Dataset Information

Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays.

ABSTRACT:

Importance

High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care.

Objective

To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays.

Design, setting, and participants

This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital. The preintervention phase occurred from April 6 through June 21, 2015; after implementation of targeted interventions, the postintervention phase occurred from April 4 through June 28, 2016. Data collected included demographic characteristics, reason for admission, and length of stay. All patients admitted to the SICU during the preintervention and postintervention phases were included in the analysis.

Interventions

Based on results collected in the preintervention phase, targeted interventions were designed and implemented from July 1, 2015, through March 31, 2016, including (1) reducing SICU care for minor traumatic brain injury, (2) optimizing postoperative airway management, (3) enhancing communication between services regarding transfers to the SICU, (4) identifying and facilitating more timely end-of-life conversations and supportive care consultations, and (5) encouraging early disposition of patients to floor beds.

Main outcomes and measures

Changes in the proportion of potentially avoidable SICU days owing to potentially avoidable admissions and/or disposition delays.

Results

A total of 459 patients (253 men [55.1%] and 206 women [44.9%]; median age, 62 years [interquartile range, 46-75 years]) were admitted during the preintervention and postintervention phases. Of 261 patients admitted during the preintervention period and 245 during the postintervention period, median SICU and hospital length of stay remained unchanged. A reduction was noted in the percentage of postintervention SICU days owing to potentially avoidable admissions (152 of 1168 days [13%] vs 118 of 1338 days [8.8%]; P?=?.001) and disposition delays (138 of 1168 days [11.8%] vs 97 of 1338 days [7.2%]; P?Conclusions and relevanceNearly one-fourth of SICU days could be categorized as potentially avoidable. Targeted interventions resulted in a significant reduction of potentially avoidable SICU days.

SUBMITTER: Dhillon NK

PROVIDER: S-EPMC5710417 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays.

Dhillon Navpreet K NK Ko Ara A Smith Eric J T EJT Kharabi Mayumi M Castongia Joseph J Nurok Michael M Gewertz Bruce L BL Ley Eric J EJ

JAMA surgery 20171101 11

<h4>Importance</h4>High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care.<h4>Objective</h4>To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays.<h4>Design, setting, and participants</h4>This prospective, observational study focused on potentially avoidable SICU days, as determined b ...[more]

PMID: 28724143

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Project description:BackgroundEpidemiologic assessment of surgical admissions into intensive care units (ICUs) provides a framework to evaluate health care system efficiency and project future health care needs.MethodsWe performed a 9-year (2008-2016), retrospective, cohort analysis of all adult admissions to 88 surgical ICUs using the prospectively and manually abstracted Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. We stratified patients into 13 surgical cohorts and modeled temporal trends in admission, mortality, surgical ICU length of stay (LOS), and change in functional status (FS) using generalized mixed-effects and Quasi-Poisson models to obtain risk-adjusted outcomes.ResultsWe evaluated 78,053 ICU admissions and observed a significant decrease in admissions after transplant and thoracic surgery, with a concomitant increase in admissions after otolaryngological and facial reconstructive procedures (all p < 0.05). While overall risk-adjusted mortality remained stable over the study period; mortality significantly declined in orthopedic, cardiac, urologic, and neurosurgical patients (all p < 0.05). Cardiac, urologic, gastrointestinal, neurosurgical, and orthopedic admissions showed significant reductions in LOS (all p < 0.05). The overall rate of FS deterioration increased per year, suggesting ICU-related disability increased over the study period.ConclusionTemporal analysis demonstrates a significant change in the type of surgical patients admitted to the ICU over the last decade, with decreasing mortality and LOS in selected cohorts, but an increasing rate of FS deterioration. Improvement in ICU outcomes may highlight the success of health care advancements within certain surgical cohorts, while simultaneously identifying cohorts that may benefit from future intervention. Our findings have significant implications in health care systems planning, including resource and personnel allocation, education, and surgical training.Level of evidenceEconomic/decision, level IV.Epidemiologic, level IV.

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Dataset Information

Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays.

Importance

Objective

Design, setting, and participants

Interventions

Main outcomes and measures

Results

Publications

Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays.

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