Targets Shatter and Outcomes Shine as The Intensivist Group Manages ICU at Mercy Suburban

When The Intensivist Group (TIG) initiated an intensivist-led critical care program for the 12-bed intensive care unit (ICU) at Mercy Suburban Hospital in spring 2009, the company set ambitious goals. With 129 beds, this mid-sized community teaching hospital in Montgomery County, Pa., was the last in the four-hospital Mercy Health System to mandate The Intensivist Group to manage its ICU.

The team moved quickly, integrating itself into the hospital community and putting in place excellent clinicians and physician leaders. Within the first six months of the team taking over the ICU, every performance target, set by The Intensivist Group in conjunction with the hospital’s administration, was surpassed.

The Benchmarks

In terms of quality-of-care metrics, first and foremost must be reduction in the mortality rate. In the first six months under The Intensivist Group’s management, the ICU mortality rate declined from 15.6 percent to 12.7 percent, for an 18.6 percent relative risk reduction year over year. This translates to the prevention of 13 additional deaths within the six-month period.

Other performance targets included reducing ICU length of stay (LOS) by 0.25 days and lessening the average duration of mechanical ventilation (DOMV) by 5 percent. These objectives were far exceeded within the first six months: The average ICU length of stay was reduced by 0.80 days or 19.5 percent, and the average DOMV was lowered by 2.1 days or 36 percent. In addition, the average hospital LOS was one day shorter (7.6 to 6.5 days), down 14 percent over the comparable period.

“The Intensivist Group brought in personnel who are truly the crème de la crème,” says Wayne Miller, DO, the hospital’s associate chief medical officer.   “They achieved clear advantages in terms of decreased length of time in the ICU and on a ventilator for patients.”

The critical care unit has continued to drive substantial reductions in these statistics. The unit also has maintained a very low incidence of hospital-acquired infections, attaining a zero ventilator-associated pneumonia (VAP) rate.

The Intensivist Group’s Program Advantages

Underlying these impressive results are less quantitative initiatives introduced by The Intensivist Group that contribute to these improved outcomes. The critical care program focuses on building a multidisciplinary ICU team to deliver evidence-based care, educating and supervising medical residents, developing a system for data-driven process improvement, and earning the trust of the nursing and medical staff through the delivery of high quality, collaborative patient care.

The success of the program’s implementation has translated into enhanced teamwork along with the improved results.  Daily intensivist-led, multidisciplinary rounds include medical residents and students, ICU nurses, and pharmacists with input from representatives from respiratory therapy, social services and nutritional support. “They have been a model for an interdisciplinary approach to patient care in a way we would like to extrapolate to other parts of the hospital,” says Dr. Miller. He adds that the critical care physicians have been widely accepted by the staff in other hospital units, who enjoy being included in the treatment team.

The Intensivist Group also established a close collaboration with the Emergency Department and other stakeholders to ensure that the most critically ill patients get to the ICU as quickly as possible.

The team likewise established a diverse and representative ICU Practice Guidelines Committee, which meets regularly to develop multidisciplinary strategies to improve workflow and patient outcomes and to create standardize evidence-based protocols and order sets, such as those for sepsis and septic shock, infection control, sedation and analgesia of mechanically ventilated patients, and standardized admission order sets.

“The Intensivist Group has done very well coming into a four-hospital system and providing a systemic approach to best practices in the ICU,” says Dr. Miller. “From economies of scale, and seeing the benefit of order sets and protocols, to standardization of metrics, it’s a real advantage having the group work in all the ICUs.”

Vital to this teaching hospital is The Intensivist Group’s contribution to the internal medicine residency training program. “The residents and students really get to see state-of-the-art critical care being provided. It’s raised the quality of the ICU rotation,” says Dr. Miller. He adds that the young doctors have the opportunity to see the intensivists interact with both patients and families, sometimes having sensitive end-of-life conversations with them: “They provide an excellent role model for residents.”

The Intensivist Group’s Financial Impact

The Intensivist Group’s management of the ICU generated a further outcome that exceeded Mercy Suburban’s expectations: a financial one. The estimated cost savings from the reduced ICU length of stay for the first year was $1,658,000; the savings from reduced mechanical ventilation for that period was $179,000. The reduced LOS also resulted in the throughput of 125 additional ICU patients. This means more virtual capacity in the ICU through greater efficiency, translating to potential incremental revenues for Mercy Suburban Hospital.