Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning.

Marya D Zilberberg,Andrew F Shorr

doi:10.1186/1472-6963-8-242

Abstract

BackgroundAdult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their annualized days and costs of hospital use and SNF discharges in year 2020 in the US.MethodsWe constructed a model estimating the relevant components of hospital utilization. We computed the total days and costs for each component; we also applied the risk for SNF discharge to the total 2020 PAMV population. The underlying assumption was that process of care does not change over the time horizon. We performed Monte Carlo simulations to establish 95% confidence intervals (CI) for the point estimates.ResultsGiven 2020 projected PAMV volume of 605,898 cases, they will require 3.6 (95% CI 2.7–4.8) million MV, 5.5 (95% CI 4.3–7.0) million ICU and 10.3 (95% CI 8.1–13.0) million hospital days, representing an absolute increase of 2.1 million MV, 3.2 million ICU and 6.5 million hospital days over year 2000, at a total inflation-adjusted cost of over $64 billion. Expected discharges to SNF are 218,123 (95% CI 177,268–266,739), compared to 90,928 in 2000.ConclusionOur model suggest that the projected growth in the US in PAMV population by 2020 will result in annualized increases of more than 2, 3, and 6 million MV, ICU and hospital days, respectively, over year 2000. Such growth requires careful planning efforts and attention to efficiency of healthcare delivery.

Highlights

Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF)
We recently described a novel sub-population of patients on mechanical ventilation (MV), those requiring prolonged acute mechanical ventilation (PAMV, defined as MV for ≥ 96 hours), who, though comprising 1/3 of all patients on MV, utilize 2/3 of the associated hospital resources
Since by virtue of spending at least 96 hours on MV the PAMV patients fall outside the estimated ranges for either acutely-ventilated populations [26,27] or those on prolonged MV [28], we developed the following approach to quantifying the MV and intensive care unit (ICU) components of their hospital utilization: 1)

Summary

Introduction

Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. Nearly half of Emergency Departments (EDs) are reporting operating at or over capacity, and one-third report some time on diversion, the most frequent reason being the lack of staffed critical care beds [16] This is not surprising, since the number of ICU beds has remained essentially unchanged between 1991 and 2004 [18]

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Conclusion