High Value Care in the Surgical ICU: Effect on Ancillary Resources

• Published in: The Journal of surgical research 2016
• Main Authors: Ko, Ara, MD, MPH, Murry, Jason S., MD, Hoang, David M., MD, Harada, Megan Y., BA, Aquino, Lia, BA, Coffey, Charles, MD, Sax, Harry C., MD, FACS, FACHE, Alban, Rodrigo F., MD, FACS
• Format: Article
• Language: English
• Subjects: Surgery
• ISSN: 0022-4804
• DOI: 10.1016/j.jss.2016.01.040

Abstract Background Changes in health care policies have influenced transformations in hospital systems to be cost-efficient while maintaining robust outcomes. This is particularly important in intensive care units (ICU) where significant resources are utilized to care for critically-ill patients. We sought to determine if high-value care processes (HVCp) implemented in a surgical ICU (SICU) have an impact on commonly utilized ancillary tests. Materials and Methods An implementation phase using a Lean-Six-Sigma approach was performed in October 2014 at a 24-bed large academic center SICU with aims to decrease orders of excessive daily laboratory tests and x-rays. The HVCp implemented included use of daily checklists, staff education, and visual reminders emphasizing the importance of appropriate laboratory tests and chest x-rays (CXR). Pre (July 2014-October 2014) and post-intervention (November 2014-June 2015) phases were compared. Results Average SICU census, case mix index (4.3vs.4.4, p=0.57), APR severity of illness (3.2vs.3.2, p=0.91) and SICU mortality (7.1%vs.5.1%, p=0.18) were similar in both phases. A significant reduction of excessive laboratory tests was evident after the implementation period. 865 arterial blood gases (ABGs)/month were obtained in the pre-intervention phase compared to 420 ABGs/month post-intervention (p = 0.004), representing a 51.4% reduction. Similar results were obtained with complete blood counts, basic metabolic profiles, coagulation profiles, and CXRs (12%, 17.8%, 30.2% and 20.3% reductions respectively), a total estimated cost-savings of $59,137/month and prevention of excess phlebotomy of approximately 4L blood/month. Conclusions By implementing an HVCp including a checklist, visual reminders, and provider education, we significantly reduced the use of commonly ordered ancillary tests in the SICU without affecting outcomes, resulting in an annual cost-savings of $710,000.