Critical Care

Critical illness is a significant driver of health care utilization in the US, with more than 5 million patients admitted annually to intensive care units (ICUs) and associated costs approaching 1% of the US gross domestic product. Costs are increasing due to increased ICU utilization, an aging population, and the rising costs of advanced therapies.

For decades, the one-size-fits-all function of the ICU has been a successful and efficient means of caring for critically ill patients. While the progression of scientific knowledge and technology has allowed for dramatic improvements in monitoring and therapeutics, the organization of critical care delivery in the hospital has failed to keep pace. Those who are well-suited to receive care in the ICU have acute, reversible critical illness and require the expertise available in that location. However, up to 40% of current ICU patients may be “too well” to benefit from the full brunt of ICU care. These patients have a low mortality risk on admission and are at low risk for needing active ICU therapies but have high labor or frequent monitoring needs that cannot be met elsewhere.
 
At the other end of the illness severity spectrum are millions of patients cared for in ICUs who are “too sick” to benefit from critical care, having serious illnesses and values inconsistent with ICU care. These days spent in the ICU are 2.5 – 4 times more expensive than days on the hospital floor and may be avoided. We set out to understand and design a model of ICU care delivery that would more appropriately address the needs of these patients and reduce the exorbitant costs associated with one-size-fits-all ICU care.
 
  1. Economical physiological monitoring technology embedded in ED and non-ICUhospital beds triggers alerts to a mobile ICUteam.

  2. The mobile ICU team is sufficiently staffed to enable frequent monitoring andtreatment adjustment for non-ICU inpatients of concern to floor nurses, but who donot require major invasive organ support.

  3. Absent a contrary order from the attending physician, within 24 hours followinghospitalization, the mobile ICU team checks hospital registration data for DNR orcomfort care only designation, discusses such pre-existing designation withattending physicians, and routinely initiates palliative care consults for all patientswith terminal illnesses.

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