ICU patients account for over 18 million patient days annually in the United States and cost 1 % of GDP. The Leapfrog group recommended that ICU patients be managed exclusively by boardcertified intensivists for their 40% reduction in ICU mortality. However, due to shortages in the intensivist work force, only about 23 % of critically ill patients are seen by board certified intensivists. With the aging population, while the demand for intensivists will increase by 38 % over next 10 years, community hospitals in this economic downturn have limited options for improving care of their ICU patients. Being unrealistic on hiring more intensivists and conflicting studies on use of telemedicine has prompted partnering with hospitalists in ICU care. Purpose: To develop an ICU hospitalist model with the goal of improving patient care and to identify its effects of this model on quality measures, nonICU hospitalists, subspecialists and the nursing staff.
A dedicated group of hospitalists who have adequate experience on care of critically ill patients were identified. They were credentialed to perform procedures such as ultrasound guided central venous catheter placement, arterial catheter insertion, lumbar puncture, paracentesis, endotrachael intubation and ventilator management. All of our ICU hospitalists had successfully completed Fundamentals in Critical Care Support course. Evidence based standardized order sets were built for common ICU conditions. The initial schedule was constructed such that a single ICU hospitalist covered the ICU from 7 am to 7 pm. Dedicated times were allotted for multidisciplinary rounds, family meetings, ICUspecific committees and nursing education. We established a focus on continuity of care where ICU patients were admitted, taken care of in the ICU, followed after downgrade to the Medical/Surgical floor and discharged home by the same hospitalist. After one year, we conducted a 360degree evaluation of the major hospital stakeholders involved and findings were reviewed.
We found that the ICU nursing staff, respiratory technicians and our solo pulmonologist were very satisfied with the care provided by the ICU hospitalists. In addition the hospital administration noted the decrease in ventilator days by 35%, and a decrease in the average length of stay by 22%. The administration has encouraged and supported us expanding this ICU model to 24 hours of coverage. An additional identified benefit was that the hospitalists not participating in the ICU model were able to spend more time on the Medical/Surgical floors and were able to discharge patients earlier in the day. Additional metrics such as cost savings analysis and the impact on patient satisfaction are currently being evaluated.
To cite this abstract:Krivopal M, Hlaing M, Himebaugh R, Felber R. ICU Hospitalist a Novel Method of Care for the Critically Ill Patients in Economically Lean Times. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97735. https://www.shmabstracts.com/abstract/icu-hospitalist-a-novel-method-of-care-for-the-critically-ill-patients-in-economically-lean-times/. Accessed February 16, 2019.