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A new study, the Intensive Care Unit Benchmarks for Success report, published in February by Solucient LLC in Baltimore (formerly HCIA-Sachs), identifies several significant opportunities for hospitals to improve their performance in critical care if they adapt the practices of top performers.
Lee Greenspon, MD, director of the intensive care unit (ICU) at Lankenau Hospital in Wynne-wood, PA, and a pulmonologist and clinical professor at Thomas Jefferson University in Philadelphia, is the first to admit that data are important, and more people in his profession are realizing that. "The Society of Critical Care Medicine is starting to develop benchmarks," he says. "And there are groups throughout the country that are working to collect data so they can create tools that will help predict mortality in the ICU."
Lankenau Hospital, a 300-bed facility, was named one of the 100 Top Hospitals in the study, which looked at DRGs from 1998 and 1999, the most recent years available. The data are derived from the Health Care Financing Administration’s Medicare Provider Analysis and Review and from 800 data elements that Solucient collects from some 6,000 hospitals around the country.
Among the key findings of the study:
• Better outcomes. If all hospitals performed like the 100 Top Hospitals, they could cut mortality rates by more than 20% for post-surgical patients, and 15% for medical patients. Complication rates for post-surgical patients could decline by 19%.
• Lower costs. Total cost of inpatient stays in the ICU could decline by $1.4 billion per year if all hospitals performed at the level of the best hospitals in the study. Ancillary service costs alone would decline by $66 million.
• Shorter stays. Average length of stay (LOS) at the best performing hospitals is 6% less for medical patients and 9% less for surgical patients.
• Lower mortality. Among patients on ventilators alone, deaths could fall by more than 8% if all hospitals performed at the level of the top 100. (See table.)
|Median Values: All Hospitals in Study|
|Performance Measure||Benchmark Hospitals||Peer Group of U.S. Hospitals|| Percent Benchmark
Outperforms Peer Group
|Risk-adjusted complications index for primary procedure group*||0.83||1.02||18.1% lower complications|
|Risk-adjusted mortality index for admission diagnosis group*||0.87||1.01||14.09% lower mortality|
|Risk-adjusted mortality index for primary procedure group*||0.77||1.01||24.13% lower mortality|
|Risk-adjusted mortality index for mechanical ventilation group||0.94||1.02||7.63% lower mortality|
|Adjusted LOS for admission diagnosis group||5.77 days||6.24 days||7.56% shorter LOS|
|Adjusted LOS by primary procedure group||8.06 days||8.98 days||10.28% shorter LOS|
|Adjusted ICU-related ancillary cost per ICU day for admissions diagnosis group||$603||$866||30.39% lower cost|
|Adjusted ICU-related ancillary cost per ICU day for primary procedure group||$631||$815||22.54% lower cost|
|Adjusted ICU-related ancillary cost per ICU day for mechanical ventilation group||$731||$939||22.18% lower cost|
|*Ratings greater than 1.0 exceed national norms; ratings less than 1.0 fall below national norms. Source: Intensive Care Unit Benchmarks for Success: 100 Top Hospitals, Solucient LLC, Baltimore.|
Greenspon says one glaring lack he sees in this and other studies is the way hospitals are lumped together. "You have to be really careful," he says. "I look at some of the hospitals that are on the list with us . . . and I know they aren’t anything like us." But he admits that comparisons are important. "You have to see why something is happening so you can improve."
Overall, Greenspon says his team does an outstanding job. "I think we move patients quickly through our unit and try to minimize LOS, but we have to look at how others like us do. Are we in the right place? I know we are at the low end of the group, but then we have to ask if our LOS is too short. So we look at minimizing returns to the unit." When Greenspon delves further into the report, he’s going to concentrate on looking at the hospitals on the list that are its size, with a residency program, and an emphasis on cardiovascular care. "We do over 1,000 hearts a year. There’s no point in looking at how we compare to a hospital that does 100."
[To find out more about the report, visit the Solucient web site at www.solucient.com.
For more information, contact:
• Lee Greenspon, MD, Director, Intensive Care Unit, Lankenau Hospital, 100 Lancaster Ave., Suite 230, Wynnewood, PA 19096. Telephone: (610) 642-3797.]