[How can we optimize medical orderings in intensive care unit (ICU)?]

Area of Science:

• Critical Care Medicine
• Health Economics
• Medical Informatics

Context:

• Intensive Care Units (ICUs) face challenges in optimizing resource utilization.
• Medical ordering practices significantly impact patient outcomes and healthcare costs.
• A monocentric evaluation was conducted to assess a medical economic procedure.

Purpose:

• To evaluate intensivists' acceptance of optimizing orders for biological samplings, X-rays, and drugs.
• To assess the impact of optimized medical ordering on patient outcomes.
• To determine the economic consequences of optimizing medical orders in an ICU setting.

Summary:

• A monocentric study involved regular meetings with physicians and pharmacists to review and adjust medical ordering practices.
• Discouraged were systematic samplings, bedside X-rays, and unjustified expensive drugs; encouraged were target samplings and lung ultrasonography.
• Training for new residents on the optimization program was implemented, alongside monthly morbidity-mortality meetings to track consequences.

Impact:

• Achieved a 3.4% increase in ICU production while decreasing potentially avoidable deaths by 34%.
• Resulted in annual cost savings of approximately €777,000 between 2006 and 2008.
• Demonstrated significant reductions in orders for biology (30%), bedside X-rays (10%), CT scans (16%), and target drugs (35%).