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Study: As Many as Half of ICU Patients Don't Need to Be There

News  |  By Alexandra Wilson Pecci  
   January 23, 2017

"ICU care is inefficient because it is devoting substantial resources to patients who are less likely to benefit from this level of care," researcher says.

Intensive care units are expensive, invasive, and are supposed to be reserved for the sickest hospital patients, but more than half the time, they're not needed, according to research from LA BioMed and UCLA.

For the study, published in the JAMA Internal Medicine, researchers examined all of the 808 ICU admissions from July 1, 2015 to June 15, 2016 at Harbor-UCLA Medical Center.

They found that more than half the patients could have been cared for in less-expensive and less-invasive settings.

Of the patients in the study, 23.4% were in need of close monitoring but not ICU-level care. Another 20.9% were critically ill but unlikely to recover because they had underlying illnesses or severity of acute illness. For another 8%, death was imminent or the same outcomes were expected in non-ICU care.

In addition, the researchers added up the number of days each of the patients in the study spent in ICU and found nearly 65% of the total number of days those patients spent in ICU were allocated to care that was considered discretionary monitoring, had a low likelihood of benefit despite critical illness, or would have been manageable in non-ICU settings.

"This research indicates that ICU care is inefficient because it is devoting substantial resources to patients who are less likely to benefit from this level of care. These findings are a concern for patients, providers, and the health care system because ICU care is frequently invasive and comes at a substantial cost," Dong W. Chang, MD, an LA BioMed researcher and the corresponding author for the study, said in a statement.

The researchers noted that in other hospitals, the ICU may be the most appropriate level of care because the hospitals don't have appropriate levels of care for those patients outside the ICU.

"However, there is likely to be a subset of patients in which ICU care leads to unwanted, invasive care without significant clinical benefit," said Chang.

"Refining our ability to identify these patients and developing approaches to improve ICU utilization for those patients are important steps to assure the best care for patients and the most efficient use of the healthcare system's limited resources."

Research by the same team last year showed that ICU 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.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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