- Using evidence-based best practices for intensive care units can improve quality and reduce unnecessary length of stay, a new analysis from Premier shows.
- The group looked at 20 million patient discharges across 786 hospitals between 2011 and 2016, comparing all facilities with those having the most efficient ICU programs.
- The analysis, published in the Premier’s latest Margin of Excellence report, identified 10 diagnoses with the highest variation in ICU stays and opportunities to reduce ICU days by nearly 200,000 a year — or 988,111 overall.
The report comes as hospitals are struggling to control costs as expenses increase and payers are pushing providers to treat more patients in lower-acuity outpatient settings. In 2005, 13.3% of total hospital expenditures — and 4.25% of U.S. healthcare expenditures — involved intensive care services, according to Premier. At the same time, Medicare covers only 83% of ICU costs, the report noted.
Overall, patients treated at top-tier hospitals spent 24% less time in ICUs than patients in lower-performing hospitals, the report said. Key opportunities to reduce variation include:
- Sepsis patients with major complications or comorbidities (19% of ICU reduction opportunity);
- Infectious and parasitic diseases linked to operating room procedures and complications and comorbidities (15%);
- Cardiac valve and other cardiothoracic procedures without cardiac catheterization, but with complications and comorbidities (12%);
- Coronary bypass without catheterization, but with major complications and comorbidities (9.8%);
- Respiratory system diagnosis with up to 96 hours of ventilator support (9.5%);
- Craniotomy and endovascular intracranial procedures with complications or comorbidities (8.9%);
- Sepsis patients with more than 96 hours of mechanical ventilator use (6.8%);
- Cardiac valve and other cardiothoracic procedures with catheterization and complications or comorbidities (6.8%);
- Cardiac valve and other cardiothoracic procedures without catheterization, but with complications or comorbidities (6.1%); and
- Heart failure and shock with complications and comorbidities (6%).
By applying best practices, providers were able to reduce ICU days by 13% across the 10 diagnoses over the study period, Premier noted.
To optimize ICU care, the report recommended using evidence-based practices to control hospital-associated infections and ICU-associated delirium, establishing intermediate care settings to facilitate transition of patients out of ICU care, using checklists to monitor patient progress and creating multidisciplinary teams to coordinate care.