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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:
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.