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

Abstract

ICU is a multifaceted organization where multiple teams care for critically ill patients. In the current era, collaboration between teams and efficient workflows form the backbone of value-based care. Geographical cohorting is a widespread model for hospitalist rounding, but its role in ICUs is unclear. This study evaluates the outcomes of geographical cohorting in a large ICU of an Academic Health Center.

Design: This is a retrospective analysis of quality metrics collected 12 months pre- and post-implementation of geographical cohorting.

Setting: A total of 130 bedded ICU at tertiary academic health center in Midwest.

Patients: All patients admitted to the ICU.

Interventions: Our institution piloted the geographical cohorting model for critical care physician rounding on September 1, 2018.

Measurements: The quality metrics were categorized as ICU harm events and ICU hospital metrics. Team of critical care providers were surveyed 12 months after implementation.

Main results: 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.

Conclusions: Geographical cohorting improves coordination of care, physician workflow, and critical care quality metrics in very large ICUs.

Keywords: burnout; collaboration of care; critical care quality metrics; geographical cohorting.