Each year, 5 million humans are rolled into the door of the ICU in the United States. 2 Half of these patients are on ventilators, unable to breathe on their own8. Demand for critical care is expected to rise – the aging “baby boomers” are estimated to grow the population aged 65 and older to 21% by the year 2050, with increased rates of chronic disease.6
For most hospitals, these are not trivial numbers. ICU costs add up to about 20% of the average hospital’s costs, even though the ICU accounts for only 7% of all hospital beds. 5
“Supporting our expert caregivers with state-of-the-art technology that delivers real value for our patient’s and community is my goal,” says Pat Davis-Hagens, President and Central Market CEO of The Jewish Hospital – Mercy Health in Cincinnati, OH. “We strive for improved patient outcomes that also result in a significant financial savings for the hospital.”
In October 2014, The Jewish Hospital – Mercy Health set out to test a new idea: whether the secret to containing costs and improving patient care could lie in these sick patient’s nutrition.
Nutrition in the ICU
Today nearly half of all those patients rolled through the doors of the ICU wind up malnourished.3 At baseline, half of these patients rely on the support of mechanical ventilators to breathe.8 Inadequate nutrition or ignoring factors as simple as extra calories often can lead to deterioration of body mass, poor wound healing, weakened respiratory muscles and increased morbidity and mortality, increasing the length of time a patient needs to be on a ventilator, and therefore in the ICU.10,11,12,13,14
“In the ICU, everything is heightened. When a patient becomes critically ill, nutrition plays an even more critical role in the recovery process” says Joseph Robertson manager of Respiratory Care at The Jewish Hospital. “Everyone knows nutrition is important in our everyday lives. So for these sick patients, every nutrient and calorie becomes that much more crucial.”
ICU care teams have traditionally used manual estimates, one-size-fits-all equations or bulky machines with high training barriers, to asses ICU patients’ nutrition needs. With a multitude of options to choose from and no consensus on the safest, most accurate or most efficient one, these manual estimates have been proven to be inaccurate as much as 70% of the time. 3,4,5
The Jewish Hospital based its hypothesis on this data – if they could give ICU care teams the ability to precisely assess their patients’ caloric needs, they reasoned, they could develop a nutritional program to provide optimal nutrition, helping get patients back to their lives sooner.
Improving care and reducing cost
To test this idea, The Jewish Hospital trialed GE’s nutrition software that automated the process of assessing ICU patients’ metabolic needs on the ventilator. The clinical team used this data to implement a data-driven nutritional assessment plan for these patients.
The Jewish Hospital added nutrition software from GE’s ventilators* to their ICU for a 90-day trial period. If all went well, The Jewish Hospital would replace all of their ventilators with GE ventilators, including the nutrition assessment software
“Our solution to the challenge of understanding nutrition in the ICU was to build automated nutrition assessment software right into the ventilator, the machines these patients are already connected to for breathing assistance,” says Thierry Leclercq, President and CEO Life Care Solution, GE Healthcare. “The ICU is where critically ill patients are cared for and we have a duty to focus more advanced innovations on making an impact in this area.”
The CARESCAPE R860 uses data to measure the patient’s needs and provides precise care guidance, not estimates, back to the care team on a touch-screen, with swipe controls. The care team can then use this data to implement a nutritional program suited to each patient’s measured nutritional needs.
The 90-day study was conducted from October 2014-December 2014 and data was compiled monthly by the hospital’s Respiratory Care team. When they reviewed the final results, the team was surprised by just how right their theory had been.
They had reduced by 28% the average length of stay for a ventilated patient in the ICU, meaning each patient stayed in intensive care on average almost three days less.
What’s more, they had saved nearly $9,000 per patient, and a projected 5 million+ dollars over the course of a year.
Today, the Jewish Hospital is now the first in the U.S. to have installed GE Healthcare’s CARESCAPE R860 ventilators with the nutrition assessment software.
Why it matters
With an aging and an increasingly sicker population driving increases in spending on hospital care, if every hospital in the U.S. were able to apply the same technology, care approach and savings as The Jewish Hospital across the half of the 5 million patients admitted to the ICU each year who are put on ventilators8, it could conceivably save the country’s hospital system a significant amount.
“We’re proud to be the first in the U.S. to use GE Healthcare’s CARESCAPE R860 ventilators and prouder still to be able to get our patients back to their lives as soon as possible. This real-life case study could pave the way for more hospitals to improve care for their sick patients, while helping to reduce costs and length of stay,” says Davis-Hagens.
That significant amount of dollars saved annually is not just about the cost savings. It would also mean care teams are no longer reliant on manual methods in caring for the nutritional needs of ventilated ICU patients. Clinicians can work together to potentially improve patient outcomes; it may mean these ICU patients are ICU patients for less time.
1. Department of Health Policy, George Washington University School of Public Health and Health Sciences, Washington, DC, USA. http://www.ncbi.nlm.nih.gov/pubmed/23672362
2. Society for Critical Care Medicine http://www.sccm.org/Communications/Pages/CriticalCareStats.aspx. More than 5 million patients are admitted annually to ICUs in the United States/2 to reflect the about half that are malnourished x $8,995 The Jewish Hospital saved per patient.
3. Souba, W. Nutritional support. N Engl J Med 1997; 336: 41.
4. Malone AM. Nutr Clin Pract. 2002; 17: 21-28.
5. Matarese LE, Gottschlich MM (eds). Contemporary Nutrition Support Practice: A Clinical Guide. 1998: 79-98.
6. The Cost of Caring. American Hospital Association
7. Am. Journal of Resp. Critical Care Med Vol 165 #6 European Respiratory Journal Vol 19 #5
8. The American Society for the Surgery of Trauma http://www.aast.org/GeneralInformation/mechanicalventilation.aspx
9. The CARESCAPE R860 nutrition software works in conjunction with a multi-disciplinary clinical program and only as part of the ventilator and the respiratory gas module
10. Reid, CL. Nutritional requirements of surgical and critically-ill patients: do we really know what they need? Proc Nutr Soc. 2004 Aug;63(3):467-72.
11. Fessler. Malnutrition: A Serious Concern for Hospitalized Patients. Today’s Dietitian. 2008;Vol. 10 No. 7; 44.
12. Delgado, Artur et al. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics. 2008;63:357-62
13. Artinian, V, Krayem, H, DiGiovine, B. Effects of Early Enteral Feeding on the Outcome of Critically Ill Mechanically Ventilated Medical Patients. Chest. 2006; 129: 960 –967.
14. Dasta, J. McLaughlin T. Mody S, et al. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit care Med 2005 Vol. 33, No. 6, pgs. 1266-71. 14.
* Trial performed on Engstrom ventialtors with E-COVX respiratory gas modules. Case study: The Jewish Hospital Demonstrates Over 2-Day Reduction in ICU Length of Stay with GE Ventilation. JB33689US