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Analysis

How to Cut Costs and Improve Outcomes in the ICU

By Philip Betbeze  
   March 08, 2018

Wright says about changing care protocols in the ICU: "My advice is go in with an open mind and expect it will take months or years to get it working as well as you want it to, but there's been a dramatic change in how we manage these patients," he says. "Before, if you went in the ICU during the day, most patients used to be asleep. Now they're awake."

Additionally, he says the hospital experienced cost savings of about $800,000 in its first year.

"We didn't hire anyone extra for this project, but I've proposed downstream that we need some more FTEs from the physical and occupational therapy side to get things where we need to be."

Kaups says in addition to better patient outcomes, Community Regional has improved its ability to serve its community.

"We're a Level 1 trauma center and we're always at capacity, so of course it has cost implications," she says. "We're looking at bed capacity and the ability to provide beds when we need them. Anything we can do to decrease length of stay from an economic standpoint is great."

Premier Inc. published a report in late 2017 focusing on ICU trends based on inpatient data from 20 million patient discharges across 786 hospitals over a five-year period (2011-2016).

Patients treated at top-performing hospitals spent 24% less time in the ICU, and the healthcare improvement company said in the same report that with the right tactics, ICU stays within this five-year period could have been reduced by nearly 200,000 days annually. The top 10 ICU diagnoses with the highest variation are as follows:

  1. Sepsis patients with major complications or comorbidities: 187,584 potentially fewer ICU days
  2. Infectious and parasitic diseases associated with operating room procedures, and major complications or comorbidities: 147,369
  3. Cardiac valve and other major cardiothoracic procedures without cardiac catheterization, but with major complications or comorbidities: 121,953
  4. Coronary bypass without cardiac catheterization, but with major complications or comorbidities: 97,422
  5. Respiratory system diagnosis with ventilator support for up to 96 hours: 94,201
  6. Craniotomy and endovascular intracranial procedures with major complications or comorbidities: 88,663
  7. Sepsis patients using a mechanical ventilator >96 hours: 67,464
  8. Cardiac valve and other major cardiothoracic procedure with cardiac catheterization and major complications or comorbidities: 63,521
  9. Cardiac valve and other major cardiothoracic procedure without a cardiac catheterization, but with complications or comorbidities: 60,583
  10. Heart failure and shock with major complications or comorbidities: 59,351

Philip Betbeze is the senior leadership editor at HealthLeaders.


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