Acuity Adaptable Patient Care Unit Shortens Length of Hospital Stay after Ventricular Assist Device Placement

Abstract

<h3>Purpose</h3> An Acuity Adaptable Patient Care Unit (AACU) allows all beds in a nursing unit to provide all levels of care, negating the need for room transfer with changes in patient status. A cardiothoracic surgery AACU was implemented in March 2006 at our institution. This study examines the impact of the AACU system on outcomes after ventricular assist device (VAD) placement. <h3>Methods and Materials</h3> We retrospectively reviewed 195 consecutive patients with VAD placement 01/2000 to 09/2012. The cohort was divided into the pre-AACU group (01/2000 to 02/2006, n=50) and the AACU group (03/2006 to 09/2012, n=145). Demographics and outcomes were assessed. <h3>Results</h3> Demographics did not differ between the groups, except for the pre-operative requirement of intra-aortic balloon pump (50 [pre-AACU] vs. 28% [AACU], p<0.01) and hemodialysis (10 vs. 1%, p=0.01). The pre-AACU cohort had fewer destination therapy (12 vs. 24%, P<0.01), and continuous flow devices (4 vs. 73%, p<0.01). The median length of intensive care unit (ICU) and hospital stays were significantly shorter in the AACU group by 5 and 6 days, respectively (p<0.01, figure). Hospital mortality, ICU and hospital readmission rates, and complications did not differ between the groups (table). <h3>Conclusions</h3> An AACU allows the appropriate level of care and ancillary support without patient transfer and has contributed to a decreased ICU and hospital stay for our VAD patients without increasing complications or readmissions. [figure 1] pre-AACU (n=50)AACU (n=145)pLength of ICU stay (d)8 (range, 0-80)3 (1-50)<0.01Length of hospital stay(d)17 (0-285)11 (1-108)<0.01Hospital mortality8%5%0.48ICU readmission10%5%0.19Hospirall readmission18%17%0.99