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Making Room for Patients When Minutes Matter

Created Aug 02 2016, 08:00 PM by Lippincott Solutions
  • Care transitions
  • critical care resuscitation unit
  • CCRU
  • critical care
  • patient transfers

Wednesday, August 3, 2016

The University of Maryland Medical Center is on to something, and it wants other academic medical centers to listen up. By adding a six-bed ICU to receive all types of critically ill patients in immediate need of lifesaving services, the medical center slashed transfer times nearly in half, speeded up access to diagnostics, surgery and specialty care, and turned away nearly 1,000 fewer patients in the course of a year.

Its critical care resuscitation unit (CCRU) is the nation’s first. Judging by its success, though, it’s unlikely to be the last.

“When we built the CCRU, we envisioned a unit mid-way between an emergency department and intensive care unit, similar to our trauma resuscitation unit but for non-trauma patients,” said trauma center physician-in-chief Thomas M. Scalea, MD, FACS, lead author of an article on the unit published earlier this year in the Journal of the American College of Surgeons.

“It has been phenomenally successful in its intended mission to serve critically ill patients, and we believe it should serve as a model for other institutions.”

Improving Critical Care Transfers

The medical center has been operating an inter-hospital call center for the transfer of critically ill patients for more than 20 years. Still, prior to the opening of the CCRU, patients needing immediate critical care from the tertiary and quaternary facility sometimes had to wait for transfer if specialized ICU beds were not available.

In July 2013, the medical center launched its CCRU to speed things along. Located in the hospital’s Shock Trauma Critical Care Tower, the short-stay ICU is staffed 24 hours a day by nurses and physicians with diverse critical care experience.

Before transfer patients arrive, staff gather information from the referring physician and then prepare patient rooms with the necessary equipment and therapeutics. After initial resuscitation and any required surgery, patients move to their appropriate subspecialty ICU for continued care.

“We built the CCRU to address the inefficiencies inherent in relying on a particular ICU to accept a transfer,” said Dr. Scalea, who also directs the trauma program at the University of Maryland School of Medicine.

“ICUs are designed to manage patients for the entire course of their stay and they are highly specialized according to disease. The CCRU is for the immediate resuscitation, evaluation and disposition of all transfer patients. That is only part of what an ICU can do, but it’s the only thing the CCRU does.”

The Difference a CCRU Makes

In its first year of operation, the CCRU has had a measurable impact. Among adults admitted to the medical center for critical care, transfers increased 64.5 percent from a previous year (2,228 vs. 1,354) and the average time to patient arrival dropped from almost 4 hours to just over 2.

What’s more, lost admissions among transfer patients in need of critical care dropped from 25.7 percent to 14 percent. Significantly more patients received surgery during their hospital stay (46 percent vs. 31.1 percent) and a higher percentage were in the operating room within 12 hours of arrival (41 percent vs. 21.4 percent), according to the medical center. Patients who required surgery had significantly shorter stays (13 days vs. 17 days), which experts say demonstrates the value of quicker stabilization in the CCRU and admission to the appropriate subspecialty care unit.

“We admitted nearly 1,000 additional transfer patients in the first year alone since opening the CCRU,” said James O'Connor, MD, surgery professor at the University of Maryland School of Medicine and critical care chief at the University of Maryland Medical Center. “Adding just six beds and borrowing practices we had honed in the Shock Trauma Center made our entire system more efficient.”

Data reported in the Journal of the American College of Surgeons article showed a trend toward lower mortality, too, although it was not statistically significant. The authors hope continued research will provide definitive data that proves the CCRU lowers mortality among patient population.

A National Model

Excitement over the unit’s success is high at the University of Maryland. 

“This is a major advance in clinical science,” said E. Albert Reece, MD, PhD, MBA, dean of the school of medicine, “akin to a fundamental discovery.”

A Lippincott Solutions customer, the University of Maryland Medical Center is eager for other academic facilities to follow its lead and also improve care for this vulnerable population of patients.

“We’ve discovered a new niche for resuscitation medicine,” said CCRU director and article co-author Lewis Rubinson, MD, PhD, an associate professor at the school of medicine.

“It’s a paradigm change but easily adaptable for other academic medical centers. While we were fortunate to model the CCRU on a similar system already in place for our trauma patients, the fundamental principles are universal.”