Emergency Department-Based ICU Improves Quality of Care and Outcomes Without Increasing Costs
Study by Weil Institute and Michigan Medicine researchers found deployment of an ED-based ICU resulted in no significant cost increase per emergency department visit.
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ANN ARBOR, MI — A recent study published in JAMA Network Open found that establishing a dedicated intensive care unit within an emergency department (ED-ICU) improved quality of patient care and outcomes without raising the overall cost of care delivery.
Investigators from Michigan Medicine and the U-M Max Harry Weil Institute for Critical Care Research and Innovation examined over 230,000 adult emergency department (ED) visits from before and after the opening of Michigan Medicine’s Emergency Critical Care Center (EC3) and compared the total direct costs per visit between the two groups. Their findings showed no significant increase in direct cost of care following deployment of the EC3, contributing further evidence toward the value of the ED-ICU as both a viable and cost-effective model for care delivery.
"Our analysis demonstrates that the ED-ICU model works in tandem with the ED and hospital to provide care in a cost-effective manner. Improving quality while holding overall delivery costs constant is a recipe for increasing value in healthcare delivery."
Benjamin Bassin, MD
Director, EC3
Associate Professor, Emergency Medicine
“In a previous study, we demonstrated how implementing an ED-ICU reduced ICU admission rates and 30-day mortality among emergency department patients,” said study author Benjamin Bassin, MD, who serves as the Director of the EC3 and is a member of the Weil Institute. “In order to assess the overall value of this model, however, we also needed to determine how it would impact direct cost of care delivery to the emergency department and to the hospital system as a whole.”
When examining the cost per visit for critically ill patients in particular, Dr. Bassin and the team found that costs decreased by more than 20% following ED-ICU implementation—a reduction that the researchers attribute to the ED-ICU model enabling earlier initiation of ICU-level care.
“Increasing emergency department volumes have resulted in a greater demand for critical care services in the ED and ICUs, which has coincided with a shortage of intensivists and led to increased boarding of patients in the ED,” said study co-author Nathan Haas, MD, Assistant Medical Director of the EC3 and Weil Institute member. “By initiating critical care early in the ED-ICU instead of waiting for an ICU bed to open up, progression of disease severity and complications due to delayed care during ED boarding are avoided, resulting in improved downstream patient outcomes with associated cost reductions overall.”
The EC3 at Michigan Medicine was established through a gift from the Joyce and Don Massey Family Foundation to improve access to timely, high-quality critical care while providing a unique and ideal setting for cutting-edge research. Since the team’s initial publication in 2019, Michigan Medicine has collaborated with over 15 health systems in the United States and seven internationally that have sought to establish similar models. Now, with the combined findings of the two studies, the team is optimistic that more hospitals will adopt the ED-ICU concept.
“Our analysis demonstrates that the ED-ICU model works in tandem with the ED and hospital to provide care in a cost-effective manner,” said Dr. Bassin. “Improving quality while holding overall delivery costs constant is a recipe for increasing value in healthcare delivery.”
Paper cited:
“Cost-effectiveness of an Emergency Department–Based Intensive Care Unit” JAMA Network Open. doi: 10.1001/jamanetworkopen.2022.33649
See Also:
“Association of an Emergency Department–Based Intensive Care Unit With Survival and Inpatient Intensive Care Unit Admissions” JAMA Network Open. doi:10.1001/jamanetworkopen.2019.7584
Study team:
Benjamin Bassin, MD (Emergency Medicine, Weil Institute); Nathan Haas, MD (Emergency Medicine, Weil Institute); Nana Sefa, MD, MPH (Emergency Medicine, Weil Institute); Richard Medlin, MD (Emergency Medicine, Weil Institute); Timothy Peterson, MD, MBA (Emergency Medicine); Kyle Gunnerson, MD (Emergency Medicine, Weil Institute); Steve Maxwell, MBA (Emergency Medicine); James A Cranford, PhD (Emergency Medicine); Stephanie Laurinec, BS (Emergency Medicine, Weil Institute); Christine Olis, MBA (Clinical Financial Planning & Analysis); Renee Havey, DNP (Emergency Medicine); Robert Loof, MHA (Emergency Medicine); Patrick Dunn, MBA (Clinical Financial Planning & Analysis); Debra Burrum, BBA (Emergency Medicine); Jennifer Gegenheimer-Holmes, RN, MHSA (Emergency Medicine); Robert Neumar, MD, PhD (Emergency Medicine, Weil Institute); all of the University of Michigan and Michigan Medicine.
About the Weil Institute, formerly MCIRCC
The team at the Max Harry Weil Institute for Critical Care Research and Innovation (formerly the Michigan Center for Integrative Research in Critical Care) is dedicated to pushing the leading edge of research to develop new technologies and novel therapies for the most critically ill and injured patients. Through a unique formula of innovation, integration and entrepreneurship that was first imagined by Weil, their multi-disciplinary teams of health providers, basic scientists, engineers, data scientists, commercialization coaches, donors and industry partners are taking a boundless approach to re-imagining every aspect of critical care medicine. For more information, visit weilinstitute.med.umich.edu.