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Effects of a multifaceted intervention QI program to improve ICU performance

Ersson, Anders LU ; Beckman, Anders LU ; Jarl, Johan LU and Borell, Jonas LU (2018) In BMC Health Services Research 18(1).
Abstract
Background

To benefit from the increasing clinical evidence, organisational changes have been among the main drivers behind the reduction of ICU mortality during the last decade. Increasing demand, costs and complexity, amplifies the need for optimisation of clinical processes and resource utilisation. Thus, multidisciplinary teamwork and critical care processes needs to be adapted to profit from increased availability of human skill and technical resources in a cost-effective manner. Inadequate clinical performance and outcome data compelled us to design a quality improvement project to address current work processes and competence utilisation.
Methods

During revision period, clinical processes, professional... (More)
Background

To benefit from the increasing clinical evidence, organisational changes have been among the main drivers behind the reduction of ICU mortality during the last decade. Increasing demand, costs and complexity, amplifies the need for optimisation of clinical processes and resource utilisation. Thus, multidisciplinary teamwork and critical care processes needs to be adapted to profit from increased availability of human skill and technical resources in a cost-effective manner. Inadequate clinical performance and outcome data compelled us to design a quality improvement project to address current work processes and competence utilisation.
Methods

During revision period, clinical processes, professional performance and clinical competence were targeted using “scientific production management methodology” approach. As part of the project, an intensivist training program was instituted, and full time intensivist coverage was obtained in the process of creating multi-professional teams, composed of certified intensivists, critical care nurses, assistant nurses, physiotherapists and social counsellors. The use of staff resources and clinical work-processes were optimised in accordance with the outcome of a “value stream mapping”. In this process, efforts to enhance the personal dynamics and performance within the teams were paramount. Clinical and economic outcome data were analysed during a seven year follow up period.
Results

• Consecutive reduced overall ICU (24%) and long-term (600 days) mortality. The effect on ICU mortality was especially pronounced in the subgroup of patients > 65 years (30%)

• Consecutive reduced length of stay (43%, septic patients) and time on ventilator (for septic patients and patients > 65 years of age (23 resp.52%).

• Substantial increase in life years gained (13,140 life years) as well as quality-adjusted life-years (9593 QALY: s) over the study period.

• High cost-effectiveness as ICU costs were reduced while patient outcomes were improved. Disregarding the cost reduction in ICU, the intervention is highly cost effective with cost- effectiveness ratios of (75€/QALY) and (55€ / life year)
Conclusions

We have shown favourable results of a QI project aiming to improve the clinical performance and quality through the development of multi-professional interaction, teamwork and systematic revisions of work processes. The economic evaluation shows that the intervention is highly cost-effective and potentially dominating. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ICU, Critical Care, LEAN, Quality improvement, Cost-effectiveness
in
BMC Health Services Research
volume
18
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85056430989
ISSN
1472-6963
DOI
10.1186/s12913-018-3648-y
language
English
LU publication?
yes
id
e9910409-692e-4a1c-bc25-5d80cb7849ee
date added to LUP
2018-11-01 14:40:45
date last changed
2019-02-20 11:34:22
@article{e9910409-692e-4a1c-bc25-5d80cb7849ee,
  abstract     = {Background<br>
<br>
To benefit from the increasing clinical evidence, organisational changes have been among the main drivers behind the reduction of ICU mortality during the last decade. Increasing demand, costs and complexity, amplifies the need for optimisation of clinical processes and resource utilisation. Thus, multidisciplinary teamwork and critical care processes needs to be adapted to profit from increased availability of human skill and technical resources in a cost-effective manner. Inadequate clinical performance and outcome data compelled us to design a quality improvement project to address current work processes and competence utilisation.<br>
Methods<br>
<br>
During revision period, clinical processes, professional performance and clinical competence were targeted using “scientific production management methodology” approach. As part of the project, an intensivist training program was instituted, and full time intensivist coverage was obtained in the process of creating multi-professional teams, composed of certified intensivists, critical care nurses, assistant nurses, physiotherapists and social counsellors. The use of staff resources and clinical work-processes were optimised in accordance with the outcome of a “value stream mapping”. In this process, efforts to enhance the personal dynamics and performance within the teams were paramount. Clinical and economic outcome data were analysed during a seven year follow up period.<br>
Results<br>
<br>
• Consecutive reduced overall ICU (24%) and long-term (600 days) mortality. The effect on ICU mortality was especially pronounced in the subgroup of patients &gt; 65 years (30%)<br>
<br>
• Consecutive reduced length of stay (43%, septic patients) and time on ventilator (for septic patients and patients &gt; 65 years of age (23 resp.52%).<br>
<br>
• Substantial increase in life years gained (13,140 life years) as well as quality-adjusted life-years (9593 QALY: s) over the study period.<br>
<br>
• High cost-effectiveness as ICU costs were  reduced while patient outcomes were improved. Disregarding the cost reduction in ICU, the intervention is highly cost effective with cost- effectiveness ratios of (75€/QALY) and (55€ / life year)<br>
Conclusions<br>
<br>
We have shown favourable results of a QI project aiming to improve the clinical performance and quality through the development of multi-professional interaction, teamwork and systematic revisions of work processes. The economic evaluation shows that the intervention is highly cost-effective and potentially dominating.},
  articleno    = {838},
  author       = {Ersson, Anders and Beckman, Anders and Jarl, Johan and Borell, Jonas},
  issn         = {1472-6963},
  keyword      = {ICU,Critical Care,LEAN,Quality improvement,Cost-effectiveness},
  language     = {eng},
  month        = {11},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Health Services Research},
  title        = {Effects of a multifaceted intervention QI program to improve ICU performance},
  url          = {http://dx.doi.org/10.1186/s12913-018-3648-y},
  volume       = {18},
  year         = {2018},
}