b'The Challenge: Wide-ranging effect of an outdated mindsetThepandemicexposedthewide-rangingeffectofthe In this existing paradigm, many C-suite professionals outdated ICU paradigm. In the critical care medicinemight consider building a full ICU program with better space, we are realizing the following trends: coverage to improve throughput and patient outcomes. To provide 24 hours of coverage seven days a week, Delays in care to critically ill patients lead to a this example of a 16-bed ICU will need two full-time rippleeffectofadditionalcoststhroughouttheintensivists and two critical care APPs. In addition, a hospital, and not just in terms of negative medical director will oversee the program.outcomes. Under-resourced or locums-resourced ICUs Here is what this hypothetical program might cost:promote net increases in cost, wasted time anddelayed patient care leading to sub-optimal Annualizedoutcomes.16-BED ICU STAFFING COSTSPoor communication amongst clinical teamsalso produces additional cost, because of delaysin care, poor throughput, and longer lengths of Intensivist: $400,000$500,000/year x2stay (LOS). Considering the total cost of ICU care from the incomeNight call: $110,000$180,000& expense statement perspective, there is one cost forMedical $80,000$100,000each service line of care delivered and a subsidy forDirectorship:the ED. Unfortunately, examining critical care from this perspective can lead to a misunderstanding of total costsAPP: $160,000$200,000 x2andthebenefitsdeliveredtopatients.Asegmentedviewleads to unsustainable services and negative outcomes for patients, clinicians, and the hospital.TOTAL: $1.31$1.68 millionConsider a typical critical care facility with a 16-bed ICU. Thecriticalcareteamcoverstheshiftsthroughoutthe Note: costs will vary depending on the location and week, usually with a fractioned coverage model. Themarket conditionshospital has some nighttime coverage with an APP, but thereisinsufficientvolumeorfinancialresourcesforadedicated coverage model.If it is a 30-bed ICU, you will need an additional This model is prone to problems in managementintensivist on days and potentially an additional APP which lead to inappropriate ICU admissions, sub-paron nights, boosting the price tag closer to $2.75 million. throughput, and negative outcomes such as higherMeanwhile, in the existing paradigm, the hospital was mortality and increased length of stay.only paying about $200,000 for those four to six hours of cross-coverage.Additionally,thecurrentstaffingmodelleadstopoordocumentationbecauseitisnosinglecliniciansprimary The program above, with a full-functioning ICU with focus. This leads to reduced fee-for-service revenue and24/7coverage,willgivealmostanychieffinancialofficera negative downstream impact on the case mix index(CFO) sticker shock. When I meet with the C-suite at (CMI). hospitals considering an expansion of coverage, they oftenblanchatthecosts.Butthisisthinkingaboutcostsin the old, siloed paradigm.Together, we healTogether, we heal 2Together, we heal SCP HEALTHIBRINGING THE C-SUITE TO THE BEDSIDE IN CRITICAL CARE MEDICINE'