Hospitals with Highest ICU Admission Rates Provide Worst Care

Researchers at the University of Michigan (Ann Arbor, USA) conducted a retrospective cohort study of Medicare beneficiaries hospitalized in 2010 with acute myocardial infarction (AMI) and heart failure (HF). They grouped the hospitals into quintiles by their risk- and reliability-adjusted ICU admission rates, and examined the rates that hospitals failed to deliver standard AMI or HF processes of care, 30-day mortality, 30-day readmissions, and Medicare spending, after adjusting for patient and hospital characteristics.

The results showed that hospitals in the lowest quintile had ICU admission rates lower than 29% for AMI or 8% for HF. Hospitals in the top quintile had rates higher than 61% for AMI or 24% for HF. While overall quality of care tended to be good, high-ICU hospitals were less likely to give AMI patients aspirin and other drugs that are known to improve outcomes after heart attacks. For HF patients, high-ICU hospitals were less likely to perform key tests of heart function and counsel patients on stopping smoking.

The researchers found that the biggest difference was in the risk of dying within 30 days of discharge; patient treated in hospitals in the top quintile had greater 30-day mortality (14.8% versus 14.0%) for AMI, as well as for HF (11.4% versus 10.6%), but no differences in 30-day readmissions or total Medicare spending, when compared to hospitals in the lowest quintile. The study was published on June 15, 2016, in Chest.

“These studies suggest that hospitals using the ICU frequently could be targets for improvement. If we find out why hospitals are using ICU beds more often for these patients, we could intervene to improve care overall,” said lead author Thomas Valley, MD, MSc. “It's important to understand both the benefits and risks of an ICU stay, like the closer monitoring from nurses, but also the risk of infections and complications resulting from the more invasive nature of care provided in an ICU.”

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