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The Challenge of the ICU

Joe Cantlupe, for HealthLeaders Media, May 13, 2011
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The intensive care unit is one of the most sensitive areas of the healthcare system: That’s where it responds to chronic and unremitting disease of the sickest of hospital patients, as well as those suffering from trauma or complications from surgery. Health systems are in the midst of an ICU makeover as healthcare leaders rethink how they are providing care in the costliest area of the hospital, to improve outcomes and attain ROI.

Hospitals are increasingly using multidisciplinary approaches, embracing high technology as well as low-tech efforts, from using checklists and standardizing patient forms to implementing telemedicine approaches, to shifting nurses and physicians to improve patient flow, and even making architectural changes to relieve the burden of the ICU.

Indeed, the ICU burden is expected to grow over the next few decades, as hospitals prepare for what some experts say will be an explosion of new patients amid an increasing elderly population with an array of comorbidities.

Multidisciplinary approaches are being seen as a way to “overcome fragmentation of the system, which has occurred on the medical school to the professional level,” says J. Perren Cobb, MD, director of the critical care center for Massachusetts General Hospital in Boston. “Historically, ICUs have been affiliated with various departments. For example, surgery ICUs, pediatric ICUs and medical ICUs would belong to their respective departments. They have not garnered resources to optimize care.”

As many as one in five patients die in the ICU because of their medical conditions and high rate of complications. While they account for only 5% to 15% of total hospital beds, ICUs account for up to 30% of a hospital’s costs.

 “The acuity of the average patient has been rising over time, and when you couple that with increases in the emergency department and patients presenting with more comorbid conditions, there will be an increased demand for critical care services,” says Eileen Young, MSN, RN, assistant vice president of quality and patient safety for Crozer-Keystone Health System
in Philadelphia.

“We have to balance efficiency in the hospital so there would be more effective treatment and efficiency of care so we can reduce length of stays,” Young says.

Success Key No.1: Overcoming sepsis

When leaders of the Crozer-Keystone Health System examined their ICU systems a few years ago, they weren’t pleased with what they had seen. Mortality rates for patients stricken with sepsis in the hospital was at 50%.

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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: http://bit.ly/fuVdO3

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