Hospitals that use ICUs frequently are more likely to perform invasive procedures and have higher costs, but without demonstrable improvement in patient survival.
Intensive care unit patients underwent costlier invasive procedures but didn't have better mortality rates than patients with the same medical conditions who weren't in the ICU, according to a new study published in JAMA Internal Medicine.
The study, conducted by researchers at LA BioMed and UCLA, looked at records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is often provided but may not be medically necessary: diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage, and congestive heart failure.
Study author Dong W. Chang, MD, a researcher at LA BioMed, said hospitals that use ICUs more frequently were more likely to perform invasive procedures and incur higher costs. Chang said, however, that those hospitals demonstrated no improvement in mortality among these ICU patients when compared with other hospitalized patients with the four conditions.
ICU Use for Cardiac Patients Linked to Higher Mortality Rates
"We found that hospitals that have high ICU utilization for one condition generally do so for other conditions as well," Chang said.
"This suggests that there are systematic institutional factors that affect whether hospitals over-use their ICUs. Importantly, hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and have higher costs, but without] improvement in patient survival."
Smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied than did larger hospitals.
Additional Hospital Costs
The difference in the average costs ranged from $647 more for upper gastrointestinal hemorrhage care in the ICU to $3,412 more to care for a patient with congestive heart failure in the ICU when compared with hospital care for the same conditions outside the ICU, according to the study.
Chang said optimizing ICU care will require assessments of institutional factors that may lead clinicians to over-utilize ICU care.
"In addition, overuse of ICUs among patients who can likely be treated in non-ICU settings may lead to inappropriately aggressive care and misallocation of resources away from patients who may truly need critical care services," he said.
"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," Chang said.
"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."