For years, the intensive care unit (ICU) has been a successful and efficient method to care for the critically ill. The patients best suited for the ICU have acute, reversible critical illnesses. However, 40% of the current patients in ICUs may be "too well" to benefit from critical care. These patients may require more intensive monitoring than the typical hospital floor provides but are not in need of active ICU treatments. At the same time, millions of patients are seen in ICUs who are "too sick" to benefit from critical care. Indeed, such care may be inconsistent with their values and expressed wishes. We set out to design a model of ICU care delivery that would appropriately address the needs of these diverse patient populations while reducing the overall costs associated with ICU care.
Opportunities for savings
A conservative estimate of national savings from full implementation of the CERC critical care model is 20% in direct healthcare spending for intensive care delivery through a reduction in ICU admissions and length of stay.
Safely reducing annual per capita spending
The key elements of the model include:
- The installation of contactless monitors on all non-ICU beds in order to detect clinical instability earlier than existing methods
- The development of a mobile surveillance team to intervene earlier than rapid response teams for deteriorating patients, to monitor patients with high labor needs, and to improve transitions of care for patients entering and leaving the ICU
- The proactive addressing of goals of care upstream of the ICU to prevent patients from being admitted to the ICU and to prevent ICU/hospital readmissions