Effectiveness of icu screening processes

SESSION TITLE: Analyzing What We Do in the ICUSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/17/2022 12:15 pm - 1:15 pmPURPOSE: In 2016, our hospital's Intensive care unit (ICU) was changed from an “open model” system, in which any physician could admit a patient to the ICU and write orders to a “closed model” system in June 2016, in which the ICU team makes all decisions regarding ICU admissions or upgrades. Our aim was to evaluate the effectiveness of ICU evaluations and to assess the outcomes of patients who were not admitted to the ICU versus those who were admitted to ICU after the requested ICU evaluation.METHODS: This is an observational study conducted at a single institution (Rutgers Health/Monmouth Medical Center), for 6 months - from July 2019 to December 2019. All patients who had ICU evaluation in their hospital stay during that period were included, a total of 239 patients. When an ICU evaluation was requested, the ICU team assessed the patient (clinical status and diagnostic studies), evaluated the need for an ICU upgrade, and discussed with an ICU attending. If the patient was not taken to ICU, a follow-up in 2-4 hours was done to assess if the patient was hemodynamically stable or needed admission to the ICU. We collected the data by retrospective review of medical records, followed by statistical analysis.RESULTS: Out of 239 ICU evaluations, 170 patients (71.1%) were initially accepted to the ICU. Of the 69 patients that were not admitted to the ICU, 13 patients (18.8%) were eventually admitted to the ICU during their hospital stay. There were no statistically significant differences (p-value > 0.05) noted in mortality and length of stay in ICU upgraded patients versus patients who were managed on floors after evaluation.CONCLUSIONS: There was no statistically significant difference in outcomes such as mortality rate or length of hospital stay in those who were admitted to the ICU after evaluation in comparison to those who were not admitted. However, the analysis is confounded by the small sample size as well as likely higher severity of illness and therefore worse prognosis in those admitted to the ICU. This study suggests that the “closed model” system is beneficial in assessing patients for ICU admission.CLINICAL IMPLICATIONS: This study showed no significant mortality benefit or length of stay difference in patients who were admitted to ICU versus those who were continued management on medical floors (despite the bias discussed above). The “closed model” system is beneficial in assessing patients for ICU admission. This study also confirms the effectiveness of the ICU evaluation process and underscores the labor-intensive ICU screening process, with an average of 1.29 new patients screened per day.DISCLOSURES: No relevant relationships by Muhammad AsifNo relevant relationships by Farrukh IqbalNo relevant relationships by Violet KramerNo relevant relationships by Mohsin Mughalno disclosure on file for Shailee Patel;No relevant relationships by Chandler PattonNo relevant relationships by vinit singhNo relevant relationships by Raghu Tiperneni SESSION TITLE: Analyzing What We Do in the ICU SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: In 2016, our hospital's Intensive care unit (ICU) was changed from an “open model” system, in which any physician could admit a patient to the ICU and write orders to a “closed model” system in June 2016, in which the ICU team makes all decisions regarding ICU admissions or upgrades. Our aim was to evaluate the effectiveness of ICU evaluations and to assess the outcomes of patients who were not admitted to the ICU versus those who were admitted to ICU after the requested ICU evaluation. METHODS: This is an observational study conducted at a single institution (Rutgers Health/Monmouth Medical Center), for 6 months - from July 2019 to December 2019. All patients who had ICU evaluation in their hospital stay during that period were included, a total of 239 patients. When an ICU evaluation was requested, the ICU team assessed the patient (clinical status and diagnostic studies), evaluated the need for an ICU upgrade, and discussed with an ICU attending. If the patient was not taken to ICU, a follow-up in 2-4 hours was done to assess if the patient was hemodynamically stable or needed admission to the ICU. We collected the data by retrospective review of medical records, followed by statistical analysis. RESULTS: Out of 239 ICU evaluations, 170 patients (71.1%) were initially accepted to the ICU. Of the 69 patients that were not admitted to the ICU, 13 patients (18.8%) were eventually admitted to the ICU during their hospital stay. There were no statistically significant differences (p-value > 0.05) noted in mortality and length of stay in ICU upgraded patients versus patients who were managed on floors after evaluation. CONCLUSIONS: There was no statistically significant difference in outcomes such as mortality rate or length of hospital stay in those who were admitted to the ICU after evaluation in comparison to those who were not admitted. However, the analysis is confounded by the small sample size as well as likely higher severity of illness and therefore worse prognosis in those admitted to the ICU. This study suggests that the “closed model” system is beneficial in assessing patients for ICU admission. CLINICAL IMPLICATIONS: This study showed no significant mortality benefit or length of stay difference in patients who were admitted to ICU versus those who were continued management on medical floors (despite the bias discussed above). The “closed model” system is beneficial in assessing patients for ICU admission. This study also confirms the effectiveness of the ICU evaluation process and underscores the labor-intensive ICU screening process, with an average of 1.29 new patients screened per day. DISCLOSURES: No relevant relationships by Muhammad Asif No relevant relationships by Farrukh Iqbal No relevant relationships by Violet Kramer No relevant relationships by Mohsin Mughal no disclosure on file for Shailee Patel; No relevant relationships by Chandler Patton No relevant relationships by vinit singh No relevant relationships by Raghu Tiperneni