In my previous article on Critical care or Intensive care(The link betweek efficiency and patient safety), we saw how efficiency can impact patient safety and thereby the outcome. Now let us examine a recent innovation in the area of critical care that has actually accomplished this at the John’s Hopkins Hospital, Baltimore,MD.

The Problem

Poor and inconsistent communication among providers in the intensive care unit (ICU) can lead to a lack of understanding of daily goals and the failure to deliver needed services that accelerate recovery and discharge.

The Solution

The ICU care team (which includes the attending physician and/or fellow, anesthesia and surgery residents, a nurse practitioner, a nurse, and a pharmacist) visits each ICU patient every day between 20 and 25 minutes and uses  the ICU Daily Goals Form to document the This creates a standardized way to communicate with one another and a focussed plan of care.

Expected Benefits

• The benefit of this innovation may be greatest with high-intensity patients, such as those in the ICU. It also may be most applicable in academic medical centers and other organizations where ICU care is provided by many different types of practitioners.
• Reduced LOS – At Johns Hopkins where this innovation was pioneered, the mean length of stay in the ICU reduced from 2.2 days to 1.1 days

Over a year approximately five million people recieve Intensive care in the United States. In hospitals we refer refer to these patients as ‘critical care’. While the ICU in most hospitals is perhaps the most well run unit  from a patient safety standpoint. There is still room for improvement from an efficiency standpoint. And if we increase efficiency we can greatly affect clinical outcomes and paitent safety.                            

Now wait a minute, how is that possible. Isn’t efficiency about  financial dollars for the hospital and something about working  like Toyota or GE. What has it got to do with patient care, safety and clinical outcomes ? Ok, let us look at some facts and you can decide for yourself.

Facts from America’s ICUs

• The average length of stay in an ICU unit is 4 days
• Average number of Critical care/ICU patients per day is 90,000
• The average survival rate is 86% 

You might say 86% is not bad, and infact its a good outcome in most clinical areas. But consider these facts,

• Infections are the main cause for fatality in critical care
• 4% of all patients contract line infections after 10 days
• After 10 days with a catheter 4% of patients (in the US) develop bladder infections
• After 10 days on a ventilator 6% develop penumonia and  40-50% of cases result in death

In other words, as length of stay increases (which is an important efficiency metric) the chances of survival reduce greatly. Ok now, let us consider the costs.

• On average ICU patients occupy 10% of total beds in the US
• On average ICU beds account for 30% of an acute care hospital cost in the US
• The total cost of critical care is $180 billion in the US

 I hope I have made a case for improvements in the ICU.

(*Stats Ref: Dr. Atul Gawande’s article in the New Yorker and the Society for Critical Care Medicine)