DOI: 10.1097/01.ccm.0000424373.08227.8d
,
Issn Print: 0090-3493
Publication Date: 2012/12/01
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Abstract
Introduction:Critical care patient-days have increased 60% faster than ICU beds, increasing providers’ workload substantially. Crowded hospitals and multiple patient handovers impinge on efficient patient throughput and waste critical care resources. Up to 20% of ICU discharges are delayed and most of these are because inability of hospital wards to accept these patients. We report the results of a change in the throughput process in our medical intensive care unit (MICU.)
Hypothesis:Changes in throughput will increase MICU bed availability without adversely affecting patient outcomes.
Methods:The implemented change in the MICU discharge process included: a) the MICU team had ultimately triaging authority, deciding the accepting floor service; b) patients were assigned any open hospital bed whenever their respective services lacked immediately available ones, and 3) the MICU team was responsible for writing the discharge orders (instead of the accepting floor team). An internally developed sign out tool was used to facilitate tracking of patient handovers. Outcomes of the project were evaluated by comparing the times from requesting a bed until the bed was assigned (R-A) and from the time the bed was assigned until the patient was placed on the floor bed (A-P). Little’s law was applied to assess the impact of reduced transfer times.
Results:1058 patients were discharged from the MICU between April 1st and August 12th 2012 and were divided in two groups for comparison, 351 before and 707 after the process change. R-A time decreased from 191 ± 222 to 134 ± 168 min (P < 0.01). A-P time was reduced from 257 ± 156 to 183 ± 112 min (P <0.001). Adjusted MICU occupancy decreased over time 93.5, 94.7, 86.3, 91.6, and 84.4%, for April, May, June, July, and August respectively. MICU LOS decreased from 5.5 ± 7.0 to 4.6 ± 6.4 days, P < 0.05. MICU readmissions within 48 hrs. and rapid response team activations remained unchanged during the study period. Applying Little’s law the reduction of MICU transfer time by 2.2 hrs. translates in 76 new admissions/year.
Conclusions:Changes in ICU throughput to facilitate the discharge process from an ICU can result in significant reductions hospital resource-utilization without adversely affecting patient safety.
