United States

The context: Standardizing and fine-tuning intensive care in a rural community

Mayo Clinic Health System (MCHS) in Mankato, Minnesota, is a community-based healthcare system that brings Mayo Clinic's resources and expertise to the community and the region. It serves the community through routine, preventive and specialized care services, wellness support and community engagement. MCHS in Mankato supports patients with an onsite intensive care unit (ICU). ICU doctors and specially trained staff deliver expert care for patients with cardiac, surgical, neurosurgical trauma and other critical medical needs.

The challenge: Taking great care to a mastery level

The ICU at MCHS in Mankato was the first ICU in the United States to participate in the CERTAIN: Global Critical Care and Emergency Medicine Program. "When we started this program in 2016, we had not thought of CERTAIN as the solution to an existing problem," says Anjum Khan, M.D. "We had a highly structured and effective approach to care already and we were proud of it. At the start, we did not realize how much we would benefit."

Our advisory approach: Consistency and values-driven engagement

As Dr. Khan and her team had established their own rounding checklist in 2007, the CERTAIN Program's training first centered on how to use the established processes more consistently. We also provided coaching focused on how to engage all the interdisciplinary experts on the team most effectively during clinical discussions. We looked at how to improve antibiotic stewardship and consistently apply best practices in patient mobility, respiratory therapy and early nutrition.

The MCHS in Mankato and CERTAIN Program teams grounded our work in the shared value of putting the needs of the patient first, including how best to include patients' family members in care decisions.

What changed: Expanded involvement for families and care teams

"CERTAIN created a lasting impact," says Dr. Khan. The ICU team's skills were reinforced by the program, and they began using their processes with greater consistency than they ever had in the past.

The MCHS in Mankato team made two key changes. First, the team started involving patients' families in all healthcare decision-making conversations. Additionally, the unit expanded the definition of a rounding team. Based on CERTAIN Program training and recommendations, ICU rounding teams at MCHS in Mankato now include as many of the following roles as are appropriate for each patient:

  • The patient and their family.
  • The patient's physician.
  • An advanced practice provider.
  • The bedside nurse and the charge nurse.
  • A pharmacist.
  • A pharmacist specialized in antibiotic stewardship.
  • A respiratory therapist.
  • A dietitian.
  • A physician therapist.
  • A social worker.
  • A palliative care nurse.

Impact

Many types of infections can occur when patients are exposed to invasive devices in the intensive care unit. A major goal for Dr. Khan's team in the CERTAIN Program was to establish a system and environment that can protect patients from such infections.

Since completing the CERTAIN Program, the MCHS in Mankato ICU team has achieved remarkably strong results in infection prevention:

  • Zero central line-associated bloodstream infections (CLABSIs) since 2019.
  • Zero catheter-associated urinary tract infections (CAUTIs) since 2022.
  • Zero cases of Clostridioides difficile-associated diarrhea (CDAD), an illness that often occurs after using antibiotic medications, since 2019.

In 2025, Mankato was one of only 10 hospitals nationwide to receive all three distinctions from Healthgrades:

  • Outstanding Patient Experience
  • Patient Safety Excellence
  • America's 50 Best Hospitals

The MCHS in Mankato ICU consistently performs as well as the unit at Mayo Clinic in Rochester — a major achievement for a regional community hospital.

What comes next: Dissemination and implementation

The MCHS in Mankato ICU team has started considering how they can share their expertise with other hospitals. "In 80% of the world, critical care teams don't include respiratory therapists," says Dr. Khan. "These teams can benefit from a structured approach to mechanical ventilation."

The team also is developing a system to screen patients so that they can be moved in a structured process through each step in physical and respiratory care recovery. Adopting such a system could allow many hospitals with varying levels of access to specialized care to provide optimized recovery support.