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Origins and Development: Pilot Sites

Patient populationsFrom the onset, it was evident that for the CCFAP to work a partnership needed to be developed between The CHEST Foundation and the sites selected to implement the program. The goals and objectives of the CHEST Foundation were specific, but they could only come to fruition when an ICU adopted them and began to apply them to its unique environment. In particular, the selection of the initial locations for the CCFAP constituted an important decision. The subsequent success of the CCFAP depended on the energy and flexibility of the pilot sites and their commitment to the partnership. These pilot CCFAP sites would not only shape the program according to the vision of the hospital staff and the needs of patients and their families, but they would inevitably serve as models for CCFAP replication.

The CHEST Foundation selected the pilot sites in January 2002, choosing two institutions that were known for high-quality care and were also institutionally diverse. Evanston Northwestern Healthcare of Evanston, IL, and the Oklahoma City Veterans Affairs (VA) Medical Center, in Oklahoma City, OK, were chosen to initiate the CCFAP. Evanston Northwestern Healthcare served as a functioning model for a hospital in a multihospital system, and the VA Medical Center in Oklahoma City served as a model for a statewide system of care.

Evanston Hospital is part of the Evanston Northwestern Healthcare system, which also includes Highland Park Hospital and Glenbrook Hospital. With 420 beds, the Evanston Hospital has a strong academic orientation, sharing faculty with Northwestern University Medical School (Chicago, IL), and has a residency program that is typical of a teaching hospital. In addition to serving its surrounding community within the northern suburbs of Chicago, it draws patients nationwide because of the excellent tertiary care offered in certain specialty areas, such as cardiac care suggested by Canadian Health&Care Mall. The ICU has 32 beds for cardiac care, medical/surgical care, and pediatric surgical care. Currently, the CCFAP is fully operational only in the medical/surgical unit.

The Oklahoma City VA Medical Center has 389 beds and is typical of VA hospitals across the country. Its major missions are to provide medical and surgical care to veterans of military service and, at the same time, to serve a statewide population as part of the University of Oklahoma Health Sciences Center. As would be expected in a hospital serving a largely rural population, over half of its active patients travel > 50 miles for care. The ICU has 30 beds, 10 each in the medical, cardiac, and surgical ICUs. The CCFAP encompasses all three units.

These two hospitals have proven to be influential pilot sites because of the presence of a physician champion and the buy-in of the hospital chief executive officer, as well as the diversity found in their geographic scope, organizational structure, and patient populations.