Reducing patient stay time in the ICU
Long stays in the intensive care unit (ICU) are associated with burdens on patient support networks as well as higher care costs. Consequently, long ICU stays in turn affect hospitals, healthcare providers, patients, families, and society. Research indicates that there are various institutional, medical, psychological, and social factors that increase stay times in the ICU. Understanding these factors can help healthcare teams implement several interventions to reduce stay time.
ICUs vary greatly in geographic location, leadership, organizational structure, and resources. Each of these traits might affect the average length of stay patients experience. Overall, however, the research points to several notable trends.
First, more resources and greater numbers of physicians(1) can lead to longer stays and more utilization of the ICU. Second, patients with lower risk of mortality are more likely to be admitted to the ICU in the U.S. than in either Canada or Japan, perhaps due to differences in practice culture(1,6). This is the primary reason that ICU use and stay time is notably different in the U.S. compared to countries such as Canada and Japan(1). It is also related to the decreased emphasis on efficiency found in the U.S. system, with its greater number of doctors and level of resources(1,6). The average length of ICU stay is shorter in major teaching hospitals than in minor teaching and non-teaching hospitals. This is, again, principally due to availability of resources.
On the other hand, the presence of full-time ICU physicians who do daily rounds can reduce stay time and complications after high-risk procedures. Staffing ICUs with doctors specially trained in critical care medicine(2) may help conserve resources, prevent complications and inappropriate transfer to ICU, and maximizes the chances of recognizing opportunities for earlier discharge. ICU physicians who are present daily also may have a better rapport with patient families and a stronger understanding of the cases.
Institutional takeaways: An emphasis on careful review and resistance to needless ICU admissions can be successful in lowering average stay times and costs; the continuity of daily rounds and special knowledge of critical care training can also be effective.
Length of stay is related to specific medical interventions and clinical laboratory values in several different ways. First and most obviously, the severity and kind of patient illness directly affect ICU stay time and are often among the most important factors. However, beyond that obvious point, there are other trends to attend to.
Post-surgical patients are less likely to experience prolonged ICU stays and fatal results than are patients admitted for other reasons(1). However, patients admitted to the ICU after emergency surgery are more likely to have a long ICU stay than are elective surgery patients(1). Substance abuse is considered to be an exacerbating factor associated with increased ICU stay time(1).
In contrast, DNR orders and advanced directives are associated with shorter stays in ICU(1). Additionally, ICU patients admitted for respiratory failure who received mobility therapy within 48 hours of insertion of their breathing tube enjoyed a reduction in their ICU stay of more than one day(4) on average.
Medical takeaways: Reducing certain variables may reduce ICU time; areas to improve and control may include infection risk management and the provision of physical therapy for respiratory failure patients within 48 hours of breathing tube insertion.
Other Techniques to Help Reduce ICU Length of Stay
Training staff in critical care and mental health may also help clinicians recognize ICU delirium and to successfully communicate with traumatized family members. This training also may help staff to implement proper protocols to manage such issues, which can affect the length of stay(5). Finally, social strategies may include the deployment of ICU team members such as social workers who are trained in communication skills and outreach(1).
Consistent attention to ICU best practices may help facilities to both reduce patient stay time and improve patient outcomes—and that’s better for everyone.
- http://ajcc.aacnjournals.org/content/15/5/502.full Factors Influencing Length of Stay in the Intensive Care Unit
- https://jamanetwork.com/journals/jama/fullarticle/195449 Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review
- https://journal.chestnet.org/article/S0012-3692(16)35463-0/abstract A Cross-Cultural Comparison of Critical Care Delivery