Impact of Geographical Cohorting in the ICU: An Academic Tertiary Care Center Experience.

Abstract

This is a retrospective analysis of quality metrics collected 12 months pre- and post-implementation of geographical cohorting. A total of 130 bedded ICU at tertiary academic health center in Midwest. All patients admitted to the ICU. Our institution piloted the geographical cohorting model for critical care physician rounding on September 1, 2018. The quality metrics were categorized as ICU harm events and ICU hospital metrics. Team of critical care providers were surveyed 12 months after implementation. The critical care utilization in the pre- and post-implementation numbers were similar for patient days (pre = 34,839, post = 35,155), central-line days (pre = 17,648, post = 19,224), and Foley catheter days (pre = 18,292, post = 17,364). The ICU length of stay was similar (4.9 d) in both pre- and post-intervention periods. Significant reduction in the incidence of Clostridium difficile infection (relative risk, -0.50; 95% CI, 0.25-0.96; p = 0.039), hospital-acquired pressure injury (relative risk, -0.60; 95% CI, 0.39-0.92; p = 0.020), central line-associated bloodstream infection incidence (relative risk, -0.19; 95% CI, 0.05-0.52; p = 0.008), and catheter-associated urinary tract infection (relative risk, -0.52; 95% CI, 0.29-0.93; p = 0.027). Healthcare providers perceived optimal utilization of their time, reduced interruptions, and improved coordination of care with geographical rounding. Geographical cohorting improves coordination of care, physician workflow, and critical care quality metrics in very large ICUs.