2012 BMT ICU Utilization Project Update

Significance & Background:  Resource utilization in healthcare continues to be a top priority. The rising cost of healthcare and limited resources, including ICU beds, makes appropriate utilization of the ICU a critical issue. 10 years ago, our BMT Program developed and began utilizing ICU admission criteria. We have monitored ICU utilization by collecting data on whether patients met criteria for ICU admission, the reason for transfer, the length stay and outcomes. Historically, BMT patients are high acuity and now older patients with co-morbidities are candidates for transplant.  Appropriate ICU utilization is an important goal of our program

Purpose: The 10 years of data allows us to evaluate probabilities of survival following ICU with the goal of appropriate ICU utilization.

Interventions: We have developed and continue to revise ICU admission criteria based on ongoing review of the ICU data.  An understanding of outcomes following ICU is used by the medical team to counsel patients and families facilitating informed decisions about their care.  To improve the care of patients in the ICU, the BMT and ICU teams round together daily  including a discussion of goals of care and family meetings every 2-3 days.  

Evaluation: Ongoing evaluation determines if ICU admission criteria was met, reasons for transfer, length of stay and outcomes.  Most of the patients transferred to the ICU meet our established criteria. We have noted trends for patients transferred to the ICU more than once have very poor outcomes.  Additionally, the length of ICU stay predicts for poor outcomes.  

Discussion:  Ongoing evaluation of our ICU utilization data and reviews of the literature provide the BMT team with information that can be used to counsel patients and families on the probabilities of survival.  This information allows for patients and families to make informed choices regarding their care and facilitates appropriate ICU utilization.