By: Dr. Tom Sequist
This is the first in an ongoing series by our Quality, Safety & Value team highlighting Partners HealthCare’s efforts to develop and implement best practices across our network of hospitals to improve the quality of care patients receive while reducing costs.
At Partners HealthCare, we’re investing in system-wide clinical teams to improve care and reduce costs. One of those teams, the Partners Critical Care Collaborative, shares best practices with all our hospitals to improve patient care and outcomes in our hospital intensive care units (ICU).
One challenge that patients frequently experience in an ICU is delirium, which is a rapid change in consciousness and brain function. And patients in an ICU with mechanical ventilation, or assisted breathing, can also acquire mental or physical weakness as a result of their care. Both delirium and ICU-related weakness increase the chance of staying in the hospital longer and can lead to negative outcomes such as reduced mental or physical function, or increased mortality.
The cost to society is enormous. Caring for delirious, mechanically-ventilated patients in the United States can cost anywhere from $6.5 to $20.4 billion a year, according to research published in Critical Care Nurse.
The cost to patients is even more troubling. Patients with delirium can have lifelong reduced mental or physical function, increased likelihood of going to a nursing home, difficulty maintaining social relationships, and delays in returning to work. Patients with ICU-related weakness can have muscle problems up to one year after their illness.
How Partners ICU Best Practices Help Patients Get Back on Their Feet
Fortunately, there are ways to decrease the risks of delirium and mechanical ventilation. At Newton-Wellesley Hospital (NWH), a 21-year-old male college student admitted to the ICU for severe pneumonia required mechanical ventilation. Typically, patients in his condition are heavily sedated and kept in bed, which can lead to worsening health.
However, following ICU best practices, NWH decreased sedation early. This decreased delirium and allowed the patient to communicate sooner with family and caregivers. On the second day in the ICU, the care team got the patient up and walking around, restoring mobility earlier than usual and improving oxygen levels. After three days the student was breathing on his own, and after seven days he went home without any negative long-term effects.
By promoting early mobility and decreasing sedation, the patient was out of the ICU sooner and had few long-term complications of ICU care.
How to Tackle This Challenge Across the Partners System
The Partners Critical Care Collaborative has been meeting since 2011 and includes doctors and nurses from every hospital in the Partners system. The team meets to share experiences, brainstorm solutions, and learn from one another. In 2013 the Collaborative began discussing practices known to reduce delirium and ICU-related weaknesses.
After two years, hospitals are reporting improvements in care for our patients as well as important reductions in cost. For example:
- At Massachusetts General Hospital the Collaborate to Extubate project decreased ventilator days for our patients and saved the system over $300,000.
- At NWH the Rise and Shine campaign helped reduce average mechanical ventilator days per each patient by 4.2 days, allowed 60 percent of our patients to achieve early mobility, and decreased our patients’ length of stay in the ICU by 4 days, resulting in savings to the system of $1.5 million.
- Early efforts at North Shore Medical Center got 81 percent of eligible patients out of bed early to decrease both delirium and ICU-related weakness.
In the future, the Collaborative will continue to work with the Quality, Safety and Value team to roll out best practices to more ICUs and will close the loop with patients by asking them how they are doing after leaving the hospital.
By coordinating the work of our clinical teams across our system, Partners can discover and share new ways to deliver the highest quality for all of our patients while lowering the cost. Improving ICU stays is just the beginning. Check back in the weeks to come to see other ways we’re implementing innovative approaches throughout the continuum of care.