ICU Avoidance: Lowering Costs, Patient Risk, and LOS

A stay in the intensive care unit (ICU) is both costly and risky. In a sobering example of the latter, nearly one third of patients admitted to the ICU experience delirium, a state of cognitive impairment that can increase risk of death in the hospital. Still, many cardiovascular patients need intensive care that can only be provided safely in an intensive care unit, requiring hospitals to assure enough beds and skilled ICU staff for these patients—while quickly identifying which patients can receive care as good or better in another unit.

Allina Health has achieved this dual objective with a concerted ICU avoidance strategy for specific complex sub-populations of cardiovascular (CV) patients. The foundation of this strategy is risk-informed decisions about which patients can avoid the ICU; clinical staff education; and an analytics platform and enterprise data warehouse (EDW) from Health Catalyst that enables CV care leaders to monitor safety metrics for those patients who avoid a stay in the ICU. So far, Allina Health’s efforts have resulted in the following achievements:

  • 636 additional ICU days made available for more critically ill patients by employing ICU avoidance strategies
  • One-day reduction length of stay (LOS) for Transcatheter Aortic Valve Replacement (TAVR) patients
  • $589,000 cumulative cost savings
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Leveraging Risk Assessment to Decrease LOS and Cost for PCI Patients

Percutaneous Cardiac Intervention (PCI) is a minimally-invasive alternative to open heart surgery—a procedure that approximately 600,000 U.S. patients will undergo this year.

Allina Health, a non-profit health system with 90+ clinics and 13 hospitals with locations throughout Minnesota and western Wisconsin, is a leading provider of the procedure in Minnesota. Allina Health discovered that major bleeding events following PCI procedures (the most common non cardiac complication of PCI), though not affecting mortality, were increasing length of stay (LOS) and cost.

To improve the quality of its PCI procedures and decrease costs, Allina Health recognized the need to accurately assess bleeding risk and then implemented best-practice interventions to prevent major bleeding events.

Already, physicians and patients have seen that these new interventions, which includes a bleeding risk assessment tool, allows clinicians to focus interventions based on risk and reduce complications. The top results from Allina Health’s interventions include:

  • 5.3 percentage point reduction (a 21.7 percent relative reduction) in complication rate.
  • $1.8M cost savings.
  • 1.4 percentage point reduction (a 36.5 percent relative reduction) in LOS for patients at high risk for bleeding who receive a closure device.
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Reducing HAC Rates to Keep Kids Safe and Healthy

Hospital-acquired conditions (HACs)—such as central line-associated blood stream infections (CLASBIs) and pressure ulcers (PUs)—cause harm and adversely affect patients’ lives, while also increasing hospital length of stay (LOS) and total hospital costs. In fact, each case of CLABSI alone costs up to $55,000 to treat and makes health systems vulnerable to reimbursement penalties.1

Children’s Hospital of Wisconsin (CHW), a nationally ranked pediatric center with two hospitals and a surgery center, recognized that reducing the rate of HACs in its facilities would require major systematic changes. CHW’s approach to transforming care to prevent HACs included cultural changes with an emphasis on staff education and engagement and a new governance structure to support the initiative. These changes were powered by high-tech tools and quicker access to new types of data that CHW didn’t have in the past.

The hospital’s implementation of its comprehensive and collaborative HAC reduction plan has resulted in measurable quality of care improvements and cost reductions, including:

  • $1.6 million savings realized to date as a result of a 30 percent reduction in the overall number of HACs
  • 23 percent reduction in central line-associated blood stream infections (CLABSIs)
  • 74 percent reduction of pressure ulcers (PUs)
  • 68 percent reduction in venous thromboembolisms (VTEs)
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Evidence-Based Care Process Model Reduces SSIs and Readmissions

The consequences of poor-quality surgical care are significant for both hospitals and patients. Consider the following: One in four patients having a colon re-section is readmitted within 90 days, costing U.S. healthcare approximately $300 million a year and negatively affecting the lives of tens of thousands of patients and their families.

In 2013, Mission Health, North Carolina’s sixth-largest health system, identified opportunities to improve clinical outcomes for its bowel surgery patients. With a vision of achieving the best outcome for each patient, Mission set goals to reduce length of stay (LOS), decrease readmissions, and reduce surgical site infections (SSIs) for its bowel surgery patients.

Mission recognized that care process models (CPMs) were key to making it easier for clinicians to deliver the best care to patients by doing the right thing consistently. The health system therefore organized a multidisciplinary improvement team charged with developing and implementing an evidence-based CPM for bowel surgery. In support of this effort, Mission leveraged technology and analytics to encourage clinician adoption of the CPM and to deliver performance insights.

Through these efforts, Mission has achieved impressive improvements in bowel surgery care:

  • 92 percent reduction in colorectal surgery SSI rates
  • 28.5 percent reduction in mortality
  • 10.6 percent reduction in 30-day readmissions
  • 4.4 percent reduction in LOS
  • 8.5 percent reduction in cost per case
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Patient-Centered LOS Reduction Initiative Improves Outcomes, Saves Costs

U.S. hospital stays cost the health system at least $377.5 billion per year. In today’s value-based care environment, hospitals are under increasing pressure to avoid patient harm and maintain quality while also lowering costs. Reducing hospital length of stay (LOS), especially as it relates to avoiding unnecessary hospital-acquired conditions (HACs), is a primary indicator of a hospital’s success in achieving these goals.

El Camino Hospital, a 395-bed multi-specialty community hospital in Mountain View, Calif., places a high priority on keeping patients safe. However, when it came to its goal of reducing LOS, leaders recognized that they faced some major challenges, including:

  • The complexity of implementing a multi-layered, multi-disciplinary approach to improving the patient discharge process.
  • Identifying what issues were contributing the most to increased LOS so that they could be addressed.

By implementing analytics and protocols that provide access to actionable data, the LOS reduction team was able to identify patients at high risk for increased LOS so that they could develop and track critical interventions. El Camino’s patient-centered approach to tackling LOS reduction also included multi-disciplinary cooperation, leadership buy-in, and additional resources to enhance discharge care coordination.

This innovative, systematic approach resulted in not only a better than anticipated reduction in ALOS of 7.8 percent, but also:

  • 14.8 percent reduction in readmissions
  • 55 percent reduction in healthcare acquired conditions (HACs)
  • 32 percent reduction in incidence of AHRQ patient safety indicators (PSIs).
  • $2.2 million projected annual cost savings
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Saving Lives with Best Practices and Improvements in Sepsis Care

Every year, severe sepsis impacts more than 1 million Americans, and an estimated 25 percent die from the condition. Thibodaux Regional Medical Center is committed to driving and keeping its sepsis mortality rate to less than have the national average. How is this health system achieving these outcomes? Thibodaux formed a sepsis improvement team charged with reducing sepsis mortality and lowering costs while improving the patient experience. The team implemented best-practice care protocols, an analytics system, and an adoption approach that engaged clinicians using education and data. Backed by executive leadership and guided by clear goals, the sepsis improvement initiative has achieved impressive results in just six months that include a decrease in sepsis mortality rate to half of the national average, a 3 percent reduction in average variable cost, a reduction in LOS in the ICU by one day, and a 7 percent improvement in patient satisfaction.

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Allina Health: A Successful Approach to Improving VTE Care and Prevention across a Large Health System

An estimated 1 million cases of venous thromboembolism (VTE) occur each year in the United States—with approximately 300,000 of these cases resulting in death. These sobering statistics led Allina Health to embark on a journey to address prevention and improved care for its VTE patients—one of the most common causes of hospital-related death in the United States—and one of the most preventable. Supported with analytics, Allina implemented a physician-led, multidisciplinary workgroup to standardize order sets and engage clinicians in improvement efforts. To date, their system-wide efforts have generated measurable improvements including an 11 percent increase in VTE bundle compliance rate, a 96.9 percent compliance with VTE prophylaxis, and a 41 percent increase in compliance with VTE warfarin therapy discharge instructions.

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How Allina Health Improved Spine Care Variation and Outcomes

Low back pain (LBP) is a common and expensive problem. The annual cost to patients, employers, and insurers collectively exceeds $100 billion in the U.S. alone. Additionally, LBP care treatment variations, impact outcomes. In 2011, Allina Health created the Spine Institute to deliver care that supports the IHI Triple Aim in the treatment of spine disorders and LBP. All clinical disciplines involved in spine care are part of the program, and care providers follow standard spine care and management evidence-based models. Access to quality data enables Allina to measure performance across providers. With this successful spine care coordination program and advanced clinical analytics, Allina has reduced length of stay by 16 percent and post-op complications by 3.6 percent, while projecting $2.7 million in savings.

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Sepsis Mortality and Length of Stay: One Hospital System’s Story

Sepsis, a serious complication that strikes quickly and is often fatal, is the single most expensive condition to treat in the hospital, in part because of the longer than average stay. To reduce sepsis mortality rates, which are between 20 and 50 percent, many hospitals have established evidence based bundles comprised of antibiotic administration, lactate level monitoring and other elements of care. However, without analytics, hospitals rely on manual processes to track sepsis rates and bundle compliance. Learn how Mission Health has streamlined surveillance by 75% while experiencing a 2.6% reduction in sepsis mortality rates and an 18% reduction in length of hospital stay.

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How to Reduce Preventable Healthcare Associated Conditions in Children Using Best Practice Bundles and Analytics

Despite the preventability of healthcare associated conditions (HACs), rates continue to be unacceptably high throughout the country. Developing and implementing best-practice bundles—and tracking providers’ compliance with these bundles—has proven to be highly effective in preventing HACs. However, tracking HAC rates and bundle compliance can present a significant reporting burden. Learn how this healthcare organization has streamlined reporting and is able to identify vulnerable patients sooner, monitor clinicians’ compliance with best-practice bundles, and minimize manual chart reviews to calculate the HAC rates. With increased bundle compliance, their overall HAC rate has decreased by 35% and their CAUTI rate by 50%.

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