Daniel L Lemkin1, Benoit Stryckman1, Joel E Klein2, Jason W Custer3, William Bame4, Louise Maranda5, Kenneth E Wood6, Courtney Paulson7, Zachary D W Dezman8. 1. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. 2. University of Maryland Medical System, Baltimore, MD, USA. 3. Division of Pediatric Critical Care, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA. 4. Data & Analytics, University of Maryland Medical System Baltimore, MD, USA. 5. Department of Quantitative Sciences, University of Massachusetts, Worcester, MA, USA. 6. Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. 7. Department of Decision, Operations, and Information Technologies, University of Maryland Robert H. Smith School of Business, College Park, MD, USA. 8. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: zdezman@som.umaryland.edu.
Abstract
PURPOSE: To measure how an integrated smartlist developed for critically ill patients would change intensive care units (ICUs) length of stay (LOS), mortality, and charges. MATERIALS AND METHODS: Propensity-score analysis of adult patients admitted to one of 14 surgical and medical ICUs between June 2017 and May 2018. The smart list aimed to certain preventative measures for all critical patients (e.g., removing unneeded catheters, starting thromboembolic prophylaxis, etc.) and was integrated into the electronic health record workflows at the hospitals under study. RESULTS: During the study period, 11,979 patients were treated in the 14 participating ICUs by 518 unique providers. Patients who had the smart list used during ≥60% of their ICU stay (N = 432 patients, 3.6%) were significantly more likely to have a shorter ICU LOS (HR = 1.20, 95% CI:1.0 to 1.4, p = 0.015) with an average decrease of -$1218 (95% CI: -$1830 to -$607, P < 0.001) in the amount charged per day. The intervention cohort had fewer average ventilator days (3.05 vent days, SD = 2.55) compared to propensity score matched controls (3.99, SD = 4.68, p = 0.015), but no changes in mortality (16.7% vs 16.0%, p = 0.78). CONCLUSIONS: An integrated smart list shortened LOS and lowered charges in a diverse cohort of critically ill patients.
PURPOSE: To measure how an integrated smartlist developed for critically illpatients would change intensive care units (ICUs) length of stay (LOS), mortality, and charges. MATERIALS AND METHODS: Propensity-score analysis of adult patients admitted to one of 14 surgical and medical ICUs between June 2017 and May 2018. The smart list aimed to certain preventative measures for all critical patients (e.g., removing unneeded catheters, starting thromboembolic prophylaxis, etc.) and was integrated into the electronic health record workflows at the hospitals under study. RESULTS: During the study period, 11,979 patients were treated in the 14 participating ICUs by 518 unique providers. Patients who had the smart list used during ≥60% of their ICU stay (N = 432 patients, 3.6%) were significantly more likely to have a shorter ICU LOS (HR = 1.20, 95% CI:1.0 to 1.4, p = 0.015) with an average decrease of -$1218 (95% CI: -$1830 to -$607, P < 0.001) in the amount charged per day. The intervention cohort had fewer average ventilator days (3.05 vent days, SD = 2.55) compared to propensity score matched controls (3.99, SD = 4.68, p = 0.015), but no changes in mortality (16.7% vs 16.0%, p = 0.78). CONCLUSIONS: An integrated smart list shortened LOS and lowered charges in a diverse cohort of critically illpatients.
Authors: Pedro Taffarel; Ana Paula Rodríguez; Claudia Meregalli; Facundo Jorro Barón Facundo Journal: Rev Fac Cien Med Univ Nac Cordoba Date: 2022-06-06