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Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays.
JAMA Surg 2017; 152(11):1015-1022JS

Abstract

Importance

High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care.

Objective

To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays.

Design, Setting, and Participants

This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital. The preintervention phase occurred from April 6 through June 21, 2015; after implementation of targeted interventions, the postintervention phase occurred from April 4 through June 28, 2016. Data collected included demographic characteristics, reason for admission, and length of stay. All patients admitted to the SICU during the preintervention and postintervention phases were included in the analysis.

Interventions

Based on results collected in the preintervention phase, targeted interventions were designed and implemented from July 1, 2015, through March 31, 2016, including (1) reducing SICU care for minor traumatic brain injury, (2) optimizing postoperative airway management, (3) enhancing communication between services regarding transfers to the SICU, (4) identifying and facilitating more timely end-of-life conversations and supportive care consultations, and (5) encouraging early disposition of patients to floor beds.

Main Outcomes and Measures

Changes in the proportion of potentially avoidable SICU days owing to potentially avoidable admissions and/or disposition delays.

Results

A total of 459 patients (253 men [55.1%] and 206 women [44.9%]; median age, 62 years [interquartile range, 46-75 years]) were admitted during the preintervention and postintervention phases. Of 261 patients admitted during the preintervention period and 245 during the postintervention period, median SICU and hospital length of stay remained unchanged. A reduction was noted in the percentage of postintervention SICU days owing to potentially avoidable admissions (152 of 1168 days [13%] vs 118 of 1338 days [8.8%]; P = .001) and disposition delays (138 of 1168 days [11.8%] vs 97 of 1338 days [7.2%]; P < .001). During the postintervention period, decreases were noted in the SICU days related to the most common sources of potentially avoidable admissions (SICU stay ≤24 hours, airway concerns, and somnolence) and disposition delays (end-of-life decisions and floor bed unavailable) as well as in the overall rate of potentially avoidable days (269 of 1168 days [23%] vs 205 of 1338 days [15.3%]; P < .001).

Conclusions and Relevance

Nearly one-fourth of SICU days could be categorized as potentially avoidable. Targeted interventions resulted in a significant reduction of potentially avoidable SICU days.

Authors+Show Affiliations

Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.Human-Centered Design Team, Cedars-Sinai Medical Center, Los Angeles, California.Human-Centered Design Team, Cedars-Sinai Medical Center, Los Angeles, California.Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28724143

Citation

Dhillon, Navpreet K., et al. "Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays." JAMA Surgery, vol. 152, no. 11, 2017, pp. 1015-1022.
Dhillon NK, Ko A, Smith EJT, et al. Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays. JAMA Surg. 2017;152(11):1015-1022.
Dhillon, N. K., Ko, A., Smith, E. J. T., Kharabi, M., Castongia, J., Nurok, M., ... Ley, E. J. (2017). Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays. JAMA Surgery, 152(11), pp. 1015-1022. doi:10.1001/jamasurg.2017.2165.
Dhillon NK, et al. Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays. JAMA Surg. 2017 Nov 1;152(11):1015-1022. PubMed PMID: 28724143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays. AU - Dhillon,Navpreet K, AU - Ko,Ara, AU - Smith,Eric J T, AU - Kharabi,Mayumi, AU - Castongia,Joseph, AU - Nurok,Michael, AU - Gewertz,Bruce L, AU - Ley,Eric J, PY - 2017/7/21/pubmed PY - 2017/11/29/medline PY - 2017/7/21/entrez SP - 1015 EP - 1022 JF - JAMA surgery JO - JAMA Surg VL - 152 IS - 11 N2 - Importance: High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care. Objective: To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays. Design, Setting, and Participants: This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital. The preintervention phase occurred from April 6 through June 21, 2015; after implementation of targeted interventions, the postintervention phase occurred from April 4 through June 28, 2016. Data collected included demographic characteristics, reason for admission, and length of stay. All patients admitted to the SICU during the preintervention and postintervention phases were included in the analysis. Interventions: Based on results collected in the preintervention phase, targeted interventions were designed and implemented from July 1, 2015, through March 31, 2016, including (1) reducing SICU care for minor traumatic brain injury, (2) optimizing postoperative airway management, (3) enhancing communication between services regarding transfers to the SICU, (4) identifying and facilitating more timely end-of-life conversations and supportive care consultations, and (5) encouraging early disposition of patients to floor beds. Main Outcomes and Measures: Changes in the proportion of potentially avoidable SICU days owing to potentially avoidable admissions and/or disposition delays. Results: A total of 459 patients (253 men [55.1%] and 206 women [44.9%]; median age, 62 years [interquartile range, 46-75 years]) were admitted during the preintervention and postintervention phases. Of 261 patients admitted during the preintervention period and 245 during the postintervention period, median SICU and hospital length of stay remained unchanged. A reduction was noted in the percentage of postintervention SICU days owing to potentially avoidable admissions (152 of 1168 days [13%] vs 118 of 1338 days [8.8%]; P = .001) and disposition delays (138 of 1168 days [11.8%] vs 97 of 1338 days [7.2%]; P < .001). During the postintervention period, decreases were noted in the SICU days related to the most common sources of potentially avoidable admissions (SICU stay ≤24 hours, airway concerns, and somnolence) and disposition delays (end-of-life decisions and floor bed unavailable) as well as in the overall rate of potentially avoidable days (269 of 1168 days [23%] vs 205 of 1338 days [15.3%]; P < .001). Conclusions and Relevance: Nearly one-fourth of SICU days could be categorized as potentially avoidable. Targeted interventions resulted in a significant reduction of potentially avoidable SICU days. SN - 2168-6262 UR - https://www.unboundmedicine.com/medline/citation/28724143/Potentially_Avoidable_Surgical_Intensive_Care_Unit_Admissions_and_Disposition_Delays_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2017.2165 DB - PRIME DP - Unbound Medicine ER -