Dr. Indu - Intensive Care Unit Utilization

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ICU

RESOURCES

ICU resources are those resources thatprovide intensive care to critically ill,

injured, physiologically unstable, or

potentially unstable patients. Although

referred to as ICU beds, they include

not only the beds but also the fullcomplement of professional staff and

capacities for physiological monitoring

and invasive diagnostic and therapeutic

interventions.


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INTRODUCTION

Research on Intensive Care Unit (ICU)outcomes provides valuable inputs indeveloping more improved models forpatient-centered outcomes, more robustpredictions of resource use, better

individual outcome prediction, andalternative outcome predictions underdifferent treatment paradigms .

Among the studies examining strategiesto improve quality and reduce costs bychanging the way care is provided to

critically ill patients, attention hasrecently focused on assessing patientswith a prolonged length of stay (LOS) inthe ICU.


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Prolonged ICU stay can adversely affect the health status by

increasing the risk of infection, complications, and possibly ,

mortality.

Operationally, it impacts upon ICU bed availability and results

in cancellation of elective surgeries, leading to long waiting

times. The lead-time, defined as the time spent on the ward

before ICU admission, is also prolonged, a factor known to

affect patient outcome.

There is a need for optimizing an efficient distribution and use

of ICU resources.


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There are many measures to assess ICU resource utilization.A

simple and readily available measure is ICU LOS.

Another measure is the duration of mechanical ventilation, as

this is one of the most common procedures in the ICU.


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To calculate the average length of stay and mechanical

ventilation days to identify their impact on ICU utilization.

And to study the average length of stay of patients admitted in

intensive care unit for benchmarking.


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Study population and setting

Paras hospital is a 250-bedmulti super specialty tertiarycare hospital in Gurgaon,Haryana, India. Its 40-bedICU (MICU, NSICU, SICU,

CCU and HDU) is staffedwith full time intensivists,senior and junior consultantsand highly experiencednursing staff. The hospital

has a separate NICU andCTVS; the patients admittedto these units are notincluded in the study.


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This study includes all the consecutive admissions in this ICU

in the month of May 2010. Data analyzed includes the patient

length of stay in ICU and mechanical ventilator days. Average

length of stay is calculated as the ratio of total discharge days

to the total discharges (including deaths and transfers). TheLOS is considered prolonged if exceeds 14 days.


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NSICU

92.69%

7.31%

short stay

long stay 53.97%

46.03%

Pateint days

of short stay

pateints

Pateint days

of prolonged

stay patients


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43%

57%

NSICU

Mechanical ventilation

days ofshort stay patients


days of Long stay patients


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SICU

The average length of stay of

a patient in SICU is 6.37 days.


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SICU

86.04%

13.95%

short stay

long stay

47.82%52.18%

Pateint days

of short stay

pateints

Pateint days

of prolonged

stay patients


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42.57%

57.14%

SICU

Mechanical ventilationdays ofshort stay patients


days of Long stay patients


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MICU

98.80%

1.20%

short stay

long stay

94.15%

5.85%

Pateint days

of short stay

pateints

Pateint days

of prolonged

stay patients


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91.81%

8.91%

MICU

Mechanical ventilation days

ofshort stay patients

Mechanical ventilation days

of Long stay patients


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The average length of stay of a patient in CCU is 1.23 days.

No patient was on mechanical ventilator and on prolonged

stay.

The average length of stay of a patient in HDU is 1.59 days.

No patient was on mechanical ventilator and on prolonged

stay.


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1 1 1 1 1

5.82 6.093.08

1.23 1.59

50

39

15

7 6

0

10

20

30

40

50

60

NSICU SICU MICU CCU HDU

LENGTHOF STAY

ICU

Comparison between different intensive care units.

MIN

AVERAGE

MAX


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-5

0

5

10

15

20

25

30

0 10 20 30 40 50 60

Duration

of mechanical

ventilation days

ICU LOS

Correlation between ICU's mechanical ventilation days and

LOS


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This shows that these patients consume a significant

proportion of ICU resources specially the ones in NSICU and

SICU. If the length of stay of such prolonged stay patients in

NSICU is reduced by 50%, then there will be 23% decrease in

the average length of stay resulting in 4.48 days.

Similarly, if the length of stay of such patients in SICU is

reduced by 50 percent, then there will be 26% decrease in the

average length of stay resulting in 4.69 days.


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ICU patients are a heterogeneous group with severe

illness, multiple system dysfunctions, and multiple coexistingmedical problems.

A systematic evaluation of LOS information provides

information of practical and operational significance that is

essential for strategic planning.


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In the present study, prospective collection and analysis of dataon ICU LOS and mechanical ventilator days, helped inidentifying that prolonged stay patients consume a significantproportion of ICU resources and there is a need to identify the

ways by which ICU resources can be fairly utilized, the factorswhich affect the ICU length of stay and the predictors of theprolonged ICU stay, which can be used in targeting this groupto further improve resource utilization and efficiency of ICUcare.

Such systematic and well planned studies can provide valuableinputs for providing quality care for more patients throughbetter targeted and more effective services.


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The average length of stay in NSICU is 5.82 days, 6.37 days in

SICU,3.08 days in MICU,1.23 days in CCU, and 1.59 days in

HDU which is very less and can be established as a

benchmark .

But, to meet the international standards, the ALOS of NSICU

and SICU needs to be further reduced.


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The reduction in the length of stay will have a major impact in

the following ways:-

Operational: - more patients can be admitted and cared in the

ICU with available resources; lead time for admission in the

ICU can be reduced.

Qualitative: - this will ensure a more optimal utilization of

scarce resources for providing quality care to the ICU patients

really in need of it.

Financial: - decrease in ICU LOS will reduce the cost per

patient in the ICU.


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References and Bibliography

Sakharkar, B M; Hospital Administration & planning 2nd edition, New Delhi, Jaypee Brothers MedicalPublishers (P) Ltd, 2009.

Kunders, G D; Hospital Planning Design & Management11th edition, New Delhi, Tata McGraw-HillPublishing Company Limited, 2009.

www.parashospitals.com

Arabi Yaseen,Venkatesh S,Haddad Samir,Al Shimemri Abdullah and Al Malik Salim. A prospectivestudy of prolonged stay in the intensive care unit: predictors and impact on resourceutilization,International journal for quality in health care, 2002; 14:403-410.

Rao,S.Manimala; Suhasini T. Organization of intensive care unit and predicting outcome of critical illness.Indian J. Anaesth. 2003; 47 (5): 328-337.

Wong DT, Gomez M, McGuire GP, Kavanagh B. Utilization of intensive care unit days in a Canadianmedical-surgical intensive care unit. Crit Care Med1999; 27: 13191324.

Quality indicators for ICU; Indian Society of Critical Care Medicine 2009.


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Dr. Indu - Intensive Care Unit Utilization

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