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CRITICAL CARE: Incidence of sepsis cases 2009 to 2014

Sepsis is a complication of an infection, for example pneumonia, that can lead to death.  Older people are at higher risk of developing sepsis.  This study, based on data from 409 hospitals, had a dual purpose – to determine the incidence rate of sepsis among hospital inpatients and to compare two different data sources.

In 2014, the incidence of sepsis was found to be 6 percent of adult hospitalizations.  Of patients with sepsis, 15 percent died in the hospital with an additional 6 percent discharged to hospice.

Analysis of these incidence and mortality data over time (2009 to 2014) shows that the incidence rate and overall mortality rate (including inhospital and discharge to hospice) have remained about the same.  This finding, based on a study of hospitals’ electronic medical records, differs from other estimates based on claims data.

Sources:

Mayo Clinic Staff. Sepsis.  Click here: http://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214

Rhee, C., Dantes, R., and Epstein, L. (2017, October 3). Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA, 318(13), 1241-1249.  Click here for publisher’s website: https://jamanetwork.com/journals/jama/article-abstract/2654187?widget=personalizedcontent&previousarticle=2654186  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ICUs: Where do patients come from? Data on source of admissions from large-scale Project IMPACT database

Cerner’s Project IMPACT (Improved Methods of Patient Information Access of Core Clinical Tasks) is – or perhaps was – a database to which many different hospitals submitted information about their intensive care unit (ICU) patients.  Although I have not yet been able to confirm this, it appears that the IMPACT database may no longer be in existence, or perhaps not being added to any more.  Researchers have studied this database and published a number of articles in the medical literature based on it.  Let’s take a look at some interesting data from one such article, based on over 250,000 adult (aged 18 or older) ICU patients who were hospitalized in 138 ICUs during the period 2001-2008.

Notes: All of the following statistics are given in the original source to one decimal place – I’ve rounded them off in this blog post.  The following statistics are based on patients who were admitted for the first time to the ICU during a hospitalization.

Where did they come from?  Source of adult ICU admissions:

  • 42 percent from the emergency department
  • 32 percent from the surgical suite
  • 16 percent from general care floor or step-down unit
  •  8 percent from another hospital
  •  3 percent from another location

What kind of adult patient is admitted to ICU?

  • 66 percent medical
  • 22 percent scheduled surgical
  • 12 percent unscheduled surgical

Is the ICU a closed model or an open model?

  • 75 percent open model with optional or no intensivist consult
  • 20 percent open model with mandatory intensivist consult
  •   4 percent closed model

Payer mix for adult ICU patients

  • 50 percent Medicare
  • 30 percent private insurance
  •  9 percent self pay
  •  9 percent Medicaid
  •  3 percent other

Source: Brown, S.E., Ratcliffe, S.J., and others. (2014, Aug.) An empirical comparison of key statistical attributes among potential ICU quality indicators. Critical Care Medicine, 42(8), 1821-1831. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212919/pdf/nihms635834.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org  Note: The link takes you to a free full text “author manuscript,” which is what I used to provide the data noted above.  It was later published in the journal Critical Care Medicine, as noted in the citation.

Utilization of Intensive Care Services

In 2011, 27% of hospitals stays included intensive care unit charges, and the ICU charges accounted for nearly half [48%] of total hospital charges. Critical care costs have been rising for years. Between 2002 and 2009, critical care stays grew 3 times faster than the rate of hospital stays and without any increase in illness severity. The reason for the greater ICU utilization is unclear, according to a new AHRQ report, but it’s likely to get more attention because of the costs involved.

The report is based on an analysis of adult ICU utilization in general medical and surgical hospitals in 29 states in 2011. Here are other highlights from the study:

  • Hospital stays involving ICU care were 2.5 times more costly than other hospital stays.
  • The highest rate of ICU use — over 93% — was for respiratory disease with ventilator support.
  • Cardiac, respiratory, and neurologic conditions dominated types of stays with high ICU use.
  • Major complications or co-morbidities were associated with greater use of ICUs.
  • Greater ICU use was correlated with larger hospitals, large urban areas, for-profit hospitals, teaching hospitals, and hospitals with level I or II trauma centers.

Source: Barret ML and others. Utilization of intensive care services, 2011. HCUP Statistical Brief [Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project], no. 185, Dec. 2014. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb185-Hospital-Intensive-Care-Units-2011.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ICUs: Are we making the best use of critical care?

Critical care costs the nation about $80 billion per year.  Observers predict a coming shortage of intensive care unit beds and of intensivists.  In this commentary, the authors draw upon the findings of their study of over 100,000 non-surgical patients admitted to 121 Veterans Affairs (VA) hospitals in FY2009.  They found, not surprisingly, that sicker patients tended to be admitted to ICUs.  But this held true for noncardiac patients; for cardiac patients, severity of illness was not strongly related to CCU admission decisions.   The authors conclude that there are factors other than severity of illness that also guide the use of critical care — such as peace of mind, staffing issues, bed availability.  The VA has developed an ICU severity score, which has proved to be a reliable predictor of a patient’s risk of death within 30 days of admission.  Routine incorporation of this tool at patient admission to the hospital is suggested as a way to help plan the overall care process and address the appropriate use of ICU resources.

Source: Chen, L.M., and others.  Use of health IT for higher-value critical care.  The New England Journal of Medicine;368(7):594-597, Feb. 14, 2013.  Click here for full text: http://www.nejm.org/doi/pdf/10.1056/NEJMp1213273  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

PATIENT ROOM DESIGN: Tips on acuity-adaptable units

Representatives from six hospitals that operate acuity-adaptable units were interviewed about how these units were implemented.  The hospitals included three academic medical centers, one heart hospital, and two community hospitals.  Cardiology was identified as the type of unit best suited to the acuity-adaptable unit concept because of the relatively predictable nature of the patient care needs.  Managers who are implementing new acuity-adaptable units must pay careful attention to organizational culture issues.  This is a lengthy scholarly article with lots of pragmatic tips.

Source: Zimring, C., and Seo, H-B.  Making acuity-adaptable units work: lessons from the field.  HERD. Health Environments Research & Design Journal;5(3):115-128, Spring 2012.  Click here to view the publisher’s website: http://www.herdjournal.com/ME2/Default.asp  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Overflow policy: ok to put your MICU patients in CCU

Jacobi Medical Center (Bronx, NY) is a large teaching hospital that established a policy of admitting critically ill patients to the coronary care unit when no bed is available in the medical ICU.  In this study of about 1100 patients over a four-year period, no higher mortality or longer length of stay was found.  The authors conclude that it is a safe practice.

Source:  Sidlow, R., and, Aggarwal, V.  “The MICU is full”: one hospital’s experience with an overflow triage policy.  The Joint Commission Journal on Quality and Patient Safety;37(10):456-460, Oct. 2011.  Click here for more information: http://www.ingentaconnect.com/content/jcaho/jcjqs/latest Posted by AHA Resource Center, (312) 422-2050, rc@aha.org