Clinical Integration Improves ICU Quality and Costs

Ian Butler

Ian Butler , MD, MBA

Director of Quality and Performance - Critical Care Medicine

Published May 22, 2017

Intensive care units (ICUs) are one of the most important and expensive components of our healthcare system, because they care for a hospital’s sickest patients. Those facing life-threatening illnesses or injuries receive around-the clock specialized care such as mechanical ventilation and cardiac monitoring in the ICU.

Because ICU patients are often admitted through the emergency department (ED) and discharged to the medical-surgical unit, coordinating care between hospital settings is vitally important.

But at many hospitals, the ED, hospital medicine, and the ICU operate in separate silos, with each group setting its own processes and priorities. Without coordination and communication across care settings, patients are at risk for medication errors, delays in treatment, duplicative tests, and conflicting care plans.

However, when these departments are part of one clinically integrated, multispecialty group, hospitals can experience a wealth of benefits.

Elements of Success

As an intensivist, I’m keenly aware that complications sometimes arise during the healing process in the ICU. Our goal, of course, is always to avoid harm.

I know I’ve done my job when I ensure only those patients who truly need critical care are admitted to the ICU. Once there, my colleagues and I make every effort to prevent complications, avoid unnecessary treatments and procedures, and to discharge patients from the ICU as quickly as possible.

What can hospitals do to deliver better, safer intensive care and what are the key performance measurements? The primary success metrics for intensive care include:
  • Reduced mortality
  • Decreased ICU and hospital length of stay
  • Fewer hospital-acquired infections
  • Increased patient satisfaction

In today’s post, I’ll share how Palomar Medical Center elevated intensive care when it integrated critical care medicine with other hospital specialties.

Integrating Intensivists

Vituity has staffed Palomar Health’s ED for decades. Building on that success, the organization began providing hospital medicine services in 2013, which resulted in improvements in hospital length of stay, case mix index, and patient satisfaction scores.

In 2015, Vituity expanded its partnership with Palomar Health and began providing intensivist services to two of its hospitals. Administrators hoped that staffing all three services with a single multispecialty group would help further improve care coordination and efficiency.

The team focused on achieving similar improvements in key intensivist quality, service, and throughput metrics through concerted efforts to improve communication, coordination, and collaboration across the three practice lines.

Almost overnight, Palomar saw dramatic improvements in patient outcomes and safety in the ICU. ICU length of stay dropped by more than 12 percent in the first year that Vituity America’s intensivists began staffing the unit. The hospital also saw immediate decreases in central-line associated blood stream infections, catheter-associated urinary tract infections, and ventilator-associated events.

The financial impact of these quality improvements? The two hospitals have realized a combined savings of several million dollars. What a difference this high level of integration has made for both patients and the hospital!

The Payoff of a Partnership

The beauty of Vituity’s democratic partnership model is that when I pick up the phone to talk with a hospitalist about a patient, I’m talking to a Partner. Our ability to deliver coordinated, high-quality care is rooted in our culture of engagement and collaboration. As Partners, we’re all truly invested in one another’s success.

Other physician management and staffing companies may have some integration capabilities, but most aren’t physician-owned partnerships. Being an employee of a company versus a partner creates a very different culture.

In the end, it is that high level of collaboration, coordination and engagement with colleagues across the hospital that truly elevates patient care. It’s a win-win for everyone.

The ICU-LUV Collaborative

While Vituity has made an impressive impact in the short time that our intensivists have staffed the ICU at Palomar, we’ve got big plans ahead. Vituity has recently created a new position, Director of ICU Quality and Performance, and I’ve stepped into that role. In this capacity, I meet regularly with the medical directors at CEP’s ICU sites to determine what best practices we’ll hold ourselves accountable to as an organization.

Our team is currently preparing to launch a new learning collaborative called the 2017 ICU-LUV collaborative. We have a long history of conducting learning collaboratives at Vituity, bringing together teams from hospitals across the country to work on improvement in a specific area.

The ICU-LUV Collaborative will focus on improvements in three areas:
  • L: Length of stay
  • U: Utilization of devices such as urinary catheters and central lines
  • V: Ventilator days

The collaborative will bring together ICU medical directors and assistant medical directors, ICU nurse managers, and hospitalists and their clinical nurse specialists. We’ll hold monthly webinars throughout the summer and fall to discuss each of these three areas and make plans for implementing best practices.

At the end of the collaborative, each ICU site will develop its own impact report. The report will provide a snapshot of current ICU performance to share with administration and identify areas for improvement. I look forward to sharing the results of the ICU-LUV collaborative later this year on Perspectives.

Achieving meaningful integration isn’t easy. But the payoff of improved patient care and the sharing of best practices across hospitals make it all worthwhile.

To learn more about Vituity’s unique approach to intensive care, visit our website.

Partnering to improve patient lives

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