Scaled-down ICU saves $5,000 per patient
Patient readmission rates, LOS reduced, too
Providing care for long-term critically ill patients is costly, but one hospital lowered its costs by an average of $5,000 per patient by creating a scaled-down intensive care unit (ICU) called a special care unit (SCU).
The SCU also saved an average of $19,000 for each patient by avoiding additional costs in other care settings, such as home health. Mortality rates on the SCU were reduced 11%, and hospital readmission rates were reduced by 12% without cutting nursing staff, says Kathy Thompson, RN, MSN, head nurse of the SCU at University Hospitals in Cleveland.
The SCU, which opened as part of a research study, was developed because chronically critically ill patients accounted for only 3% of overall admissions but generated 25% of patient days within the traditional ICU, Thompson says.
"The ICU was filling up with long-term ICU patients and preventing surgical and medical patients from being admitted, which created a logjam effect. Plus, there was a lack of continuity in care for these patients, who would often stay as long as 90 to 180 days. Average length of stay now averages 12 days.
"The problem was compounded because we're a teaching hospital and physician residents rotate monthly, and patients would see different physicians," Thompson explains.
Any patient in the ICU can be evaluated for placement in the SCU, which consists of a private room with limited monitoring equipment, such as electrocardiogram monitors, ventilators, and arterial pressure monitors, depending on each patient's needs. Patients who meet hemodynamic stability and mortality stability criteria are transferred to the SCU, Thompson says. Mortality risk is scored using a computer program developed by McLean, VA-based APACHE Medical Systems.
Additional patient criteria for transfer to the SCU includes:
* traditional ICU stay of five days;
* no acute exacerbation within the previous three days;
* no need for vasopressor or pulmonary artery monitoring.
Nurse case managers who staff the six-bed unit rotate every six weeks, Thompson says. One case manager is assigned to the entire unit. "We do this to ease the stress of caring for a patient group that demands a lot of resources and time," she adds.
Patients are monitored through the use of weaning, nutrition, and emergency care protocols developed by a multidisciplinary team, says Thompson. "We originally developed a ventilator-dependent pathway, but found that the patients tended to drop off the path. This is not a good patient group for paths," she explains.
Patient care plans are reviewed daily with an attending physician assigned to the SCU, who becomes the primary physician for patients on the unit. "When a patient is transferred to the SCU, their physician becomes a consultant, and initially some of our physicians were hesitant to refer patients. But after individual conversations with nurses and talking to other physicians, most are supportive of the unit," Thompson explains.
Family members are encouraged to participate in the patient's care through overnight accommodations arranged by the hospital, and unlimited visiting hours. Families also learn how to care for patients long-term so patients who return home aren't readmitted.
The hospital also works with home health agencies and physicians to help families problem-solve at home. Families with ventilator patients, for example, are taught how to look for signs of infection and report those findings to the home health agency, physician, or hospital, Thompson says. *
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