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More lives saved with 24/7 enhanced staffing in medical ICU
Date:11/29/2010

ther important clinical outcomes, including substantial decreases in daily doses of sedatives for patients receiving those medications. "Sedation has been shown to be a factor in causing delirium in patients, prolonging ventilation and it is an independent risk factor for death," says Carl Shanholtz, M.D., study co-author and medical director of the MICU at the University of Maryland Medical Center. "If you over-sedate patients, they stay longer on ventilation, have more complications and a longer stay in the MICU," says Dr. Shanholtz, who is also associate professor of medicine at the University of Maryland School of Medicine.

Also following the changes, the proportion of patients receiving mechanical breathing assistance for one or more days was smaller, while there was a significant increase in ventilator-free days among those who required a ventilator.

The length of stay in the MICU increased slightly after the changes, from a median 2.4 to 2.7 days, but there was no change in total hospital length of stay. The researchers report that they could not ascertain what caused the longer stay, but say the reduction in deaths may have resulted in patients who would have previously died with a short length of stay now surviving with a commensurately longer stay.

MICU costs rose after the changes, from a median of $4,071.10 per patient admission to $6,232.20. The total per admission hospital variable costs also increased from median $11,819.90 to $13,178.90.

"With improvements in the staffing model, we were able to implement major changes in clinical practice," says Dr. Shanholtz. "On the sedation front, for example, we increased the number of critical care physicians who know the need to reduce sedation, clinical pharmacists to create drug algorithms and protocols, respiratory therapists to help wean patients from ventilation and coupled that with a great nursing staff and modern physical plant. A lot of folks can take cred
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Contact: BILL SEILER
bseiler@umm.edu
410-328-8919
University of Maryland Medical Center
Source:Eurekalert

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