1. High-value care in the surgical intensive care unit: effect on ancillary resources.
- Author
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Ko A, Murry JS, Hoang DM, Harada MY, Aquino L, Coffey C, Sax HC, and Alban RF
- Subjects
- California, Checklist, Cost Control, Critical Care economics, Critical Care methods, Education, Medical, Continuing, Education, Nursing, Continuing, Hospital Costs statistics & numerical data, Hospital Mortality, Humans, Intensive Care Units economics, Internship and Residency, Outcome and Process Assessment, Health Care, Quality Improvement economics, Retrospective Studies, Unnecessary Procedures economics, Critical Care organization & administration, Intensive Care Units organization & administration, Quality Improvement organization & administration, Unnecessary Procedures statistics & numerical data
- Abstract
Background: Changes in health care policies have influenced transformations in hospital systems to be cost-efficient while maintaining robust outcomes. This is particularly important in intensive care units where significant resources are used to care for critically ill patients. We sought to determine whether high-value care processes (HVCp) implemented in a surgical intensive care unit (SICU) have an impact on commonly used ancillary tests., Materials and Methods: An implementation phase using a Lean Six Sigma approach was performed in October 2014 at a 24-bed large academic center SICU with aims to decrease orders of excessive daily laboratory tests and X-rays. The HVCp implemented included use of daily checklists, staff education, and visual reminders emphasizing the importance of appropriate laboratory tests and chest X-rays. Preintervention (July 2014-October 2014) and post-intervention (November 2014-June 2015) phases were compared., Results: Average SICU census, case mix index (4.3 versus 4.4, P = 0.57), all patient refined severity of illness (3.2 versus 3.2, P = 0.91), and SICU mortality (7.1% versus 5.1%, P = 0.18) were similar in both phases. A significant reduction of excessive laboratory tests was evident after the implementation period. Eight hundred sixty-five arterial blood gases/mo were obtained in the preintervention phase compared with 420 arterial blood gases/mo after intervention (P = 0.004), representing a 51.4% reduction. Similar results were obtained with complete blood counts, basic metabolic profiles, coagulation profiles, and chest X-rays (12%, 17.8%, 30.2%, and 20.3% reductions, respectively), a total estimated cost savings of $59,137/mo and prevention of excess phlebotomy of approximately 4 L of blood/mo., Conclusions: By implementing an HVCp including a checklist, visual reminders, and provider education, we significantly reduced the use of commonly ordered ancillary tests in the SICU without affecting outcomes, resulting in an annual cost savings of $710,000., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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