There is significant variation in practice for intensive care, and a new report identifies best practices for several conditions, including sepsis and cardiac procedures, that could reduce costly intensive care unit stays. Premier, Inc. found that between 2011 and 2016 there was room to eliminate more than 988,000 patient ICU days.
Premier Inc. analyzed more than 20 million patient discharges from 786 hospitals that were recorded between 2011 and 2016. It found that patients in the highest-performing hospitals spend 24% less time in the ICU, and that there was space to reduce more than 988,000 patient ICU days or nearly 200,000 annually during the study period.
Intensive care is costly, and can also lead to an increase in invasive and unneeded procedures. New models, like intensive home health care, have increased patient satisfaction and cut costs.
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"Spending too much time in the ICU can negatively impact patients and the bottom line, particularly in this era of value-based care payment models,” Robin Czajka, R.N., service line vice president of cost management at Premier, said in an announcement. “Decisions around admitting patients to the ICU and how they are treated can often be subjective calls, rather than guided by evidence."
The 10 diagnoses the report identified as having the most variation in ICU length-of-stay are:
- Sepsis in tandem with significant complications or other comorbidities
- Sepsis cases in patients who have been attached to a ventilator for more than 96 hours
- Infectious or parasitic diseases, which were linked to surgical procedures and are also tied to other complications and comorbidities
- Cardiac valve and other cardiothoracic procedures performed without a cardiac catheter, combined with major complications and comorbidities
- Cardiac valve and other similar procedures with catheterization in patients who have other complications
- Cardiac valve and other similar procedures without cardiac catheterization, in patients with less-significant comorbidities
- Coronary bypass without cardiac catherization that also includes other conditions or complications
- Respiratory disease that requires at least 96 hours of ventilation
- Craniotomy and other similar procedures in patients who have comorbidities and other complications
- Heart failure or shock in patients with significant comorbidities
By isolating these cases, providers have made improvements in reducing variation and optimizing ICU care, according to the report. The study found a 13% decrease in ICU days for patients with those 10 conditions during the five-year window.
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The study also identified several best pest practices for making ICU care more efficient. Providers found success in creating an intermediate care setting that eased patients' transition from intensive care. They also encouraged more care coordination, and created checklists that could monitor patient progress and goals more effectively.
Success stories, according to the study, also included providers that used evidence-based approaches to reduce hospital-acquired infections and ICU delirium simultaneously.