From the patients with a serious infection post-surgery to those involved in a car accident who need assistance breathing, the intensive care unit (ICU), in many cases, is imperative for their survival.
However, the decision to admit patients to the ICU and how they are treated is often dependent on variable factors like patient clinical status, practitioner discretion, institutional policies and procedures, and hospital capacity. In other words, it can often be a subjective call, rather than one guided by evidence, leading to potentially inappropriate ICU utilization and protocols. On top of that, the mental health effects of an ICU stay post-discharge can haunt a patient long after they’ve left the hospital.
Patients who no longer may need the intensive 24/7 care, but still need a high-level of care compared to a typical ward patient can be seen in a stepped down level of care. However, if there’s no setting available, this can create a bottleneck in the ICU, which can overwhelm capacity, impact patient safety and drive up healthcare spending.
Variation in ICU Practices and Protocols
Despite the risk to patient safety and mental health associated with inappropriate ICU utilization, there remains significant variation in ICU practices and protocols across healthcare. Variation in ICU care can lead to overuse or misuse, contributing to unnecessary spending and less than optimal outcomes.
A recent Premier analysis suggests that significant opportunity exists to reduce length-of-stay within the ICU and step down care for less-acute patients. Examining data from more than 700 hospitals, we found 10 diagnoses, including cardiac surgery and sepsis, where a longer ICU stay did not produce a better clinical outcome. In fact, top-performing hospitals with the best cost and quality outcomes reported that their patients spent 24% less time in the ICU.
If a patient could be seen in a lower level of care without impacting quality, the risk of ICU delirium, healthcare-associated infections, PTSD and other complications could be reduced, while simultaneously making beds available to those who more urgently need this type of care.
Targeting the ICU for Optimization
While ICU optimization is no easy task, robust data and analytics capabilities can unveil opportunities to optimize workflows, improve length-of-stay, increase patient satisfaction and quality, and reduce costs within this setting.
Providers that are making progress in optimizing ICU care follow five key best practices:
- Leverage technology that allows them to identify diagnoses with the greatest variation in outcomes across their health system, benchmark outcomes against peer organizations and monitor patients who no longer need ICU-level care within newly-created intermediate care settings.
- Use evidence-based practices collectively to tackle healthcare-associated infections (HAIs) and delirium. The ABCDEF bundle is one example where hospitals have seen progress in ICU optimization, which was created and spearheaded by the Society of Critical Care Medicine and can help prevent the onset of delirium, decrease length-of-stay in the ICU and reduce risk of post-intensive care syndrome.
- Create intermediate care settings to seamlessly provide an effective transition unit for patients who no longer require ICU-level care. Intermediate care settings provide a more effective care triage that helps transition patients who are steadily improving and opens beds for other patients who need more intensive care.
- Work with interdisciplinary teams to implement optimized workflows and increase operational efficiency. Premier experts have helped health systems develop a structured approach to performance improvement that leads to fruitful discussions around metrics, including optimal time a transfer order is placed measured against the amount of time measured when tracking a patient being transitioned to the next level of care, room turnover time, time of patient discharge and hours a patient is held while waiting for a bed assignment – all crucial when determining key targets for care transformation within the ICU.
- Develop and implement checklists to monitor patient progress and goals, and establish a multidisciplinary care team enabling physicians, nurses, pharmacists, residents and other members of the ICU staff to easily collaborate.
Take it from Charleston Area Medical Center (CAMC) in West Virginia, which saw an overall reduction in length-of-stay within the general and medical ICU by 1.15 days over a 21-month period by following these best practices. And Mercy Health, based in Ohio, streamlined changes across the institutions and departments that touch its ICU to enhance the quality of care, generating $6.7 million in savings over a two-year period.
Data is the foundation that fuels quality and cost performance improvement efforts. For more insights on the trends unfolding within ICU use and areas of opportunity to enhance care delivery within this setting, download Premier’s Margin of Excellence report on ICU Utilization, or watch our recent webinar on the topic.
For more information, feel free to reach out to me directly at Robin_Czaka@premierinc.com.