Hospital ICU Overutilization Impairs Patient Outcomes

The patients were assigned priority rankings according to society of critical care (SCCM) guidelines, with those that needed close monitoring that could be provided outside of the ICU ranked as priority 2, and patients with limited life expectancy or poor prospects categorized as priority 3.

The results showed that 23.4% of the patients treated in the ICU were in need of close monitoring, but not ICU-level care. Another 20.9% of the patients were critically ill, but unlikely to recover because they had underlying illnesses or severity of acute illness. For another 8%, death was imminent or the same outcomes were expected in non-ICU care. In all, of 3,794 patient days, 35.2% were priority 1, 25.3% were priority 2, 27.5% were priority 3, 3.3% priority 4, and 8.7% were patients not prioritized as they were waiting for transport out of the ICU. The study was published on December 27, 2016, in JAMA Internal Medicine.

“Over 50% of patients admitted to the ICU were categorized into groups suggesting that they were potentially either too well or too sick to benefit from ICU care, or could have received equivalent care in non-ICU settings,” said lead author Dong Chang, MD, of LA BioMed. “ICU care is inefficient because it is devoting substantial resources to patients who are less likely to benefit from this level of care. These findings are a concern for patients, providers, and the health care system because ICU care is frequently invasive and comes at a substantial cost.”

SCCM guidelines prioritize patients for ICU admission based on projected likelihood of benefit. Priority 1 patients are critically ill, and need intensive treatment and monitoring that cannot be provided outside of ICUs; priority 2 patients are not critically ill, but require close monitoring and potentially immediate intervention; priority 3 patients are critically ill, but with reduced likelihood of recovery due to underlying diseases or severity of acute illness; and priority 4 patients are not appropriate for the ICU, as equivalent outcomes are achievable with non-ICU care, based on low risk of clinical deterioration, presence of irreversible illness, or imminent death.

Related Links:
LA BioMed
University of California, Los Angeles
Harbor-UCLA Medical Center