Higher ICU usage led to increased invasive procedures, costs

The study, published online in JAMA Internal Medicine, examined records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is frequently provided but may not be medically necessary: diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage and congestive heart failure.

The study found the hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and incur higher costs. But the study found these hospitals had no improvement in mortality among patients in the ICU when compared with other hospitalized patients with these four conditions.

"The study findings suggest that optimizing the value of ICU care will require assessments of systematic institutional factors that may lead clinicians to over-utilize ICU care," said Dong W. Chang, MD, an LA BioMed researcher and corresponding author of the study. "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."

The researchers reported that smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied that did larger hospitals. 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.

"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 Dr. Chang. "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."