A quality and cost analysis of interprofessional team continuity in ICUs

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PROJECT ABSTRACT Critical care is the most complex, resource-intensive and costly care setting contributing over $130 billion to national health expenditures annually. Approximately 4 million patients are admitted to intensive care units (ICUs) each year with average mortality rate ranging from 8-19. Recently COVID-19 has highlighted that staffing interprofessional teams in ICUs is quite challenging. One feature of healthcare staffing that has received much attention in settings outside of the ICU is continuity of care – whereby a patient is cared for by a small team of identified professionals over time – has been long recognized as an essential attribute of high- quality, patient-centered care. In primary care, greater continuity of patient care is associated with fewer emergency department visits and hospitalizations, lower healthcare costs, and higher patient satisfaction. Continuity-based acute care staffing models also exist, but are rarely adopted and sustained in practice, particularly in ICUs where continuity-based assignments can be challenging to operationalize. Importantly, although critical care is delivered by interprofessional teams of physicians, nurses, and respiratory therapists, continuity of interprofessional ICU teams has never been conceptualized or measured before. Without this knowledge, it is difficult to know whether hospitals and administrators should prioritize continuity of ICU care, which could be a missed opportunity to improve quality of patient care and outcomes in this critically ill, costly patient population. The overall goal of our study is to examine the effect of continuity of ICU interprofessional teams on patient outcomes and organizational economic outcomes, in order to develop an interprofessional assignment decision-support tool that optimizes the continuity of interprofessional ICU team care. We propose to examine the quality and costs of an interprofessional team continuity staffing approach in ICUs to guide future interventions in 13 ICUs across two different healthcare systems using data from over 2 years. We will examine interprofessional team continuity of shift-level ICU clinician teams (a nurse, a physician, and a respiratory therapist) assigned to each patient during the ICU stay. We define two dimensions of team continuity: intra-professional continuity, measuring each of the clinician’s experience caring for the patient previously during the patient’s stay, and inter-professional continuity, measuring the clinicians’ joint experience working together as a team. We hypothesize that care delivered by shift-level ICU teams with higher intra- and inter-professional continuity will result in improved patient outcomes and reduced costs. Our research team has a strong record of joint publications on attributes of patient care teams including continuity of care with expertise in health economics, critical care nursing and medicine and engineering. Completion of the study will generate the most robust evidence, to date, to inform organizational priorities about continuity-based interprofessional staffing in ICUs, to improve care for critically ill ICU patients.