Intensive care units (ICUs) are designed for patients with life-threatening conditions, where continual monitoring and care is required. Current literature has raised concern regarding improper use of ICUs, and the potential negative impact on patient’s health and on health care costs. Therefore researchers investigated whether ICU utilization is associated with mortality, invasive procedures, and heath care costs for patients with diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal bleeding, and congestive heart failure. They found that higher ICU utilization was associated increased invasive procedures, higher health care costs, and no difference in mortality in comparison to low ICU utilization. Optimizing use of ICUs is beneficial as it can benefit patient health and decrease health care costs.
Intensive care units (ICUs) are specialized wards within hospitals, designed for patients with life-threatening injuries or illnesses that require continual monitoring and care. Misusing ICUs can lead to potentially harmful clinical and economic outcomes. For instance, a patient who is not necessarily required to be in the ICU can sometimes undergo unnecessary invasive procedures. Furthermore, overusing the unit can prevent other severely ill patients from having access to the ICU’s facilities. Finally, unnecessary and excessive use of ICUs can waste a lot of money that could be put to more appropriate use. In the United States, ICU’s consume 13.4% of total hospital costs and 4.1% of the national health expenditures. Therefore, the proper and most efficient use of ICUs is an important health care priority.
Identifying and preferentially placing patients who would benefit most from being under intensive care can lead to a more efficient use of ICUs. In fact, patients that do not benefit from being placed under intensive care, don’t have to be placed in ICUs at all. Of course, it is important to note that certain conditions like respiratory failure and septic shock absolutely require ICU admission, whereas others do not. There are also certain conditions where the need for critical care is highly debated and subject to opinion, like diabetic ketoacidosis (DKA), pulmonary embolisms (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF). Diabetic ketoacidosis occurs in diabetic patients with low insulin levels, resulting in fatty acid breakdown, which leads to the formation of ketone bodies that are toxic to the body. Pulmonary embolism results from blockage in the arteries leading to the lungs resulting in breathing problems. Upper gastrointestinal bleeding refers to any bleeding that may occur in the upper regions of the gastrointestinal tract including the esophagus, stomach, and beginning of the small intestine. Finally, congestive heart failure occurs when the heart is unable to pump enough blood to meet the demands of the body. Although all four conditions mentioned are potentially life-threatening, the need to place the patients in ICU is controversial and subject to debate. Therefore, a group of researchers aimed at examining whether higher ICU utilization may be associated with hospital costs, use of invasive procedures, and mortality rates.
Between 2010 and 2012, researchers collected data for 156, 842 hospitalizations from patients with DKA, PE, UGIB or CHF. The researchers first noted that there was a significant variation in ICU admission between the four conditions. The study demonstrated that increased ICU utilization was not significantly associated with decreased mortality for any of the four conditions. Furthermore, they were able to show that increased ICU utilization was associated with increased use of invasive procedures including catheter use. Finally, researchers also demonstrated that increased use of ICU was associated with higher costs for each of the four conditions. The results illustrate that the inappropriate use of intensive care units can lead to potentially increased invasive procedures that may cause patient harm, increase health care costs, and ultimately don’t result in lower mortality. In conclusion, the study suggests that optimizing ICU utilization can result in improved quality of care and economic benefits. The next step in optimization of ICUs would be to understand why physicians may improperly place patients in critical care, even though there are no potential health benefits. This way, future physicians can be educated into making more appropriate decisions regarding whether a patient should or should not be sent to the ICU.
Written By: Haisam Shah, BSc