Hospitals with a high percentage of patients cared for in the intensive care unit are more likely to incur higher costs and perform more invasive procedures with no improvement in patient mortality rates when compared with hospitals with less ICU usage, according to a new study published in JAMA Internal Medicine.
For the study, researchers examined data on more than 150,000 hospitalizations involving four conditions from 94 hospitals across Washington state and Maryland between 2010 and 2012. The four conditions examined were diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal bleeding and congestive heart failure.
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ICU admission rates ranged from 6.3 percent to 81.2 percent for DKA, 5.0 percent to 44.2 percent for PE, 11.5 percent to 51.2 percent for UGIB and 3.9 percent to 48.8 percent for CHF. Rates of invasive procedures were higher among hospitals with higher rates of ICU usage. Higher costs related to all four conditions were also associated with high ICU admission. ICU utilization was unassociated with hospital mortality. Smaller hospitals with fewer beds typically displayed higher rates of ICU admission, as did teaching hospitals.
"This study begins to tell the story of how the inappropriate use of ICUs can be harmful for patients and costly for the healthcare system," said Dong W. Chang, MD, a researcher with LA BioMed in Torrance, Calif., and corresponding author of the study. "But the story is incomplete, and we need more information on the mechanisms that drive some hospitals to use their ICUs more readily. In the meantime, hospital policies and institutional protocols in non-ICU settings that lead to overutilization of ICU care should be examined because they represent the best opportunities for reducing invasive procedures and lowering costs while ensuring the best possible care for the patient."
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