The Challenge of the ICU
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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.”
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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