Featured Research

from universities, journals, and other organizations

When ICUs get busy, doctors triage patients more efficiently

Date:
September 30, 2013
Source:
Perelman School of Medicine at the University of Pennsylvania
Summary:
A new study has found that busy intensive care units (ICUs) discharge patients more quickly than they otherwise would, and do so without adversely affecting patient outcomes – suggesting that low-value extensions of ICU stays are minimized during times of increased ICU capacity strain.

When ICU providers are not busy they are more likely to keep patients in the ICU for longer than necessary -- providing low-value critical care services.
Credit: beerkoff / Fotolia

A new study by Penn Medicine researchers published Oct. 1 in the Annals of Internal Medicine found that busy intensive care units (ICUs) discharge patients more quickly than they otherwise would and do so without adversely affecting patient outcomes -- suggesting that low-value extensions of ICU stays are minimized during times of increased ICU capacity strain.

An expected growth in the number of patients requiring critical care resources combined with a projected shortage in critical care providers will likely result in ICUs operating under conditions of increasing strain, leading to increased competition for ICU beds among greater numbers of more seriously ill patients. Many fear that this strain on an ICU's capacity to provide high quality care will result in patients spending shorter periods of time in the ICU and therefore experiencing worse health outcomes due to "rationing" of necessary critical care.

However, the new study, led by Jason Wagner, MD, MSHP, a senior fellow in the Division of Pulmonary, Allergy and Critical Care at the Perelman School of Medicine at the University of Pennsylvania, helps dispel the notion that resource-strained ICUs will ration critical care resources and negatively affect patient care, with findings that have important implications for planning U.S. critical care capacity. If bed crunches in the ICU cause reductions in the delivery of low-value ICU care for patients nearing ICU discharge without adversely affecting patients, it is conceivable that reductions in the number of U.S. ICU beds could yield considerable cost savings without reducing the quality of care.

In a retrospective analysis of over 200,000 patients from 155 ICUs in the United States between 2001 and 2008, the authors found that when ICUs were at their busiest, patients were discharged an estimated 6.3 hours sooner than they otherwise would be. Nonetheless, such patients experienced no increase in the odds of dying in the hospital, no greater overall length of hospital stay, and no decrease in the odds of ultimately going home. ICU capacity was measured by ICU census, number of new admissions, and the average acuity of the other patients in the ICU at the time of a patient's discharge.

"Many believe there will be a break at the intersection of the growing demand and our ability to supply high-value critical care. So we asked the question: When busy, do critical care providers discharge patients quicker than they otherwise would and does it result in negative consequences such as rationing critical care resources or promoting breakdowns in the quality of patient handoffs among providers?" said Dr. Wagner. "We found that patients are discharged earlier but are no worse off -- which suggests that in a strained-resource setting, doctors are more efficiently discharging patients into the appropriate next step of care. This rightfully frees up critical care providers and beds for any potential incoming patients."

Said differently, when ICU providers are not busy they are more likely to keep patients in the ICU for longer than necessary -- providing low-value critical care services.

Together, these results suggest, the authors write, that rather than causing the rationing of beneficial care, strain spurs providers to reduce their provision of what seems to be low-value care by critically re-examining a patient's need for ICU-level care and transferring patients who could be equally well-managed outside the ICU. Avoiding waste, the authors also point out, serves the interest of individual patients and society simultaneously.

"Although the reductions in ICU length of stay during times of strain were modest, focusing efforts on achieving similar reductions in ICU length of stay for majority of patients admitted to the nearly 100,000 ICU beds in the United States could reduce the overall use of critical care in the country," said Dr. Wagner. "Rather than reflexively moving towards the higher cost approach of adding more ICU beds, perhaps more effort should be focused on increasing the efficiency with which we provide critical care services with our existing resources."


Story Source:

The above story is based on materials provided by Perelman School of Medicine at the University of Pennsylvania. Note: Materials may be edited for content and length.


Journal Reference:

  1. Jason Wagner. Outcomes Among Patients Discharged From Busy Intensive Care Units. Annals of Internal Medicine, 2013; 159 (7): 447 DOI: 10.7326/0003-4819-159-7-201310010-00004

Cite This Page:

Perelman School of Medicine at the University of Pennsylvania. "When ICUs get busy, doctors triage patients more efficiently." ScienceDaily. ScienceDaily, 30 September 2013. <www.sciencedaily.com/releases/2013/09/130930200035.htm>.
Perelman School of Medicine at the University of Pennsylvania. (2013, September 30). When ICUs get busy, doctors triage patients more efficiently. ScienceDaily. Retrieved April 23, 2014 from www.sciencedaily.com/releases/2013/09/130930200035.htm
Perelman School of Medicine at the University of Pennsylvania. "When ICUs get busy, doctors triage patients more efficiently." ScienceDaily. www.sciencedaily.com/releases/2013/09/130930200035.htm (accessed April 23, 2014).

Share This



More Health & Medicine News

Wednesday, April 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Big Pharma Braces for M&A Wave

Big Pharma Braces for M&A Wave

Reuters - Business Video Online (Apr. 22, 2014) Big pharma on the move as Novartis boss, Joe Jimenez, tells Reuters about plans to transform his company via an asset exchange with GSK, and Astra Zeneca shares surge on speculation that Pfizer is looking for a takeover. Joanna Partridge reports. Video provided by Reuters
Powered by NewsLook.com
Study Says Most Crime Not Linked To Mental Illness

Study Says Most Crime Not Linked To Mental Illness

Newsy (Apr. 22, 2014) A new study finds most crimes committed by people with mental illness are not caused by symptoms of their illness or disorder. Video provided by Newsy
Powered by NewsLook.com
Hagel Gets Preview of New High-Tech Projects

Hagel Gets Preview of New High-Tech Projects

AP (Apr. 22, 2014) Defense Secretary Chuck Hagel is given hands-on demonstrations Tuesday of some of the newest research from DARPA _ the military's Defense Advanced Research Projects Agency program. (April 22) Video provided by AP
Powered by NewsLook.com
How Smaller Plates And Cutlery Could Make You Feel Fuller

How Smaller Plates And Cutlery Could Make You Feel Fuller

Newsy (Apr. 22, 2014) NBC's "Today" conducted an experiment to see if changing the size of plates and utensils affects the amount individuals eat. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

    Health News

    Environment News

    Technology News



    Save/Print:
    Share:

    Free Subscriptions


    Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

    Get Social & Mobile


    Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

    Have Feedback?


    Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
    Mobile: iPhone Android Web
    Follow: Facebook Twitter Google+
    Subscribe: RSS Feeds Email Newsletters
    Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins