The link between efficiency and patient safety in the ICU

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)