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Increased MICU Staffing Saves Lives

December 02, 2010

Increased MICU staffing can enhance patient survival and enable patients to breathe sooner without assistance, according to research published in Critical Care Medicine.

The researchers analyzed the files of patients in the Medical Intensive Care Unit at the University of Maryland Medical Center in Baltimore two years before and two years after a move from a 10-bed MICU to a 29-bed state-of-the-art facility.

The changes resulted in a 19 percent decrease in mortality in the ICU and a 16 percent decrease in hospital-wide mortality.

Even in a high-functioning MICU, "targeted reorganization and investment has been associated with further, substantial improvements in patient outcomes," the investigators report. "By establishing an even higher standard of ICU staffing and care, it may be possible to effect even greater increases in survival," and "potentially even greater overall cost effectiveness than previously estimated with traditional, high-intensity physician staffing."

The observational study was composed of 1,263 patients admitted to the UMMC MICU before the move to new quarters, and 2,424 admitted after the move.

Before the move, the MICU was staffed eight hours daily, seven days a week, with physicians who specialize in intensive and critical care medicine. It had a nursing ratio of one nurse for every 1.7 patients and the physician staffing level was consistent with the recommendations of the Leapfrog Group.

After the move, UMMC's MICU adopted 24-hour critical care physician coverage, as recommended by the American College of Critical Care Medicine. Clinical pharmacists evaluated patients daily and the number of respiratory therapists was increased.

This was the first study to look at the impact of increasing staffing levels to meet the ACCCM guidelines, according to Giora Netzer, MD, assistant professor of medicine and epidemiology and preventive medicine at the University of Maryland School of Medicine and the principal investigator. "We found that taking the staffing to an even higher level may save even more lives."

The length of stay in the MICU increased slightly after the changes, from a median 2.4 to 2.7 days, but there was no change in total hospital length of stay. MICU costs rose post-change, from a median of $4,071.10 per patient admission to $6,232.20. The total per admission hospital variable costs also increased from median $11,819.90 to $13,178.90.

"While we did assess hospital variable costs, we do caution readers that these are simple, crude measures and are not the same as cost effectiveness," Netzer explained in an interview. "Determining the return on resource allocation in terms of Quality Adjusted Life Years or comparative effectiveness are substantial endeavors and are outside of the scope of our study. We would like to pursue those analyses moving forward."

Simply spending money won't achieve MICU's results, researchers caution: "It is unlikely that untargeted expenditures of additional resources in an ICU would result in patient improvements."

Moreover, many hospitals will be unable to replicate MICU's success, especially given the additional cost. "It's neither feasible nor likely that every ICU in the U.S. would reorganize according to ACCCM Level I recommendations and see dramatic improvements." Netzer says. "However, organization to optimal Level I guidelines … should be seriously considered by urban, tertiary care medical centers. This is especially true of the main hospital within a medical system."

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