SCCM | Intensive care statistics (2023)

Intensive care statistics
The Society for Critical Care Medicine (SCCM) represents more than 16,000 highly trained professionals in more than 100 countries who provide care in specialized units and work to achieve the best possible outcomes for all critically ill and injured patients. SCCM asserts that interdisciplinary care teams led by intensivists (physicians trained and licensed in critical care medicine [CCM]) are critical to delivering critical care, improving conditions for healthcare workers, and increasing hospital financial performance. This guide provides statistics on many current issues in critical care in the United States. It is intended for use as a reference in efforts such as advocacy, PR and general education.

Costs of intensive care
Between 2000 and 2010, annual CCM costs increased by 92%, from $56.6 billion to $108 billion. The costs for 2010 represent 13.2% of hospital expenditure, 4.1% of national health expenditure and 0.72% of gross domestic product. The costs of an intensive care unit (ICU) per day in 2010 was estimated at $4,300 per day, an increase of 61% from 2000, when the price per day was $2,669.

Possible savings
Cost savings of up to USD 1 billion per quality-adjusted life years gained can be achieved by managing severe sepsis, acute respiratory failure, and general intensive interventions. The use of 24-hour intensive care staffing has been hypothesized to have several benefits, including reduced costs, mortality, complications, hospital length of stay (LOS), improved physician satisfaction, and reduced burnout. However, most studies regarding the benefits of 24-hour intensive care staffing have primarily been conducted in tertiary or academic centers that have high patient acuity and volume. Up to $13 million in annual hospital savings can be realized when care is provided by a multidisciplinary team led by intensivists. The impact of this type of care is demonstrated by the example of a local hospital that achieved a 105% return on investment by implementing mandatory ICU consultations and admission standards, thereby reducing ICU LOS, ventilator-associated events, and central venous access unit infections.

Hospitals without on-site intensivists can benefit from telemedicine or telecritical care services, where sophisticated electronic systems link ICU patient data with intensivists in remote locations. Intensivists provide real-time monitoring, diagnosis and intervention services and work with bedside staff. Telemedicine intensivists also communicate with patients and their family members. In selected settings, ICU treatment has shown shorter ICU LOS and lower ICU mortality, which may translate into lower hospital costs and better resource utilization. A systematic review and meta-analysis of 19 ICU telemedicine studies concluded that ICU programs are associated with reductions in ICU and hospital mortality and ICU LOS, but not in hospital LOS, and that their implementation is costly. A recent study by the Emory Critical Care Center found that implementing an Advanced Practice Provider Internship (APP) and tele-ICU program with critical care nurses and consultant intensivists resulted in $4.6 million in savings.

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Patients in intensive care
More than 5 million patients are admitted to intensive care units in the United States annually for intensive or invasive monitoring; airway, breathing or circulatory support; stabilization of acute or life-threatening medical problems; comprehensive treatment of injuries and/or illnesses; and maximizing comfort for dying patients. ICU patients are a heterogeneous population, but all have the need for frequent investigations and a greater need for technological support in common than patients admitted to non-ICU beds.

Adult: Cardiac, respiratory and neurological conditions are common in adult patients in intensive care. The five primary ICU admission diagnoses for adults are ventilator-assisted respiratory insufficiency/failure, acute myocardial infarction, intracranial hemorrhage or cerebral infarction, percutaneous cardiovascular procedures, and septicemia or severe sepsis without mechanical ventilation. Other conditions and procedures involving high use in intensive care are poisoning and toxic effects of drugs, pulmonary edema and respiratory failure, heart failure and shock, cardiac arrhythmia and conduction disturbances, renal failure with major complications or comorbidities, gastrointestinal bleeding with complications or comorbidities, and diabetes with complications or comorbidity. The most common technological support is mechanical ventilation, which is required by 20%-40% of intensive care unit admissions in the United States.

Pediatrics: Patients admitted to the pediatric intensive care unit (PICU) may have either acute illness or acute exacerbations associated with complex chronic conditions. Diseases of the respiratory tract are the most common diagnoses. The average age of children admitted to the PICU varies from less than 1 year to 1.9 years. The most common indications for PICU admission are respiratory disease, cardiac disease, and neurological disorders. Children with developmental delays may account for as much as 38% of PICU admissions. LOS is greater than 7 days in more than 35%-40% of hospitalized patients, and more than 40% of PICU admissions require mechanical ventilation. Severe sepsis and septic shock are also common in the PICU, with a prevalence of more than 8% worldwide and a mortality of more than 24%.

Neonatal patients admitted to the neonatal intensive care unit (NICU) were born prematurely or at term with serious medical or surgical conditions. While most newborns with very low birth weight (< 1500 g) are cared for in intensive care units, more than half of those admitted to intensive care are born at term and of normal birth weight. Outcomes are improved for high-risk babies, especially premature babies born in intensive care units. Mortality rates in intensive care units range from 4% to 46% in developed countries and 0.2% to 64.4% in developing countries. The American Academy of Pediatrics (AAP) defines a NICU as a facility that can provide neonatal care with life support, a full range of respiratory support, access to pediatric medical and surgical specialties, pediatric anesthesiologists, and pediatric ophthalmologists. The AAP defines the NICU in terms of four levels of care with increasing capabilities as the levels increase (Level I: Well Baby Nursery, Level 2: Special Care Nursery, Level III and IV: Full Intensive Care).

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Intensive wards
Data on intensive care units in the United States are available in two national hospital databases: the American Hospital Association (AHA) Hospital Statistics System and the US Centers for Medicare and Medicaid Services' Healthcare Cost Reporting Information System (HCRIS). The AHA provides data on the number of ICU beds and units for adult (medical-surgical, cardiac, and other) and pediatric (pediatric and neonatal) units, as well as similar data for burn units and observation, drop-down, or progressive beds. AHA does not provide data on bed use. HCRIS provides data on beds and bed utilization for adult (intensive care, coronary care, surgical/trauma, burn, psychiatric/detox) and pediatric (pediatric and neonatal) beds (but not units). HCRIS data includes US government use of Medicare and Medicaid. HCRIS does not have data on observation, descent, or progressive beds.

AHA data:According to the AHA's 2015 annual survey, the United States had 4,862 registered acute care hospitals; 2814 of them had at least 10 beds for acute care and at least 1 bed for intensive care. These hospitals had a total of 540,668 staffed beds and 94,837 ICU beds (14.3% ICU beds/total beds) distributed among 5229 ICUs. There were 46,490 medical-surgical beds in 2,644 wards, 14,731 cardiology beds in 976 wards, 6,588 other beds in 379 wards, 4,698 pediatric beds in 307 bed wards and 22,330 neonatology bed wards. The average number of beds in medical-surgical, cardiology and other units was 12, of which 10 beds were in paediatrics and 18 in neonatology. 52 percent of hospitals had 1 ward, 24% had 2 wards, and 24% had 3 or more wards.

HCRIS data:In 2010, there were 2,977 emergency hospitals with intensive care beds. These included a total of 641,395 emergency beds with 103,900 intensive care beds (16.2% of intensive care beds/total number of beds). From 2000 to 2010, the number of intensive care beds in the United States increased by 17.8%, from 88,235 to 103,900. But most of the growth in the supply of ICU beds is occurring in a small number of regions in the United States, which tend to have large populations, fewer initial ICU admissions per 100,000 inhabitants, higher initial occupancy in intensive care units and increased competition in the market. Furthermore, the largest percentage increase between 2000 and 2010 was recorded in infant beds (29%), followed by adult beds (26%). there are minimal changes in pediatric beds (2.7%). Of the 103,900 ICUs in 2010, 83,417 (80.3%) were adult, 1,917 (1.8%) were pediatric and 18,567 (17.9%) were neonatal. The total number was 33.6 beds per 100,000 inhabitants, 35.5 beds per 100,000 adult beds (age > 18 years), 2.7 beds/100,000 pediatric beds (age 1-17 years) and 470 beds/100,000 neonatal beds (age <1 year) . ).

Days of intensive treatment:HCRIS analysis showed that there were 150.9 million inpatient days, including 25 million intensive care days in 2010 (16.5% intensive care days/days total). Medicare accounted for 7.9 million intensive care days (31.4%), and Medicaid accounted for 4.3 million intensive care days (17.2%).

Coating:Occupancy rates were calculated from HCRIS data (days/possible days). In 2010, the occupancy rate in hospitals and intensive care units was 64.6% and 68% respectively. Occupancy rates vary by hospital size, with higher occupancy rates associated with larger hospitals.

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Duration of stay
ICU LOS has been estimated at 3.8 days in the United States. However, it varies depending on the characteristics of the patient and the intensive care unit.

Morbidity in mortality
Despite the increasing age and severity of illness of ICU patients, there was a relative decrease in mortality of 35% for ICU admissions from 1988 to 2012. The leading causes of death in the ICU are multiorgan failure, cardiovascular failure, and sepsis. Sepsis affects more than 1.7 million people in the United States and is the leading cause of death in American hospitals, causing 270,000 deaths annually. It is also the leading cause of hospital readmissions within 30 days, costing more than $2 billion annually. Of patients diagnosed with sepsis, up to 51% develop acute renal failure and up to 20% develop acute respiratory failure requiring mechanical ventilatory support. More than 75,000 children develop sepsis each year, and 6,800 of these children die.

Overall, mortality in adult ICU patients averages 10% to 29%, depending on age, comorbidity, and disease severity. Mortality for patients admitted to the intensive care unit is higher in the next 10 years after they leave the intensive care unit compared to age-matched patients who have never been admitted to the intensive care unit. The overall mortality rate for pediatric intensive care patients ranges from 2% to 6%.

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Personnel and salaries
A multidisciplinary critical care team may consist of critical care nurses, APPs (nurse and physician assistants), intensivists, paramedics, pharmacists, respiratory therapists, nutritionists, social workers, and other professionals. There are challenges in defining these groups and obtaining data. For example, an intensivist may be defined as a physician formally trained in critical care, with or without CCM board certification, who works in an intensive care unit with variable time commitments. However, a paramedic without formal CCM training may be privileged to provide CCM care. Intensive care nurses are easy to recognize; However, the American Association of Critical Care Nurses (AACN) does not maintain a global database. Similar problems exist in determining the total number of respiratory therapists and pharmacists and those who work primarily in the intensive care unit. Salaries are also difficult to determine because they vary widely based on experience, location, type of hospital and work model, and of course public reporting.

CCM nurses: According to Connie Barden, AACN's chief clinical officer, the number of critical care nurses is approximately 512,000 (a figure derived from the 2017 National Council of State Boards of Nursing Practice Analysis, the 2016 State of Nursing White Paper [nursing.org], and the 2015 National Nursing Survey [ J Nurs Regul. 2016;7:S1-S90]). Critical care nurse salaries range from $66,316 to $79,962, but these salaries vary widely based on education, certifications, additional skills, and years in the profession.

APPs: Estimates suggest that more than 29,700 emergency nurses and 1,500 physician assistants practice critical care in the United States. Median salaries were estimated at $122,432 for emergency room nurses and $122,957 for physician assistants.

Intensivister: AHA data for 2015 indicated that there were approximately 29,000 licensed intensivists in the United States, equivalent to 20,000 full-time intensivists. Physician compensation data from the American Medical Group Association shows that the average compensation for intensivists in 2017 was $400,000; The 2018 Medscape Intensivist Compensation Report lists this number as $354,000.

Respiratory therapists: The most recent data (2016) from the US Bureau of Labor Statistics estimates that there are a total of 130,200 respiratory therapists in the country. Their average salary is $59,710.

Pharmacists in intensive care: In 2012, a task force on emergency pharmacists sponsored by the American College of Clinical Pharmacy, the American Pharmacists Association, and the American Society of Health System Pharmacists (ASHP) estimated that there are 6000–7000 emergency pharmacists in the United States. with an estimated average annual salary of $125,000. A 2011 national ASHP survey found that pharmacists were assigned to critical care in 68.8% of US hospitals.

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Labor shortage
The increasing number of intensive care beds over the past four decades appears to reflect an increase in demand for intensive care services. Several factors appear to have led to the increase in demand. These include increased life expectancy, an increasingly aging population and advances in medical therapy.
At the same time, the Society for Pulmonary and Critical Care Workforce Committee (COMPACCS) released a well-researched statistical projection study in 2000 that suggested a looming shortage of intensivists. Recent government reports have shown ambiguous information. There are two minds about whether there is actually a shortage of intensivists. The first suggests that intensive care beds, although the number is increasing, are not always being used correctly. Therefore, many patients admitted to intensive care either cannot benefit from intensive treatment because they are too healthy or at the end of life. So there are too many intensive care beds, and perhaps too many intensivists. In addition, not all ICU patients require intensive care during their entire ICU stay. Another school of thought suggests that there is a persistent and growing shortage of intensivists who cannot keep up with the reality of intensive care admissions and the stretching of intensive care specialists to provide care throughout the hospital (ie staffing 24/7 rapid response -teams), participation in internal 24/7 ICU coverage, coaching and training for all ICU staff and participation in ICU administrative oversight and quality and safety and research activities.

A study analyzing 2,814 acute care hospitals in the United States with ICU beds in the 2015 AHA database found that the hospitals were evenly distributed in terms of the presence of intensivists; 1469 (52%) had intensivists and 1345 (48%) did not. Hospitals with intensivists were more likely to be located in urban areas and had almost three times the number of total hospital beds, 3.6 times as many ICU beds and almost twice as many intensive care units compared to hospitals without intensivists. However, hospitals with intensive coverage had approximately 75% of ICU beds, suggesting that the shortage of intensivists may not be as problematic as previously thought.

Another problem in understanding the extent of ICU coverage and the adequacy of the intensive care workforce is that it is difficult to determine the scope of ICU telemedicine programs. It is possible that hospitals without intensivists who are privileged and provide on-site care may have telemedicine contracts.

Training Pipeline:Understanding the CCM scholarship environment is challenging. Over the past decade (2008-2018), there has been a steady increase in the number of critical care staff in all specialties (CCM, pulmonology-CCM, emergency medicine-CCM, surgery, anesthesiology, pediatrics and neonatology). There were 369 accredited adult and pediatric CCM training programs with 2,023 fellows in 2008, a 25% increase to 462 programs with 3,074 fellows in 2018. More than 80% of intensivists in the United States are trained in internal medicine CCM fellowships.

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