Healthcare economics in critical care units
This graph is based on a 343,000 patient study. As is evident in the graphic things are fairly orderly in the first three days with almost 80% of all critical care patients being discharged from the unit in that period of time. The remaining 20% linger on in the tail. The problem is, the overwhelming majority of resources are spent on those patients in the tail.
This Zimmerman study concludes that 22% of the ICU patients account for 63% of the ICU bed-days. Since these bed-days in the tail are associated with the more complex patients, these tail bed-days are more expensive than those before the tail. So it is safe to assume that > 80 % resources of critical care resources are used on those patients in the tail.
The cost of hTEE technology is almost insignificant relative to the potential return for these patients that may otherwise linger in the Tail.
It would be a mistake to wait until a patient reaches the tail and then decide to use hTEE technology. In fact, per the cited studies, once a patient reaches the tail it may be too late to change the LOS trajectory.
Per the cited studies day one profiling should be used to filter those patients that may reach the tail. In the case of surgical patients this early profiling could be surgical complexity as discussed in the Wagener cardiac study. The Zenati Trauma study discussed the relationship between LOS and day 1 hypotension depth. The Levy Sepsis study discusses how important effective day 1 intervention is for improved outcomes in Sepsis patients.
Also refer to the hTEE approach for recommended clinical indications.