Hospital ICU Admission Often Unnecessary, Overused: Study

More patients are admitted to hospital intensive care units (ICUs) than necessary, according to the findings of a new study that suggests that level of care is often unnecessary for most individuals receiving ICU treatment. 

Researchers from LA BioMed and Harbor-UCLA Medical Center found that many patients cared for in the ICU do not benefit from the invasive level of care and could be sufficiently treated in other settings. The findings were published this week in the Journal of the American Medical Association Internal Medicine.

The study involved a review of more than 800 ICU admissions at Harbor-UCLA Medical Center from July 1, 2015, to June 15, 2016. Among the findings, researchers determined more than half the patients could have been cared for in less expensive and less invasive settings.

Over 50% of the patients admitted to the ICU were categorized into low priority care groups. These group categories suggested the patients are either too well for the ICU or too sick to benefit from the focused cared of the ICU. They could have received equivalent care in non-ICU settings.

About 23% of patients were in need of close monitoring, but did not need ICU-level care. Another 21% were critically ill, but were considered unlikely to recover because they had underlying illnesses, or their illness was very severe and thus did not need ICU care. Among eight percent of ICU patients, death was imminent, or the patient would have also faced imminent death in a non-ICU care facility.

“Our findings suggest that ICU care is inefficient, devoting substantial resources to patients less likely to benefit,” wrote Dr. Dong W. Chang, the study’s lead author.

The study found that about 65% of the total number of days patients spent in the ICU were for care that was considered “discretionary monitoring.” Those patients had a low likelihood of benefitting from ICU-level care, or their condition would have been treatable in a non-ICU setting.

The findings raise questions about ICU overuse and unnecessary medical costs associated with the treatments. ICUs offer the most invasive and the most expensive forms of care in a hospital.

A study published in August suggested many hospitals overuse high-cost intensive care and it does not improve patient outcomes. Researchers concluded in that study that higher use rates of ICU were linked to higher hospital costs and higher rates of invasive procedures and death.

While this study only focused on ICU care in one hospital, Harbor-UCLA Medical Center, researchers said the findings are commonplace in many other hospitals as well. They recommended that hospitals focus on the overuse of ICU to offer patients the best care.

Researchers emphasized the importance of refining a hospital and medical staff’s ability to identify patients who would not benefit from ICU care and develop approaches to improve ICU utilization.