Intensive care unit (ICU) is a specializedsection of a hospital that provides intensive care to patients suffering fromlife threatening injuries or illnesses. An ICU is equipped with complex andspecialized equipment designed to monitor and assist in physiologicalfunctions; these include monitors to measure heart rate, blood pressure andrespiratory rate, while ventilators help patients to breath. An ICU alsoconsist of a group of trained professionals, like nurses, clinical nursespecialist, respiratory therapists, doctors, pharmacists amongst others. Themajor five reasons patients are admitted to an ICU are respiratoryinsufficiency or failure, postoperative management, ischemic heart disorder,sepsis, and heart failure. ( Encyclopedia of Surgery, 2015)A respiratory therapist is a trainedprofessional specialized in cardiopulmonary diagnosis, treatment andmonitoring.
The RT responsibilities include interviewing patients, executingchest exams, analyzing tissue specimens, analyzing blood oxygen, determiningpatient’s breathing capacities and educating patients on the use of ventilatorsand life support systems. During emergencies such as a Code Blue the RT playsan important role in managing and assisting to this type of situations (University of Kansas Medical Center, 2015). In the ICU settingrespiratory therapists have an active role in ventilator management, using bothinvasive and non-invasive ventilation techniques. Furthermore, they insert Radial Arterial Line,assist with percutaneous tracheostomy and bronchoscopy, they do intubations andextubations, and other measures required during a respiratory emergency. A RTnot only is required in the adult ICU but also is a very important member ofthe Special Care Nursery, they set up oxygen, administer surfactant, and manageinfant ventilators and infant continuous positive airway.
Overall, arespiratory therapist is a very important part of a healthcare system (St. Luke’s Hospital , 2015).As mentioned above patients in the ICU aremainly treated for cardiopulmonary diseases and postoperative care. Therefore,the major causes of death in the ICU include multi-organ failure,cardiovascular failure, and sepsis.
Among the patients with sepsis, half ofthem will develop renal failure, about a quarter will develop acute respiratoryfailure, and over 80% will have either a myopathy or a polyneuropathy. It isestimated that the overall mortality rate in the ICU is about 30%. Recentstudies have demonstrated that these rates can drop up to a 6% when the ICU hasan adequate number of qualified staff; in comparison, it has also been proventhat the mortality rates increase when there is lack in number or qualificationof the ICU staff (Society of Critical Care Medicine, 2015).Analysis Regardingthe current case, as a hospital administrator is my responsibility to know thehospital budgeting and financing plans. As the physicians have requested theaddition of Respiratory Therapists, is my duty to find all the data possible toaccept or deny such request.
In order to make this decision, the data to becollected needs to show ICU admission rates in the past last year, ICU costs,Morbidity and Mortality rates, respiratory costs, success rate, employmentcosts and revenues generated. Once I have obtained all the data then, I canmake a decision regarding the addition of new staff.Data and statistics1ICU costsIn the United States, the number of ICUbeds has increased over the years, it is estimated that over 5 million patientsare admitted to the ICU every year (Society of Critical Care Medicine, 2015). While ICU bedsaccount for 15% of all inpatients beds, ICU costs account for a third of allinpatient costs. These high costs are relatedto a higher staffing ratio, higher use of services and resources, and a longerstay at the ICU. (Dahl, et al.
, 2012).ICU admissions The ICU patients are a heterogeneouspopulation, of all ages and ethnicity, however, children and adolescent are ata high range of 18% of all admissions (Society of Critical Care Medicine, 2015). In the adultpopulation, the major diagnosis at admission are respiratory diseases, diabetesketoacidosis, coronary artery bypass, and cerebrovascular accident (Dahl, et al.
, 2012). Among the neonatepopulation, the major diagnosis at admission are respiratory problems,infections, hemolytic jaundice, premature birth, and fluid and electrolytemisbalance (Society of Critical Care Medicine, 2015). Morbidity and Mortality ratesMortality and Morbidity rates are directlylinked to duration of stay, being higher the longer the patient stays. Asmentioned before the mortality rate ranges between 15-30%.Respiratory costsRespiratory costs increases with thelength of stay.
Therefore, the first day it is estimated to be around 50,000USD, as the stay lengthens the cost increases, being so that by the 50thday after admission it can be as high as 300,000 USD (Dahl, et al., 2012).Employment costsThe ICU is composed by a team ofprofessionals, the salary for this varies according to the position. Thefollowing is the list of the estimated salary in dollars for a year (Society of Critical Care Medicine, 2015):- Critical care staff physician: $261,383- Critical care staff nurse: $74,330- Critical care nurse practitioner: $100,406- Respiratory therapist: $56,1821- Critical care clinical pharmacist:$108,960DiscussionAfter carefully analyzing all the dataabove mentioned, I can sit with this group of physicians and consider thepossibility of adding new staff. As a hospital administrator my key concern isto optimize the hospital resources and offer and excellent health service. Mymain goal is to reduce costs without affecting patient care. As mentionedabove, the ICU treats life-threatening conditions and the success of thisrelies on a carefully chosen group of specialists. The respiratory therapist is a very importantmember of this group.
The shortage on respiratory therapist can bring manydisadvantages to the hospital. The first disadvantage will be an increase inall costs. Firstly, the length of stay will increase, and as seen in the analysisthe longer the patients stay the higher the costs are.
Secondly, the mortalityrates increase when the ICU staffing is not adequate, a shortage of RT wouldcontribute to an increased mortality rate; as a secondary adverse effect of ahigher mortality rate, a family member can suit the hospital for malpractice orinsufficient resources, causing us an unnecessary and preventable cost. Anotherdisadvantage is that if the hospital success rates decrease due to the shortageof RT, the patients will no longer want to go to this hospital, they will askfor transfers, this can severely decrease the revenues generated. Ishould consider that maybe there are other alternatives to reduce costs insteadof keeping a low staffing. For example, by reducing the length of stay, I’mdirectly reducing the costs. Immediate and effective treatment of diseases,will help reducing the number of days a patient needs to stay hospitalized.
Havinga 24 hours intensivist team has shown to optimize care and reduce costs. Byhaving the adequate staff during an emergency, over $13 million annually can bereduced. As seen above, the major causes of admission to an ICU are ofrespiratory origin. In the current case, this hospital is well known for theirrespiratory department, therefore, it makes sense that we should prioritizerespiratory care and optimize it in the best way, even if it implies hiring newstaff. The new addition might be an additional cost, but it can help us reduceand prevent future costs.Conclusion The ICU and the ER are departments thattreat life-threatening conditions, the combination between good equipment andadequate staff ensure a positive outcome. The RT is a specialist well trainedto respond to emergencies such as Code Blue and to treat cardiopulmonaryconditions.
Regarding the case study, the hospital is well known for theirrespiratory medicine, which implies, that more patients needing the assistanceof an RT are admitted. In my opinion, is optimal to have more RTs to ensure asatisfactory patient care.As the hospital administrator, I need toconsider all variables before making a decision.
The data I need to collect hasto prove or deny that is possible to hire more staff. These data includes,hospital records, admissions to the ICU and ER departments, length of stayduring ICU, ICU admission rates, mortality and morbidity rates, employmentcosts and financial budgeting; all the data has to be within the past lastyear. Finally, I need to take into consideration that a negative outcome due tostaff shortage, can lead to a hospital suit; a lawsuit costs a lot of money andis something we should avoid. Once I have collected all the data, I would havean intelligent conversation with these physicians and we could together come toan understanding.1For purposes of this exercise all the data and statistics has been taken fromprevious studies made in different hospitals of the USA