REDUCING RESOURCE CONSUMPTION THROUGH WORK REDESIGN IN A SURGICAL INTENSIVE-CARE UNIT - A MULTIDISCIPLINARY, PROTOCOL-BASED PROGRESSIVE CARE AREA

Patients with prolonged intensive care unit (ICU) length of stay, thou gh few in number, consume as much as 50% of ICU resources. With increa sing pressures for cost containment in health care, the availability o f ICU beds may be jeopardized. To improve the efficiency of care for p atients requiring a surgical intensive care unit (SICU) stay of 3 or m ore days, a multidisciplinary highly ''protocolized,'' Progressive Car e Area was developed within the existing SICU environment. Entry into this area is limited to patients whose acuity level is not high by ICU standards, but too high for a general surgical floor. In designing th e Progressive Care Area, we drew on a number of published management s trategies-including total quality management concepts and our prior ex perience in establishing ventilator management teams. The Progressive Care Area has resulted in a reduction in both the frequency and variat ion of resources used. A Progressive Care Area within an existing ICU is a viable alternative for the care of the patients who have prolonge d lengths of stay and are less acutely ill, and it significantly impro ves ICU efficiency.