build on the foundation created by our indomitable Carolyn Holder.
Over the years, Carolyn led an interprofessional team to implement an educational intervention that decreased the ICU’s average glycemic index from 145 mg/dl to 137 mg/dl. Implementation of a chlorhexidine gluconate (CHG) oral care protocol decreased the MICU's ventilator-associated pneumonia rate by 33%. Carolyn led an initiative to improve antibiotic stewardship that decreased care costs by decreasing vancomycin use by 10%.
Carolyn advocates for resources to enhance care outcomes and improve the practice environment. Several years ago, she obtained additional APRN team members who then demonstrated the value of APRN-led Primary Palliative Care in the ICU. They decreased hospital costs by significantly decreasing the average length of stay (ALOS) from 15.5 to13.4 days and ventilator days from 11.5 to 4.1 for involved patients. These outcomes outperformed initial estimates of return on investment (ROI). Carolyn led a collaboration across the care continuum creating a program for adult patients with cystic fibrosis that decreased ALOS from 11.5 to 5.5 days in nine months of operation, delivering on its three-year ROI in a year and improving patient experience by 63 percent. She and a team demonstrated the impact of an expanded Vascular Access Team (VAT) in two Emory Healthcare (EHC) system hospitals that decreased Central Line-Associated Bloodstream Infection (CLABSI) rates, and increased nurse satisfaction and ROI. All of these impressive initiatives involved multiple interprofessional partners. Carolyn creates teams where each has complementary talents. She demonstrates respect for each member, and the teams reach their decisions by consensus.
The Medical Director of the MICU, Jon Sevransky, MD, states, "Carolyn convenes people from across the system to identify issues and solve problems that will benefit the patient.” He mentions that Pain Agitation and Delirium Guidelines implemented across the ICUs resulted in an 82% increase in patient days with controlled pain. This work brought Carolyn to Dr. Wes Ely's attention at the national level, who writes, “In leading the SCCM ICU Liberation Collaborative, I invited my colleague, Carolyn Holder, to collaborate with us. Carolyn’s work implementing the ABCDEF bundle enhanced the care of patients throughout EHC.”
In 2016, Carolyn became the EHC system co-chair of an interprofessional CLABSI prevention team due to prior work aimed at decreasing CLABSI. Carolyn previously reported decreased CLABSI rates with (CHG) treatments. As a co-principal investigator, Carolyn and the team demonstrated a significant 32% decrease in CLABSI rates with silver-coated needleless connectors. She and a team implemented CHG treatments to patients with central lines on three acute care oncology units, decreasing methicillin-resistant staphylococcus aureus BSI rates by 62% on one unit and rates of zero on the other units, representing a cost avoidance of $646,000. By September 2019, the EHC CLABSI prevention team decreased the EHC Standardized Infection Ratio (SIR) from 1.38 to 0.78 and the EUH SIR from 1.48 to 0.81. Carolyn’s collaborative work to establish a culture of safety, high reliability, and superior empirical outcomes embodies the best of DAISY. Thus far, in fiscal year 23, there is a 36% decrease in CLABSI and a 30% reduction in CLABSI across the system.
Carolyn is a proponent for specialty certification, with the MICU nurses often leading the system for professional certification. In the MICU, she expects each nurse to be ready to sit for the critical care specialty exam near the end of their residency. The certification rate in the MICU is routinely greater than 51% of nurses certified. She hand-writes notes of appreciation and has served as a mentor to many nurses and interdisciplinary colleagues. Carolyn’s support of pulmonary hypertension patients led to her supporting nurses in Women’s Services at Emory University Hospital Midtown in caring for this most vulnerable patient population during late pregnancy and childbirth. Several years ago, when the first pregnant patient with newly diagnosed pulmonary hypertension presented, Carolyn spent countless hours at the bedside and on the EUHM’s 71 ICU helping the interprofessional team manage the patient. In three short months, three pregnant patients with pulmonary hypertension successfully delivered very healthy babies.
When she retires, she will leave behind an interprofessional team that was mentored by Carolyn and will continue to achieve and build on the foundation created by our indomitable Carolyn Holder.