Report: Cardiac procedures have high variability in ICU lengths of stay

A healthcare improvement company has released a report detailing how hospitals can reduce length-of-stay in intensive care units (ICUs), with cardiac procedures presenting the biggest opportunity for trimming inefficiencies.

Premier’s Margin of Excellence report used an analysis of 20 million patient discharges from 786 hospitals from 2011 to 2016. Researchers found if all hospitals performed at the level of the top-quartile centers, nearly 200,000 ICU days could have been avoided each year. Patients at top-performing hospitals spent 24 percent less time in the ICU, and those hospitals didn’t compromise quality metrics such as inpatient mortality rates and unplanned 30-day readmissions, according to a press release.

Cardiac procedures alone accounted for approximately 400,000 of the 988,000 ICU days that could have been reduced over the entire study period. The following ICU diagnoses—all accompanied by major complications or comorbidities—were associated with high variation in length of stay:

• Sepsis patients represent 19 percent of the ICU reduction opportunity.
• Cardiac valve and other major cardiothoracic procedures without cardiac catheterization, 12 percent of ICU reduction opportunity.
• Coronary bypass without cardiac catheterization, 9.8 percent of reduction opportunity.
• Craniotomy and endovascular intracranial procedures, 8.9 percent of reduction opportunity.
• Cardiac valve and other major cardiothoracic procedures with cardiac catheterization, 6.8 percent of reduction opportunity.
• Heart failure and shock, 6 percent of reduction opportunity.

“Spending too much time in the ICU can negatively impact patients and the bottom line, particularly in this era of value-based care payment models,” Robin Czajka, RN, service line vice president of cost management at Premier, said in the release. “Decisions around admitting patients to the ICU and how they are treated can often be subjective calls, rather than guided by evidence.

“While ICU optimization is no easy task, robust data and analytics can help unveil opportunities to improve care delivery and quality within this setting—ranging from identifying diagnoses with the greatest variation in outcomes to monitoring patients who no longer need ICU-level care within newly-created intermediate care settings.”

According to the report, hospitals are already improving in this area. The fifth year of the study showed a 13 percent decrease compared to the first year in ICU days related to the top 10 diagnoses. The researchers attributed the decline to multidisciplinary collaboration, evidence-based practices to reduce hospital-acquired infections and delirium and intermediate care settings for transitioning patients out of the ICU.