Easing ICU Admission Threshold May Improve Care and Reduce Costs

Joseph M Carrington DO, MHA Department of Medicine - PGY3 Johns Hopkins University/Sinai Hospital

Dr. Carrington

MedicalResearch.com Interview with:
Joseph M Carrington DO, MHA
Department of Medicine – PGY3
Johns Hopkins University/Sinai Hospital

Medical Research: What is the background for this study? What are the main findings?

Dr. Carrington: This study looked at a total of 886 patients at a community hospital. We were faced with the dilemma that our ICU beds were frequently over utilized with severely ill patients for whom our interventions had minimal impact. This prevented patients who were less ill from coming to the ICU who may have benefited from our services. We made a hospital wide culture change to lower ICU admission thresholds. Any patient felt to be “borderline” received an automatic ICU evaluation without any push-back. The result of these earlier interventions was a decrease in complications from patients decompensating¬†in the ED and floors. In turn, the overall ICU length of stay, mortality, and ICU transfers all decreased. By decreasing these overall complications and mortality, our number of ICU over-utilizes decreased. This saved our hospital an annualized amount of over $2 million and freed up ICU beds and resources.

Medical Research: What should clinicians and patients take away from your report?

Dr. Carrington: The take away from this study is that we do not have perfect guidelines for who will benefit most from ICU care. However, our data seems to support our hypothesis that earlier investment in borderline patients can lead to real returns on those investments for both health outcomes and dollars.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Carrington: The data being presented here is from one community hospital. Since reporting this data we have found similar results at a large tertiary care center within the same region. It would be preferable to study this design throughout other populations to determine if it holds true. Hopefully applying this design in different populations throughout the country will help us develop an understanding of who will benefit the most from ICU services.

Citation:

CHEST 2015 abstract:

Carrington J, Barnes J.
Chest
2015;148(4_MeetingAbstracts):246A.
doi:10.1378/chest.2270816.
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Joseph M Carrington DO, MHA (2015). Easing ICU Admission Threshold May Improve Care and Reduce Costs