Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: implications for budgets, plant and personnel planning

Abstract

Background: Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their annualized days and costs of hospital use and SNF discharges in year 2020 in the US.

Methods: We constructed a model estimating the relevant components of hospital utilization. We computed the total days and costs for each component; we also applied the risk for SNF discharge to the total 2020 PAMV population. The underlying assumption was that process of care does not change over the time horizon. We performed Monte Carlo simulations to establish 95% confidence intervals (CI) for the point estimates.

Results: Given 2020 projected PAMV volume of 605,898 cases, they will require 3.6 (95% CI 2.7-4.8) million MV, 5.5 (95% CI 4.3-7.0) million ICU and 10.3 (95% CI 8.1-13.0) million hospital days, representing an absolute increase of 2.1 million MV, 3.2 million ICU and 6.5 million hospital days over year 2000, at a total inflation-adjusted cost of over $64 billion. Expected discharges to SNF are 218,123 (95% CI 177,268-266,739), compared to 90,928 in 2000.

Conclusion: Our model suggest that the projected growth in the US in PAMV population by 2020 will result in annualized increases of more than 2, 3, and 6 million MV, ICU and hospital days, respectively, over year 2000. Such growth requires careful planning efforts and attention to efficiency of healthcare delivery.

Figure 1

Projected Annual Hospitalization Days in 10-year Increments Spent by a Patient on Prolonged Acute Mechanical Ventilation (PAMV) in Various Strata of Hospital Care. ICU is intensive care unit. MV is mechanical ventilation. Y is year.

Figure 2

Tornado diagram. The solid vertical line represents the point estimate for the projected annualized hospital days occupied by PAMV patients in year 2020. The horizontal bars represent the range of this difference when the corresponding single input is varied across its designated range with all other input parameters held constant. PAMV is prolonged acute mechanical ventilation. MV is mechanical ventilation. ICU is intensive care unit.

Figure 3

Tornado diagram. The solid vertical line represents the point estimate for the projected annualized hospital costs for PAMV patients in year 2020. The horizontal bars represent the range of this difference when the corresponding single input is varied across its designated range with all other input parameters held constant. PAMV is prolonged acute mechanical ventilation. MV is mechanical ventilation. ICU is intensive care unit.