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When healthcare systems say they don’t have the resources to support proper practices, is that true? How much do deep sedation and immobility cost our ICU teams, hospitals, and healthcare systems? How can we use the research to support our plight for safe staffing ratios and evidence-based practices? Let’s dive deep into the money talk.

Episode Transcription

Finally! The long-promised episode on the financial picture of early mobility and delirium management in the ICU. This topic can be a vast rabbit hole, so it has taken a while to feel like I compiled enough but not too much information on this. Additionally, and not-so-surprisingly, there is poor accessibility and transparency when it comes to the financial side of medicine. It is difficult to find clear estimates for things like the costs for 1 day in the ICU, or 1 day of mechanical ventilation. There are some reports but they are usually from at least 15 years ago. We also know that costs vary drastically between ICU specialties, patients, and stages of an ICU stay.

Also, cost analysis can be conflicting in this realm. What is cost-effective can be contrary with our mission as healthcare workers and the objective of the ICU. For example, early death is often more cost-effective but not in line with our societal values. Additionally, the bigger picture of ICU care such as rehabilitation, length of stay, return to work, outpatient care, long-term healthcare costs, and such are not captured in any cost-analysis that I could find.

Cost analysis in the ICU from the standpoint of physical therapy
Yamauchi L. Y. (2018). Cost analysis in the ICU from the standpoint of physical therapy. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 44(3), 175. 

Nonetheless, despite these gaps, there is a lot that we do know about the costs benefits of early mobility and delirium management in the ICU. So, let’s start with what we know. I’ll try to stay calm, but I get really worked up about this aspect of the discussion.

We know that the ICU is very expensive for hospital systems.

In 2011, approximately 27% of the hospital stays across the US involved time in the ICU, which accounted for 48% of aggregate charges from the hospital.

Utilization of Intensive Care Services, 2011: Statistical Brief #185 – PubMed
Barrett, M. L., Smith, M. W., Elixhauser, A., Honigman, L. S., & Pines, J. M. (2014). Utilization of Intensive Care Services, 2011: Statistical Brief #185. In Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US).

I’ve talked to teams that say, “we’re not sure if we can invest in training and supporting our staff in these changes. We’re trying to save $25 million this year”. To that, I share the following insights into why our system cannot afford to continue to deeply sedate and immobilize every patient on a ventilator.

Throughout this podcast, we have talked about patient suffering, quality of life, survival, staff fulfillment, etc…. but let’s be honest- the businesses are ultimately not going to change the current status based on that. Investing in safe staffing ratios, training, interdisciplinary collaboration, etc. will not be a priority until we can demonstrate that investing thousands will save them millions. So… let’s do just that.

Since we know that ICU care contributes to such a substantial part of our total healthcare costs and especially hospitalization costs, and even outpatient costs, let’s dive into what we know about the costs of our current sedation and immobility culture.

An easy first target is delirium.

We know that 81% of ICU patients have delirium.

Of importance to note, 1 episode of delirium leads to a 40% increase in ICU and hospitalization costs.

Abuse Notice
Pisani MA, Murphy TE, Van Ness PH, Araujo KLB, Inouye SK. Characteristics Associated With Delirium in Older Patients in a Medical Intensive Care Unit. Arch Intern Med. 2007;167(15):1629–1634. doi:10.1001/archinte.167.15.1629

Kyeremanteng, Kwadwo; Bhardwaj, Kalpana; Chaudhuri, Dipayan; Herritt, Brent; Foster, Madison; Lawlor, Peter; Bush, Shirley; Kanji, Salmaan; Tanuseputro, Peter; Rosenberg, Erin 501: ICU DELIRIUM, CLINICAL OUTCOMES, AND COST: SYSTEMATIC REVIEW AND META-ANALYSIS, Critical Care Medicine: January 2018 – Volume 46 – Issue 1 – p 235
doi: 10.1097/01.ccm.0000528519.33388.17

A study from 2004 (18 years ago)- Total ICU costs increased from median of $13,000 for patients without delirium to $22,000 for patients that had at least 1 episode of delirium in the ICU. Total hospitalization costs increased from $27,000 without delirium to $41,000 with at least 1 episode of delirium. Higher severity and duration of delirium were associated with incrementally greater costs.

Costs associated with delirium in mechanically ventilated patients – PubMed
Milbrandt, E. B., Deppen, S., Harrison, P. L., Shintani, A. K., Speroff, T., Stiles, R. A., Truman, B., Bernard, G. R., Dittus, R. S., & Ely, E. W. (2004). Costs associated with delirium in mechanically ventilated patients. Critical care medicine, 32(4), 955–962. https://doi.org/10.1097/01.ccm.0000119429.16055.92

A study from 2008 showed that the total cost attributable to delirium ranged from $16,303-$64,421 PER PATIENT. This implies that the national burden of delirium on the healthcare system ranges from $38 billion to $152 billion each year — *****1 back in 2008- pre-COVID and pre-inflation.

****The economic impact of delirium rivals the healthcare costs of falls and diabetes.

One-year health care costs associated with delirium in the elderly population – PubMed
Leslie, D. L., Marcantonio, E. R., Zhang, Y., Leo-Summers, L., & Inouye, S. K. (2008). One-year health care costs associated with delirium in the elderly population. Archives of internal medicine, 168(1), 27–32. https://doi.org/10.1001/archinternmed.2007.4

A lot of the increase in costs ties directly to the increased length of stay from delirium. One study showed that the mean difference of ICU length of stay for patients was 4.77 days longer than ICU patients without delirium. Then total hospital length of stay was 6.67 days longer for patients with delirium compared to those without. https://www.hindawi.com/journals/ccrp/2021/6612187/

One study showed that patients with delirium stayed twice as long in the hospital, accounted for twice the number of nursing hours, and twice the total cost per case. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045819/

This is just on the acute care side, but the financial cost doesn’t stop at discharge.

A study from 2016 in Australia showed that delirium causes an estimated 10.6% of all dementia in Australia. Keeping in mind that the USA has 13 times the population of Australia: In 2016, the total costs of delirium in Australia was the equivalent of $5.3–12.1 billion American dollars. Within those costs, about 1.9 billion of those costs were contributable to the financial loss of the delirium victims suffered. $3.4 billion was from the loss of a healthy lifestyle after delirium. Dementia from delirium was attributable to 2.9 billion dollars of the total almost 12 billion dollar cost of delirium. Now, the USA population is 13 times that of Australia, so the financial impact of delirium our system is much greater.

Economic impact of delirium in Australia: a cost of illness study – PubMed
Pezzullo, L., Streatfeild, J., Hickson, J., Teodorczuk, A., Agar, M. R., & Caplan, G. A. (2019). Economic impact of delirium in Australia: a cost of illness study. BMJ open, 9(9), e027514. https://doi.org/10.1136/bmjopen-2018-027514

The cognitive impairments acquired from the delirium/acute brain failure developed under our care impacts survivors, their caregivers, and our system. A study about this was performed in 2008 in Italy, where there, nursing homes are rare and care for delirium survivors comes down to families hiring private caregivers. The estimate was that there were about 900,000 of these caregivers for such delirium survivors. The monthly stipend for these caregivers was about $1,100 a month paid by the families- posing a significant burden to most families.

Abuse Notice
Bellelli G, Bianchetti A, Trabucchi M. Delirium and Costs of Informal Home Care. Arch Intern Med. 2008;168(15):1717. doi:10.1001/archinte.168.15.1717-a

So… enough about the problem- what is the solution? Delirium prevention and management strategies.

The most obvious modifiable risk factor for delirium in the ICU is sedation. We know that sedation causes delirium at varying rates, right?

Ativan- 1mg = 20% increased risk. So if you give 2mg every 6 hours, that is a 160% increase in risk in 24 hrs.

Pandharipande, P., et al. (2006). Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology, 104(1). https://pubmed.ncbi.nlm.nih.gov/16394685/

Midazolam- 1mg= 7–8% increased risk. So, theoretically, 5mg/hr = 120mg/day x 7% = 840% RISK INCREASE.

Taipale, P., et al. (2012). The association between nurse-administered midazolam following cardiac surgery and incident delirium: an observational study. International Journal Nursing Student, 49(9). https://pubmed.ncbi.nlm.nih.gov/22542266/

Propofol has a lower risk compared to benzodiazepines but certainly depends on the dose, duration, and depth of sedation.

Dexmedetomidine has the lowest risk of delirium- though it still can impede delirium prevention interventions such as family engagement and mobility if used for a deeper RASS. Yet, its lower risk of delirium explains in large part why it is so much more cost-effective than other sedatives.

One study compared the costs per patient between dexmedetomidine, propofol, and midazolam. The costs were estimated to be $21,115 for dexmedetomidine, $27,073 for propofol, and $27,603 for midazolam. Dexmedetomidine was associated with a savings of $5,958 per patient compared to propofol and a saving of $6,487 compared to midazolam. These savings were primarily driven by a reduction in ICU length of stay and the degree of monitoring and management required.

Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation…
Aggarwal, J., Lustrino, J., Stephens, J., Morgenstern, D., & Tang, W. Y. (2020). Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation During Mechanical Ventilation in the United States. ClinicoEconomics and outcomes research : CEOR, 12, 389–397. 

So, rates of delirium depend on the agent, dose, depth, and duration of sedation. Subsequently, patient harm or complications and healthcare costs are directly impacted too.

We know that decreasing and especially avoiding sedation drastically prevents and decreases delirium.

One delirium bundle that included sedation cessation, early mobility, pain management, and sleep promotion decreased delirium rates by 78%. https://pubmed.ncbi.nlm.nih.gov/27965224/

The largest ABCDEF bundle study with over 20,000 patients showed that the ABCDEF bundle reduced delirium and coma days by 25–50% and significantly reduced healthcare costs.

Another expensive aspect of our current culture and process of care is the cost of immobility.

We know that when patients are sedated and immobilized while on mechanical ventilation, it causes significant muscular atrophy that can lead to prolonged time on the ventilator, time in the hospital, and discharges to LTACHs and rehabilitation centers. It has been seen that patients on mechanical ventilation for more than 21 days (presumably sedated and immobile) continue to suffer prolonged physical impairments that require extensive rehabilitation, outpatient care, and result in loss of income.

They found that 6 months after discharge that though lung volumes had normalized, only 38% of patients had returned to work in their previous role, and only 32% had returned in their previous role and hours. This results in a financial burden for healthcare systems and survivors.

Likely due to the prolonged time on the ventilator and stay in the hospital and care facilities, ICU acquired weakness increases healthcare costs by 30.5%.

Clinical review: intensive care unit acquired weakness – Critical Care
Hermans, G., Van den Berghe, G. Clinical review: intensive care unit acquired weakness. Crit Care 19, 274 (2015). 

So, the financial problem of immobility is clear. So, what’s the solution? Early mobility.

Early mobility has been proven to drive down healthcare costs.

The total net present value over a seven-year time horizon of an early mobility program for a US hospital with 1000 yearly ICU admissions exceeds $2.3 m. The yearly cost-of-care savings generated by reducing ICU and Non-ICU for both ventilated and non-ventilated patients and the number of days on ventilation for a hospital is approximately $927,000. The impact of early mobility programs on hospital readmissions generates an additional $93,000 annual savings by reducing US hospital readmission penalties. (Remember, the benefits and likely cost-savings of early mobility depend on the extent in which it is used. These kind of saving likely were with a less progressive early mobility program than the full “Awake and Walking ICU” approach. Nonetheless, the financial benefit is clear.)

Financial implications of a hospital early mobility program
Bognar, K., Chou, J. W., McCoy, D., Sexton Ward, A. L., Hester, J., Guin, P., & Jena, A. B. (2015). Financial implications of a hospital early mobility program. Intensive Care Medicine Experimental, 3(Suppl 1), A758. 

Another study evaluating the financial savings from early was from Johns Hopkins in 2013. Using extremely conservative calculations, with 900 annual admissions, early mobility led to length of stay reductions of 22% in the ICU and 19% for floor. The saving were conservatively $817,836.

Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions for ICU and floor costs, across ICUs with 200–2,000 annual admissions, yielded financial projections ranging from -$87,611 (net cost) to $3,763,149 (net savings). They applied these projections to 24 scenarios and 20 of them demonstrated net savings with small net cost.

Again, these were VERY conservative models. We have to continue to remember that just as the outcomes from the ABCDEF bundle are dose-dependent, so are the financial benefits. Meaning, the more aggressive and consistently we prevent delirium and atrophy, the more healthcare costs will be saved. It is repeatedly demonstrated that the investments hospitals make to facilitate those practices have an impressive return on investment.

Early mobility has also shown to reduce the incidence of delirium even by 95%.

Association between nonpharmacological strategies and delirium in intensive care unit – PubMed
Bersaneti, M., & Whitaker, I. Y. (2022). Association between nonpharmacological strategies and delirium in intensive care unit. Nursing in critical care, 10.1111/nicc.12750. Advance online publication. 

Remember: delirium increases costs by 40%. This is a significant saving with delirium prevention alone! Yet when ICU acquired weakness increases costs by 30.5%, and by implementing the ABCDEF bundle we can greatly reduce both delirium and ICU acquired weakness… can we suspect that combining the costs of those complications could lead to 70% reduction in healthcare costs for many ICU patients?

Another very expensive aspect of the ICU is mechanical ventilation. The longer patients are on the ventilator, the more expensive their in-hospital and post-acute care costs are going to be.

Things that lead to increased time on the ventilator:

Sedation — respiratory suppression, slower ventilator weaning, respiratory failure from the weakness of the respiratory muscles/diaphragm paralysis and dysfunction, delirium, decreased lung aeration from immobility, ventilator-associated pneumonia perhaps in large part from the immobility, impaired cough, decreased secretion mobilization and clearance, etc.

• VACs (Ventilator associated conditions — ARDS, barotrauma, pulmonary edema, pulmonary embolism )
• IVACs (infection-related ventilator associated conditions- sepsis, ventilator associated pneumonia)
• (The more time a patient spends on the ventilator, the more at risk they are of developing a VAC and/or IVAC, but then those VAC and IVAC increase the time on the ventilator)
• Delirium
• ICU acquired weakness and diaphragm dysfunction

So a huge priority in our teams and system should be to only keep patients on mechanical ventilation for the minimal amount of time required to treat the initial complication that led them to require mechanical ventilation. The more we sedate patients and cause preventable prolonged time on the ventilator, the more we expose them to the risks of mechanical ventilation. So, sedation and immobility are ultimately financial sinkholes for our systems.

One study showed that mechanical ventilation was associated with a 25.8% increase in the daily costs of ICU care.

What is the best way to decrease time on the ventilator, preventing ventilator associated complications, and drastically cut costs ? Avoid sedation and prompt and active mobility.

So when hospital systems refuse to invest in hiring more rehabilitation clinicians such as occupational and physical therapists, are they really being financially responsible and driving down healthcare costs?

What do we know about physical therapy and medical costs?

We know that physical therapy in the ICU can decrease time on the ventilator, time in the ICU, and time in the hospital. It improves functional status and improves discharge home rates, long-term functional status, and decreases hospital and ICU readmissions. All resulting in decreased healthcare costs.

Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis – PubMed
Kayambu, G., Boots, R., & Paratz, J. (2013). Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Critical care medicine, 41(6), 1543–1554. https://doi.org/10.1097/CCM.0b013e31827ca637

Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults…
Falvey, J. R., Burke, R. E., Malone, D., Ridgeway, K. J., McManus, B. M., & Stevens-Lapsley, J. E. (2016). Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community. Physical therapy, 96(8), 1125–1134. https://doi.org/10.2522/ptj.20150526

A study in Brazil showed that having physical therapists in the hospital for 24 hrs rather than 12 actually resulted in decreased total, medical, and staff costs because they so drastically lowered length of stay and time on the ventilator. Perhaps that is why I’m getting so many incredible pictures and videos from Brazil of COVID patients with high ventilator settings playing volleyball and such. They are very motivated to decrease their costs by increasing the presence and application of physical therapy.

Relationship between availability of physiotherapy services and ICU costs
Rotta, B. P., Silva, J., Fu, C., Goulardins, J. B., Pires-Neto, R. C., & Tanaka, C. (2018). Relationship between availability of physiotherapy services and ICU costs. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 44(3), 184–189. https://doi.org/10.1590/S1806-37562017000000196

One study scoured medicare records and found that occupational therapy was the only spending category in which there was a significant reduction in readmission rates for diagnosis of heart failure, pneumonia, and acute myocardial infarctions. https://pubmed.ncbi.nlm.nih.gov/27589987/

There are so many ways in with occupational therapy prevents readmissions and decreases length of stay.

They have proven that the bigger their role and presence is in acute care, the more patients can discharge home safely, the shorter their lengths of stays are, and the less hospital-acquired conditions they suffer- which is all shown to drive down the healthcare costs.

The Johns Hopkins MICU admits about 900 patients each year. In 2008, the hospital created an early rehabilitation program with dedicated physical and occupational therapists, which added about $358,000 to the cost of care annually.

However, by 2009, the length of stay in the MICU had decreased an average of 23 percent, down from six-and-a-half days to five days, while the time spent by those same patients as they transitioned to less-intensive hospital units (step-down, medical floor, LTACHs) fell 18 percent. Using their financial model, the authors estimated a net cost saving for the hospital of about $818,000 per year, even after factoring in the up-front costs.

hospitals would have overall cost savings by providing early rehabilitation to their intensive care unit patients.”

Physical Rehabilitation in the Intensive Care Unit is Better For Patients and the Hospital’s Bottom…
In a study evaluating the financial impact of providing early physical therapy for intensive care patients, researchers…
www.hopkinsmedicine.org

Presumably, their costs savings for physical and occupational therapy also depend on a unit’s sedation practices and the utilization of those therapies. We can have those therapists there 24 hours a day, but if our patients continue to be deeply sedated, then we have deprived them of the benefit that physical, occupational, and speech therapists can offer.

We know that true implementation of the ABCDEF bundle decreases time on the ventilator. A study done with 12 ICUs evaluated the impact of daily awakening and breathing trials. — Keep in mind- these are just breathing trials- adequate sedation vacations to allow for breathing trials. This is without true early mobility and full delirium prevention with minimal sedation.

Ventilator Days and Length of Stay (LOS) Reductions

• 2.4 vent days
• 3.0 ICU days
• 6.3 LOS days

VAE Reductions

• 37% in VACs (Ventilator associated conditions — ARDS, barotrauma, pulmonary edema, pulmonary embolism )
• 65% in IVACs (infection-related ventilator associated conditions- sepsis, ventilator associated pneumonia)

Klompas, M., Anderson, D., Trick, W., Babcock, H., Kerlin, M. P., Li, L., Sinkowitz-Cochran, R., Ely, E. W., Jernigan, J., Magill, S., Lyles, R., O’Neil, C., Kitch, B. T., Arrington, E., Balas, M. C., Kleinman, K., Bruce, C., Lankiewicz, J., Murphy, M. V., E Cox, C., … CDC Prevention Epicenters (2015). The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. American journal of respiratory and critical care medicine, 191(3), 292–301. https://doi.org/10.1164/rccm.201407-1394OC

Overview: Getting Patients Off the Ventilator Faster: Facilitator Guide
Say: In this module, we will introduce strategies and interventions, as well as adaptive and technical measures, which…
www.ahrq.gov

ABCDEF bundle implementation in 2 different ICUs resulted in reduced duration of MV, ICU and hospital LOS, restraint use, and reduced hospitalization costs by 24–30% depending on the compliance with all the elements of the bundle.

We also have seen that the ABCDEF bundle reduced discharges to nursing homes and rehabilitation facilities by 40% and cut ICU readmissions in half, continuing to keep healthcare costs lower even after hospital discharge.

Ultimately, our current culture and practices are needlessly expensive and create significant waste in our system. It is imperative that we make this clear to the purse-string holders- hospital administration, insurance companies, medicare, Medicaid- anyone with influence in our staffing ratios, and invested interest in decreasing healthcare costs. They need to understand that in this, there is a need to spend money to save money.

When hospital systems force ICU nurses to struggle to care for 4 patients instead of 1 or 2, they are creating a storm of death, suffering, and incredible expense. When nurses do not have the support, training, and opportunity to avoid sedation, prevent delirium, and mobilize their patients, then they end up doing far more work running to change sedation drips, consequently run and titrate vasopressors, break their backs to turn obese flaccid bodies every 2 hours, and bear the emotional trauma of constantly poor outcomes.

Our practices are leading to at least 4.77 more days in the ICU — though this has to be higher now. I am confident that this is higher because complications like ventilator-associated pneumonia, failure to wean from the ventilator, pressure injuries, etc are all on the rise because of the impact on quality of care. These studies and estimates on increased time on the ventilator were not done during COVID and this staffing crisis. That data was collected when a different quality of care was being provided. Logic would lead us to suspect that patients are staying in the ICU far longer as these complications increase. Also, as the staffing crisis affects LTACHs and sedation practices has worsened in the ICU, more patients are having tracheostomies and requiring LTACH admissions, but are unable to transfer from the ICU. I asked online how often ICU survivors are staying at least 1 extra day in the ICU because LTACHs were unable to receive their patients. 30% was 25–50% of the time, 36% said 50–75% of the time, and 30% said 75–100% of the time. This is INCREDIBLY expensive and taxing on our nurses and entire teams. We don’t have the workforce to afford to make patients sicker, more debilitated, and stuck in our facilities for longer. It doesn’t make sense. This must contribute to the mass exodus of nurses and the increased cost on systems to rehire and half-attempt to retrain nurses. If we had better protocols and support to provide better care, it would be cheaper and far more effective for ICU teams, patients, families, hospitals, and our entire healthcare system.

By understanding the reality of our practices- that sedation is so often unnecessary and results in expensive, lethal, and inhumane repercussions, then we can use the evidence to speak the language of the stakeholders- which is money. We can talk about human suffering with all the passion, but in this, the strongest card to play is likely money. Yet, it is our card to play. Let’s show them that poor care is expensive to care. The misguided approaches to decreasing healthcare costs and increasing revenue by staffing hospitals at the bare minimum have backfired.

What if reimbursement agencies such as insurance, medicare, or Medicaid really understood that though they won’t reimburse hospitals for additional time and care in the hospital for central line infections…. They are still reimbursing hospitals for days to weeks of extra time on the ventilator and hospital and then often preventable additional weeks to months in LTACH or SNFs- all because of the failure to implement preventive measures such as the ABCDEF bundle.

Hospitals ran to standardize preventative measures such as foley and central line care when they realized they would be financially penalized for those hospital-acquired infections. They increased education, standardized process of care, ran chart audits, and held people accountable when preventable events happen.

What will get them to have the same approach to preventing delirium and ICU acquired weakness? If they knew they would lose potentially hundreds of thousands of dollars because a patient was inappropriately sedated and immobilized and suffering delirium for weeks? Would they rush to adequately staff the units, make sure RASS scores were accurate, CAM tests were being done, physical and occupational therapy were being promptly and optimally utilized? What reimbursement agencies audited for awakening and breathing trials? What if hospitals weren’t reimbursed for tracheostomies and the rehabilitation required from diaphragm dysfunction and ICU-acquired weakness that occurred during inappropriate sedation and immobility? Would the ABCDEF bundle suddenly become important when framed in terms of dollar figures?

What if poor sedation and mobility practices were recognized as malpractice in court? It is easy to demonstrate that we are generally practicing against 10–15 years of evidence. It is simple to trace patient harm, suffering, and costs back to sedation and immobility practices and the failure to practice the ABCDEF bundle. What if we started to think, “Wow, how would I defend myself in court for a RASS of -3? How would I explain allowing that dose of midazolam? How could we justify the failure to have this patient out of bed for 3 weeks?” — What if hospital systems and even clinicians felt the pressure of those liabilities?

I am convinced that if talk money is what it takes, then we can do that. References to all these studies are on the blog. Use them. As we face this medical revolution, let’s bring this evidence to the table to support our plight for safer staffing ratios and better patient care. It is clear that humane care is cost-effective care.

Thank you for staying in critical care medicine. Thank you for advocating for your patients against all the barriers. I am convinced that painting the financial picture in these discussions will provide compelling advocacy for staff and patients alike. It’s up to us to shape the future of critical care. Study and understand the research. Play these cards with confidence.

Cost Savings of early mobility for Trauma ICU Patients:

The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project

Hsieh SJ, Otusanya O, Gershengorn HB, et al. Staged implementation of awakening and breathing, coordination, delirium monitoring and management, and early mobilization bundle improves patient outcomes and reduces hospital costs. Crit Care Med. 2019 Jul;47(7):885-893. doi: 10.1097/CCM.0000000000003765

Fish JT, Baxa JT, Draheim RR, Willenborg MJ, Mills JC, Sticht LA, Hankwitz JL, Wells JA, Jung HS. Five-Year Outcomes After Implementing a Pain, Agitation, and Delirium Protocol in a Mixed Intensive Care Unit. J Intensive Care Med. 2022 Aug;37(8):1060-1066. doi: 10.1177/08850666211063404. Epub 2021 Nov 29. PMID:34841939.

Louzon, P., Jennings, H., Ali, M., & Kraisinger, M. (2017). Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 74(4), 253–262. https://doi.org/10.2146/ajhp150942

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