Hospital ICU Overuse Costing Patients More, Not Improving Survival: Study

The findings of a new study suggests that many hospitals tend to unnecessarily use high-cost intensive care units (ICUs), and invasive procedures for patients that do not appear to improve overall outcomes. 

Researchers from the David Geffen School of Medicine at UCLA found an association between higher use rates of ICU’s and higher hospital costs, as well as higher rates of invasive procedures and death. The findings were published online August 8, in the journal JAMA Internal Medicine.

The study focused on four common medical conditions; including diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal bleeding and congestive heart failure. They analyzed more than 156,000 hospitalizations in 94 acute-care nonfederal hospitals in Washington State and Maryland from 2010 to 2012.

ICU admission rates ranged from 16% to 81% for diabetic ketoacidosis, or high blood acid levels, five percent to 44% for pulmonary embolism, 11% to 51% for upper gastrointestinal bleeding, and four percent to 49% for congestive heart failure.

Overall, hospitals that regularly used ICU care when it was not necessary, used more invasive procedures. Those hospitals also had higher costs, but had no improvement in hospital death rates for all four conditions studied.

Smaller hospitals and teaching hospitals tended to have higher ICU admission rates and used a greater number of invasive procedures.

The costs of conditions varied among lower and higher ICU use hospitals. They ranged from $7,100 and $8,200 for diabetic ketoacidosis, $10,800 to $11,100 for pulmonary embolism, $10,200 and $10,800 for upper gastrointestinal bleeding, and $10,200 and $13,600 for congestive heart failure.

Researchers highlight how inappropriate it is to use ICUs when it is medically unnecessary, as it can be harmful for patients and the healthcare system. It may lead to aggressive care and misallocation of resources from patients who truly need critical care services.

Researchers also say the reason why this often occurs is because there are a large number of patients who are “in-between” critical care and standard care. They have illnesses like the ones studied, but they are not extreme cases and can be cared for both in the ICU or general ward.

Each hospital will approach this patient differently. Some will send these patients to the ICU because they want to use the ICU at maximum capacity and refrain from over working nurses in general wards. Other hospitals will use these patients to train residents or simply send them to the general wards.

“Interventions that seek to improve the value of critical care services will need to address these factors that lead clinicians to admit patients to higher levels of care when equivalent care can be delivered elsewhere in the hospital,” wrote Dr. Dong Change, lead author of the study.