The Association of ICU Acuity With Outcomes of Patients at Low Risk of Dying.

Objective: Many ICU patients do not require critical care interventions. Whether aggressive care environments increase risks to low-acuity patients is unknown. We evaluated whether ICU acuity was associated with outcomes of low mortality-risk patients.

The high cost of low-acuity ICU outliers.

Direct variable costs were determined on each hospital day for all patients with an intensive care unit (ICU) stay in four Phoenix-area hospital ICUs. Average daily direct variable cost in the four ICUs ranged from $1,436 to $1,759 and represented 69.4 percent and 45.

Readmissions and death after ICU discharge: development and validation of two predictive models.

Introduction: Early discharge from the ICU is desirable because it shortens time in the ICU and reduces care costs, but can also increase the likelihood of ICU readmission and post-discharge unanticipated death if patients are discharged before they are stable. We postulated that, using eICU® Research Institute (eRI) data from >400 ICUs, we could develop robust models predictive of post-discharge death and readmission that may be incorporated into future clinical information systems (CIS) to assist ICU discharge planning.

Methods: Retrospective, multi-center, exploratory cohort study of ICU survivors within the eRI database between 1/1/2007 and 3/31/2011.

Severity scoring in the critically ill: part 2: maximizing value from outcome prediction scoring systems.

Part 2 of this review of ICU scoring systems examines how scoring system data should be used to assess ICU performance. There often are two different consumers of these data: lCU clinicians and quality leaders who seek to identify opportunities to improve quality of care and operational efficiency, and regulators, payors, and consumers who want to compare performance across facilities. The former need to know how to garner maximal insight into their care practices; this includes understanding how length of stay (LOS) relates to quality, analyzing the behavior of different subpopulations, and following trends over time.

Severity scoring in the critically ill: part 1--interpretation and accuracy of outcome prediction scoring systems.

This review examines the use of scoring systems to assess ICU performance. APACHE (Acute Physiology and Chronic Health Evaluation), MPM (mortality probability model), and SAPS (simplified acute physiology score) are the three major ICU scoring systems in use today. Central to all three is the use of physiologic data for severity adjustment.

Remote ICU care programs: current status.

The desire to provide continuous intensivist management for all intensive care unit (ICU) patients in the face of a massive shortfall of available intensivists prompted the introduction of remote ICU care programs in 1999. The past several years have seen a dramatic increase in the number of health systems adopting this care model. These health systems have increased our understanding of both the ability of this new care model to improve clinical outcomes and the clinical processes that are required to achieve program quality goals.

Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing.

Objective: To examine whether a supplemental remote intensive care unit (ICU) care program, implemented by an integrated delivery network using a commercial telemedicine and information technology system, can improve clinical and economic performance across multiple ICUs.

Design: Before-and-after trial to assess the effect of adding the supplemental remote ICU telemedicine program.

Setting: Two adult ICUs of a large tertiary care hospital.