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PARETO PRINCIPLE IN THE ICU: THE CASE OF MECHANICAL VENTILATION

      SESSION TITLE: Critical Care Posters
      SESSION TYPE: Original Investigation Posters
      PRESENTED ON: October 18-21, 2020
      PURPOSE: Pareto principle can be stated as “majority of the effect comes from a minority of the causes.” This property is widely utilized in quality improvement science. We sought to determine if it applies it to patients requiring mechanical ventilation (MV) by examining the quintiles of MV duration, to identify potential nodes for high value interventions aimed at reducing costs without compromising quality.
      METHODS: We conducted a multicenter retrospective cohort study from ∼780 hospitals in the Premier database, 2014-2018. Using ICD-9-CM and ICD-10 codes we identified MV patients, and, dividing them into quintiles by MV duration, compared their hospital costs, post-MV onset LOS, ICU LOS, and cumulative post-MV onset hospital days per quintile.
      RESULTS: A total of 691,961 patients were included in the analysis. Median [interquartile range, IQR] duration of MV in days by quintile was as follows: quintile (Q) 1:1[1,1]; Q2:2[2,2]; Q3:3[3,3]; Q4:6[6,7]; Q5:13[10,19]. Median [IQR] post-MV onset LOS (Q1: 2 [0,5]; Q5: 17 [12,26]) and hospital costs (Q1: $15,671 [$9,180, $27,901]; Q5 $70,133 [$47,136, $108,032]) rose from Q1 through Q5. Cumulatively, patients in Q5 consumed 47.7% of all post-MV initiation hospital days of the entire population requiring MV. Adjusted marginal mean (95% confidence interval) hospital costs rose exponentially from Q1 through Q5: Q2 vs. Q1 $3,976 ($3,354, $4,598); Q3 vs. Q2 $5,532 ($5,103, $5,961); Q4 vs. Q3 $11,705 ($11,071, $12,339); Q5 vs. Q4 $26,416 ($25,215, $27,616).
      CONCLUSIONS: MV patients in the highest quintile of MV duration utilize nearly 50% of all hospital days among all patients requiring MV.
      CLINICAL IMPLICATIONS: Because of vastly disproportionate use of hospital resources, patients in MV Q5 present a potential target for streamlining MV care.
      DISCLOSURES: No relevant relationships Added 03/23/2020 by Brian Nathanson, source=Web Response, value=Consulting fee
      Removed 03/23/2020 by Brian Nathanson, source=Web Response
      Consultant relationship with Lungpacer Please note: $5001 - $20000 Added 03/23/2020 by Andrew Shorr, source=Web Response, value=Consulting fee
      Employee relationship with Lungpacer Medical Inc Please note: $1-$1000 Added 03/23/2020 by Judy Ways, source=Web Response, value=Ownership interest
      Owner/Founder relationship with Neuronetics Please note: $20001 - $100000 Added 03/23/2020 by Judy Ways, source=Web Response, value=Ownership interest
      Consultant relationship with Lungpacer Please note: $20001 - $100000 Added 02/20/2020 by Marya Zilberberg, source=Web Response, value=Grant/Research Support
      Consultant relationship with Merck Please note: $20001 - $100000 Added 02/20/2020 by Marya Zilberberg, source=Web Response, value=Grant/Research Support
      Consultant relationship with Spero Please note: $5001 - $20000 Added 02/20/2020 by Marya Zilberberg, source=Web Response, value=Grant/Research Support
      Consultant relationship with Melinta Please note: $1001 - $5000 Added 02/20/2020 by Marya Zilberberg, source=Web Response, value=Consulting fee
      Consultant relationship with Nabriva Please note: $1001 - $5000 Added 02/20/2020 by Marya Zilberberg, source=Web Response, value=Consulting fee