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Clinical Performance Improvement Leaders Zero In on ICU Challenges

January 10, 2018
by Mark Hagland
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Two leaders at Premier Inc. share their perspectives on a new study in ICU patient safety

Last month, leaders at the Charlotte, N.C.-based Premier Inc. released a report on the potential for clinical performance improvement in intensive care units (ICUs) in U.S. healthcare. As the health alliance’s Dec. 14 press release noted, Premier leaders had “identified 10 diagnoses with the biggest opportunity to curb variation within the intensive care unit (ICU) and reduce unnecessary length-of-stay. The analysis was published in Premier’s latest Margin of Excellence report, which provides unparalleled, data-driven, evidence-based insights on cost and quality improvement opportunities.”

As Premier executives noted in releasing details from the study, “The Premier report focuses on evidence-based improvement steps in the ICU based on an analysis of 20 million patient discharges across 786 hospitals over a five-year period (2011-2016). According to the analysis, Premier found opportunities to reduce ICU days by 988,111 days overall or nearly 200,000 annually. Overall, patients treated at top-performing hospitals spent 24 percent less time in the ICU. Opportunities were identified by comparing all hospitals in the analysis to peers that utilized the ICU for the same populations in the most efficient manner without compromising quality (metrics examined included inpatient mortality rates and unplanned 30-day readmissions).

Among the study’s findings:

>  Sepsis patients with major complications or comorbidities: Represents 19 percent of the ICU reduction opportunity

> Infectious and parasitic diseases associated with operating room procedures, and major complications or comorbidities: Represents 15 percent of the ICU opportunity

>  Cardiac valve and other major cardiothoracic procedures without cardiac catheterization, but with major complications or comorbidities: Represents 12 percent of the ICU reduction opportunity

>  Coronary bypass without cardiac catheterization, but with major complications or comorbidities: Represents 9.8 percent of the ICU reduction opportunity

>  Respiratory system diagnosis with ventilator support for up to 96 hours: Represents 9.5 percent of the ICU reduction opportunity

> Craniotomy and endovascular intracranial procedures with major complications or comorbidities: Represents 8.9 percent of the ICU reduction opportunity

>  Sepsis patients using a mechanical ventilator >96 hours: Represents 6.8 percent of the ICU reduction opportunity

>  Cardiac valve and other major cardiothoracic procedure with cardiac catheterization and major complications or comorbidities: Represents 6.8 percent of the ICU reduction opportunity

> Cardiac valve and other major cardiothoracic procedure without a cardiac catheterization, but with complications or comorbidities: Represents 6.1 percent of the ICU reduction opportunity

>  Heart failure and shock with major complications or comorbidities: Represents 6 percent of the ICU reduction opportunity

The findings underscore the value of identifying evidence-based improvement opportunities that healthcare leaders are focused on,” Premier executives noted on Dec. 10. “For instance, a recent Premier C-Suite survey found respondents overwhelmingly ranked reducing clinical variation and standardizing the use of products, resources and services as a top cost management priority (96 percent), with more than half ranking it as the top priority when tackling cost inefficiencies. The ICU report can help providers pinpoint areas with the most opportunity to reduce variation.”

Shortly after the release of the study, two Premier executives spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the implications of the study.

Robin Czajka, R.N. is service line vice president in the cost management division at Premier; Cindy Salyer, R.N., is a director in the Premier Performance Partners consulting arm at the alliance. Czajka is based in St. Charles, Ill., while Salyer is based in Kingsport, Tenn. Below are excerpts from that interview.

What led you and your team members to begin looking at this subject area?

Salyer: What really got us started was that hospitals are dealing with EDs that are totally full; they’re holding patients because they can’t find appropriate beds for them. They’re trying to find ways to become more efficient, and to take unnecessary costs out. How many times are patients undergoing unnecessary tests and procedures, just because that’s how it’s done in a particular unit? And we’re looking to decrease the amount of time patients are exposed to those that might cause problems.

How were the percentages and calculations derived?

Salyer: The Premier database is very robust, and we have 3,900 hospitals participating and contributing to that database, to help us determine the best practices, and determine how patients can get out with good outcomes. And the fact that we can tie the outcomes to lengths of stay, is unique to us. And then we wanted to see what percentage of patients went to ICUs or step-down units, and the outcomes, and the costs, coming out of that? Placing patients in areas that meet their hemodynamic needs. So we wanted to drill down to that detailed level, even to the patient level, and to determine what the differences are, and what the factors are driving those differences.

Were either of you surprised at the rankings of areas of risk, as they were revealed in the findings?

Salyer: I actually was not, because I’m in hospitals every day. It really is what we see day in and day out.

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