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These 10 procedures hurt your bottom line by causing longer hospital stays

Best practices are emerging that healthcare organizations can use to optimize care and reduce ICU utilization that results from the procedures.

Beth Jones Sanborn, Managing Editor

New research by Premier Inc. has pinpointed 10 diagnoses that spawn the most care variation within the ICU as well as unnecessary extensions in hospital stays. Cardiac procedures and sepsis top the list.

The bottom line, when patient care improves, everyone wins -- which is why these findings should be compelling to finance and operations executives looking to save money, widen margins and improve quality.

[Also: The 5 lowest-value care services and what providers can do about them]

When patients aren't staying extra days in the ICU, or the hospital in general, that often positively impacts the patient experience and improves satisfaction, as well as opens up beds sooner to treat more patients. Reductions in complications, hospital-acquired infections and readmissions improves a hospital's safety, which can often affect public ratings and rankings as well as helps reduce or avoid government penalties.

Premier compared all hospitals in the analysis to peers that utilized the ICU for the same populations in a more efficient manner to pinpoint opportunities for reducing ICU utilization, based on metrics including inpatient mortality rates and unplanned 30-day readmissions.

[Also: Some doctors are now scaling back on low-value care to save in costs]

Here they are followed by percent of ICU reduction opportunity:

1. Sepsis patients with major complications or comorbidities: 19 percent
2. Infectious and parasitic diseases associated with operating room procedures, and major complications or comorbidities: 15 percent
3. Cardiac valve and other major cardiothoracic procedures without cardiac catheterization, but with major complications or comorbidities: 12 percent
4. Coronary bypass without cardiac catheterization, but with major complications or comorbidities: 9.8 percent
5. Respiratory system diagnosis with ventilator support for up to 96 hours: (9.5 percent)
6. Craniotomy and endovascular intracranial procedures with major complications or comorbidities: 8.9 percent
7. Sepsis patients using a mechanical ventilator >96 hours: 6.8 percent
8. Cardiac valve and other major cardiothoracic procedure with cardiac catheterization and major complications or comorbidities: 6.8 percent
9. Cardiac valve and other major cardiothoracic procedure without a cardiac catheterization, but with complications or comorbidities: 6.1 percent
10. Heart failure and shock with major complications or comorbidities: 6 percent

The analysis was published in Premier's latest Margin of Excellence report, and is based on an analysis of 20 million patient discharges across 786 hospitals in 45 states over a five-year period from 2011-2016.

[Also: Low-value health services fuel $586 million in wasteful spending, Health Affairs study says]

The researchers also determined that Patients treated at top-performing hospitals spent 24 percent less time in the ICU, and Premier highlighted opportunities to reduce ICU days by 988,111 days overall or nearly 200,000 annually.

But Premier found that providers involved in the analysis have made strides in optimizing care, highlighting a 13 percent decrease in patient days spent in the ICU across the top 10 diagnoses over the five year period.

Some of the key best practices that fueled the improvement include: using evidence-based practices performed collectively to tackle healthcare-associated infections and delirium;
implementing "intermediate care settings" to help smoothly transition patients to other units when they no longer require ICU-level care; using checklists to monitor patient progress and goals; and a putting together a multidisciplinary care team collaboration with physicians, nurses, pharmacists, residents and other ICU staff.

"Focusing on unnecessary ICU days has the potential to improve patient outcomes, reduce payment penalties, create additional bed capacity, decrease patient holding time within the emergency department, optimize workflow and increase patient satisfaction - all while reducing cost pressures and creating additional savings. As we continue on this journey, data is fueling this initiative to understand our performance and ability to improve ICU and critical care delivery," said Pinckney McIlwain, chief medical officer of Charleston Area Medical Center in West Virginia. CAMC is a member health systems with Premier.

Twitter: @BethJSanborn
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