ICU care is frequently overused and may not improve hospital mortality

Hospital mortality rates do not improve in institutions that frequently use ICU care for patients.
Hospital mortality rates do not improve in institutions that frequently use ICU care for patients.

Institutions that more frequently use ICU care are more likely to perform invasive procedures with no improvement in hospital mortality rates, according to research published in JAMA Internal Medicine.

Dong W. Chang, MD, MS, Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute, UCLA Medical Center, and colleagues conducted a retrospective cohort study of 156,842 hospitalizations across 94 acute-care nonfederal hospitals. The researchers studied cases involving diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland between 2010 and 2012.

ICU admission rates were as follows:

  • 16.3% to 81.2% for DKA
  • 5% to 44.2% for PE
  • 11.5% to 51.2% for UGIB
  • 3.9% to 48.8% for CHF

Invasive procedures and hospitalization costs were greater in institutions with higher ICU use across all 4 conditions.

“Maximizing the value of critical care services requires understanding the relationship between ICU utilization, clinical outcomes, and costs,” noted Dr Chang. “For medical conditions where ICU care is frequently provided, but not only necessary, institutions that utilize ICUs more frequently are more likely to perform invasive procedures and have higher costs, but have no improvement of hospital mortality.”

Reference

  1. Chang DW, Shapiro MF. Association between intensive care unit utilization during hospitalization and costs, use of invasive procedures, and mortality. JAMA Intern Med. 2016; doi: 10.1001/jamainternmed.2016.4298
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