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Improving Outcomes for ICU Patients on Prolonged Mechanical Ventilation Through Early Transfer to Kindred Hospitals

Female patient walking down hallway
 
 

Lengthy stays in the ICU, often caused by prolonged mechanical ventilation (PMV), are associated with a number of adverse outcomes.  One way to mitigate these outcomes is to transfer stable patients needing mechanical ventilation to a specialized Kindred Hospital that aggressively weans patients from the ventilator.

Prolonged Stays in the ICU Related to Mechanical Ventilation

Conditions requiring mechanical ventilation for greater than 96 hours have some of the longest inpatient lengths of stay, which have serious clinical and financial consequences.[1]

DRGDescriptionInpatient ALOS
207

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

14
3

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

31
4

TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

26

Clinical Risks

Lengthy stays in the ICU are associated with serious consequences for the patient, including higher mortality and readmission risk, particularly when the ventilator dependence is related to acute respiratory failure.[2],[3]  An extended ICU stay is also a risk factor for post-intensive care syndrome, which includes symptoms such as ICU-acquired weakness (ICUAW), cognitive deficits, and PTSD-like recurrence of frightening memories.[4]  In fact, as many as 55% of patients remaining in the ICU for just 7-10 days and 60% of those admitted with acute respiratory distress syndrome develop ICUAW.[5]

Studies also show that PMV leads to higher rates of ICUAW and readmission.[6],[7]  One study found that as many as 67% of patients on PMV developed ICUAW. [8]  Additionally, the longer the period of mechanical ventilation, the higher the risk of readmission, with 36% of patients on PMV for 28 days readmitting to the ICU.[9]

Researchers attempting to address this dilemma have found that transferring PMV patients to specialized settings that focus on ventilator weaning could be beneficial for those whose conditions are otherwise stable.[10],[11]

Financial Considerations

In additional to clinical consequences of prolonged ICU stays for PMV, there are significant financial considerations. The average Medicare payment per day ranges from around $3,500 to over $6,000 for the above DRGs with prolonged mechanical ventilation. [12]   During a one-year period, the total Medicare spend alone for encounters with these DRGs amounted to $3.4 billion. Additionally, these conditions have an average readmission rate of around 20%.[13] With the average cost of a readmission being $17,700, prolonged mechanical ventilation in an ICU is costly both during and after the initial treatment.

These figures further support the need for early transfer of patients to care settings that specialize in ventilator liberation.

Clinical and Financial Outcomes at Kindred Hospitals

Kindred Hospitals provide specialized acute care and rehabilitation for medically complex patients, including those on mechanical ventilation.  Our focused treatment of such patients allows us to efficiently help them recover and regain their independence.

Data show that the average 30-day readmission and mortality rates are significantly lower for DRGs 003, 004, and 207 at Kindred than in a traditional inpatient hospital. [14] Not represented in this graph are the levels of patient complexity with these DRGs which are far greater at Kindred.[15]

 
Outcomes by DRG Chart
 
 

Discover how early transfer of ventilator patients to a specialized Kindred Hospital can help improve outcomes and reduce readmissions. 

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Beyond these outcomes, 86% of Kindred’s ventilated patients are able to reach a high level of mobility, based on the Johns Hopkins level of mobility scale.[16]

Additionally, Medicare spend per day is significantly lower at Kindred Hospitals than at traditional hospitals.[17]

 
chart of Average Medicare Spend Per Day by DRG
 

Kindred Hospitals’ specialized caregivers and highly targeted programs allow them to achieve these exceptional outcomes.

Kindred Hospitals’ Specialized Care

Founded in 1985 as a hospital company dedicated to the care of ventilator patients, Kindred Hospitals has been treating serious pulmonary conditions for 40 years. 

At Kindred, patients receive physician-led interdisciplinary care, which includes consultation from pulmonologists as needed and 24/7 access to respiratory therapists.  Our ICUs, which have low nurse-to-patient ratios, are staffed with ACLS-certified nurses.  The high-level staffing in our hospitals allows us to accept critically ill patients on mechanical ventilation once they have reached a stable condition.

As part of our patients’ treatment, we incorporate movement into care plans as soon as is safe, even for those on mechanical ventilation, through our Move Early program.  All our patients benefit from the physical, occupational, and speech rehabilitation provided by our specialists.

Through our commitment to excellence in respiratory care, almost all our hospitals have achieved disease-specific care certifications in Respiratory Failure from The Joint Commission.  Certification ensures a standardized, evidence-based approach to care and to performance measurement and improvement. 

At a Kindred Hospital, medically complex patients, including those on mechanical ventilation, benefit from highly specialized and efficient care in a facility focused specifically on their needs. 

With the significant clinical risks and financial considerations associated with prolonged stays in the ICU for mechanical ventilation, transferring these patients to a Kindred Hospital once they are stable is an important strategy in improving patient outcomes, and reducing readmission risk and cost.

 
 

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References

  1. The Advisory Board. The Post-Acute Care Pathways Explorer. State Average Outcomes by MS-DRG. Accessed August 2024.
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588762/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523242/
  4. https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome
  5. https://pubmed.ncbi.nlm.nih.gov/26242743/
  6. https://pubmed.ncbi.nlm.nih.gov/26242743/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515670/
  8. https://pubmed.ncbi.nlm.nih.gov/26242743/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515670/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852505/
  11. https://pubmed.ncbi.nlm.nih.gov/28403404/  
  12. The Advisory Board. The Post-Acute Care Pathways Explorer. State Average Outcomes by MS-DRG. Accessed August 2024.
  13. https://hcup-us.ahrq.gov/reports/statbriefs/sb307-readmissions-2020.jsp
  14. The Advisory Board. The Post-Acute Care Pathways Explorer: State Average Outcomes by MS-DRG, Accessed August 2024; Systems Outcomes Report, MS-DRG, Kindred Hospital Medicare IDs, Q4 2022-Q1 2023.
  15. As measured by HCC Scores. Average HCC scores for Kindred patients with DRGs 207, 3, and 4 are 9.1, 9.4, and 9.6 respectively, compared to 6.2, 6.7, and 7.7 at traditional inpatient hospitals. Source: see endnote 14.
  16. Kindred Internal Data, 2023 Average; https://www.hopkinsmedicine.org/physical_medicine_rehabilitation/education_training/amp/toolkit.html; “high level of mobility” defined as a score of 4 or better.
  17. As measured by Medicare payment per encounter divided by ALOS for each DRG. Source: see endnote 14.
 

By: Dean French, MD, CPPS – Chief Medical Officer

Dr. Dean French is Executive Vice President and Chief Medical Officer of ScionHealth, parent company of Kindred Hospitals. Having previously served as Chief Medical Officer for multiple hospitals, Dr. French is an experienced physician executive.  His unique perspective and capabilities are based on his nearly 20 years of outstanding experience in transformational and collaborative leadership in hospitals and health systems nationwide.

Dean French