The Challenge of the ICU

Joe Cantlupe, for HealthLeaders Media , May 13, 2011
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“By working proactively, we are in a position to quickly initiate stepped-up levels of care and reduce the potential for more serious complications,” says Dacey.

The rapid response team is activated when physicians and nurses believe there has been an acute change in the patient’s condition. The team includes critical care nurses who have at least 2.5 years of critical care experience, a respiratory therapist, and a physician assistant. “Each represented discipline responds promptly. They consistently work toward either stabilizing the patient or assisting with transfer to a higher level of care, if required.”

Kent Hospital saw results within a year of instituting the team. Cardiac arrests decreased from 7.6 per 1,000 discharges to 3.0 per 1,000 discharges in the subsequent 13 months. Overall, the cardiac arrests decreased from approximately nine per month to two per month after the rapid response team program was initiated. The rapid response team has worked inside the ICU focusing on sepsis patients, with the number of calls increasing from 30 per month in January 2009 to about 73 calls per month a year later. The sepsis and septic-shock mortality rates were at 19%, compared to 29% of the national average, Dacey says, referring to patients treated for sepsis. He attributed the changes to early resuscitation with IV fluids and antibiotics.

The cost of the system, he notes, “is not cheap. To implement such a system costs about $500,000 a year. “The payback is in lives saved, which in our study was around 100 per year.”

In addition, by decreasing the number of ICU admissions—from 105 per month to about 85—“there were certainly cost savings, but that was not quantified,” Dacey says.

In a report, Dacey notes, “Although both financial and personnel resources may be limited, an RRT led by PAs can improve several key metrics relating to quality of care and may be a worthwhile investment for hospitals to make.”

Success Key 3: Reducing CLABSIs

Nationwide, hospitals are becoming increasingly successful in finding ways to reduce central line–associated bloodstream infections. CLABSIs are a deadly healthcare-associated infection with a reported mortality rate of 12% to 25%, according to the CDC.

The central line tube is a lifeline for patients in the ICU, whether as a route for blood or nutrients. But it also can be a conduit for infections and cause serious bloodstream infections.

In 2001, some 43,000 CLABSIs occurred among patients hospitalized in ICUs in the United States. In 2009, the estimated number of ICU CLABSIs had decreased to 18,000, a 58% reduction, the CDC states. That represents up to 6,000 lives saved and $414 million in potential excess healthcare costs in 2009 and about $1.8 billion in cumulative excess health care costs since 2001, according to the CDC.

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2 comments on "The Challenge of the ICU"

Nick King (5/16/2011 at 11:40 AM)
The article briefly mentions telemedicine but it is worth expounding on. One of the more promising high technology approaches to improving ICU care is the use of tele-ICUs. This technology has been shown to have clinical benefits for patients and cost-saving benefits for hospitals and insurers. By staffing specially-trained critical care doctors and nurses in a command center to monitor and care for patients in multiple and remote hospital units, tele-ICUs can also absorb the expected increase in ICU demand at a time when there is a shortage of critical care cluinicians. Command centers can be licensed to monitor up to 500 adult ICU beds. Recent research on tele-ICUs is worth a read:

Scott Arnold, PT (5/13/2011 at 2:14 PM)
I would like to add to the above items the impact early ICU patient mobility programs are having on reducing ICU length of stay and improving quality of life of ICU survivors including vent-dependent patients. Physical and occupational therapists have partnered with intensivists and nursing staffs at our hospital to get ICU patients moving as soon as possible. Evidence-based literature shows the safety and cost-savings associated with this practice change. Scott Arnold PT, Mayo Clinic Hospital, Jacksonville, FL




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