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Unnecessary ICU use affects patient costs, care

Some institutions unnecessarily utilize ICU care for patients with certain medical conditions who can likely be treated in non-ICU settings, resulting in increased costs, according to findings published in JAMA Internal Medicine.

Further, the overutilization of ICU care led to higher likelihood of performing invasive procedures and did not improve hospital mortality, the researchers found.

“Overuse of ICUs for patients who can likely receive equivalent care in non-ICU settings may lead to invasive, potentially harmful, care and decrease access for patients for whom critical care services may be beneficial,” Dong W. Chang, MD, MS, from the department of Medicine at Harbor-UCLA Medical Center, and Martin F. Shapiro, MD, PhD, of the David Geffen School of Medicine, University of California, Los Angeles, wrote. “Determining whether variation in ICU utilization stems from disease-specific or institutional factors is an important step in developing interventions to reduce unwanted variation.”

The researchers examined whether hospitals had consistent patterns of ICU use across four common medical conditions. They also evaluated the connection between higher use of the ICU and hospital costs, use of invasive procedures, and mortality.

The retrospective cohort study included 156,842 hospitalizations in 94 acute-care nonfederal hospitals in Washington and Maryland from 2010 to 2012 for diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal bleeding, and congestive heart failure.

The researchers ranked hospitals based on the predicted ICU utilization rate to examine the variability in ICU utilization for each condition across institutions. Multilevel logistic regression models predicted hospital-level ICU utilization during hospitalizations for the four conditions.

Chang and colleagues found ICU admission rates ranged from 16.3% to 81.2% for diabetic ketoacidosis, 5% to 44.2% for pulmonary embolism, 11.5% to 51.2% for upper gastrointestinal bleeding, and 3.9% to 48.8% for congestive heart failure. There were high correlation rates in ICU use between all four conditions among the hospitals (P < .01 for all). The researchers found no association between hospital-level ICU utilization rate and hospital mortality for each medical condition; however, costs of hospitalization and use of invasive procedures were higher in institutions with greater ICU utilization.

“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,” Chang and colleagues wrote. “Optimizing ICU utilization may improve quality and value of ICU care, but accomplishing that will require institutional assessments of factors that lead clinicians to admit patients to the ICU for cases in which that level of care may not be necessary.” – by Savannah Demko

Disclosure: The researchers report no relevant financial disclosures.