Intensive Care Units Do Better Under Pressure: Study

Busy ICUs discharge patients more quickly than usual, but they do so without compromising patient care and outcomes, suggesting that low-value extensions of ICU stays are minimized during times of increased ICU capacity strain, according to a new study from Penn Medicine.

In light of anticipated growth in the number of patients requiring critical care resources, and the projected shortage in critical care providers, researchers set about studying how these factors would likely strain the resources of ICUs. They assumed that there would be increased competition for ICU beds among greater numbers of more seriously ill patients, and those patients would spend shorter periods of time in the ICU, experiencing worse health outcomes due to rationing of necessary critical care.

But researchers found the opposite: reductions in the number of U.S. ICU beds could yield considerable cost savings without reducing the quality of care. The study’s findings have important implications for planning U.S. critical care capacity, researchers note.

In a retrospective analysis of over 200,000 patients from 155 ICUs in the United States between 2001 and 2008, researchers found the following:

  • When ICUs were at their busiest, patients were discharged an estimated 6.3 hours sooner to other parts of the hospital than they otherwise would be.
  • Such discharged patients experienced no increase in the odds of dying in the hospital, no greater overall length of hospital stay, and no decrease in the odds of ultimately going home.
  • When ICU providers are not busy they are more likely to keep patients in the ICU for longer than necessary, providing low-value critical care services.

ICU capacity was measured by ICU census, number of new admissions, and the average acuity of the other patients in the ICU at the time of a patient’s discharge.

These results suggest that rather than causing the rationing of beneficial care, strain pushes providers to reassess their patient’s need for ICU–level care and transfer them where they could be equally well-managed.

Avoiding waste, the researchers point out, serves the interest of both individual patients and society. Although the reductions in ICU length of stay during times of strain were modest, focusing efforts on achieving similar reductions in ICU length of stay for the majority of patients admitted to the nearly 100,000 ICU beds in the United States could reduce the overall use of critical care in the country. More effort needs to be focused on increasing the efficiency with which critical care services are provided with existing resources, the study says.

Source: Penn Medicine, September 30, 2013

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33 Metrics for Care Transition Management provides a graphic compendium of performance benchmarks in key areas impacting care transitions — from key tasks performed at hospital discharge to the prevalence of home visits in programs to improve medication adherence.

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