Single Center Study Finds Extensive Overuse of ICU

January 4th, 2017

LOS ANGELES — More than half of the ICU patients in a single center study could have been adequately treated in less expensive and less invasive settings.

A research letter published recently in JAMA Internal Medicine reports that ICUs are being used too frequently for patients who actually don’t require that level of care.

For the study — conducted by LA BioMed, a nonprofit independent biomedical research institute, and UCLA researchers — 808 ICU admissions from July 1, 2015, to June 15, 2016, at Harbor-UCLA Medical Center were analyzed.

Results found the following:

• 23.4% of the patients were in need of close monitoring but not ICU-level care,
• 20.9% of the patients were critically ill but unlikely to recover because they had underlying illnesses or severity of acute illness, and
• in 8%, death was imminent or the same outcomes were expected in non-ICU care.

"Our study found 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," explained corresponding author Dong W. Chang, MD, an LA BioMed researcher. "This research indicates that 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 healthcare system because ICU care is frequently invasive and comes at a substantial cost."

Calculating the number of days each of the patients in the study spent in an ICU, researchers found that nearly 65% of the total number was allocated to care that was considered discretionary monitoring, had a low likelihood of benefit despite critical illness, or would have been manageable in non-ICU settings.

"While this is a study of just one hospital and results may differ at other medical centers, we suspect that these characteristics of ICU utilization are commonplace and prevalent in many institutions," Chang added.

Study authors conceded that the research would not apply in all settings, adding that, in some hospitals, the ICU could be the most appropriate level of care because other alternatives simply aren’t available.

"However, there is likely to be a subset of patients in which ICU care leads to unwanted, invasive care without significant clinical benefit,” Chang said. "Refining our ability to identify these patients and developing approaches to improve ICU utilization for those patients are important steps to assure the best care for patients and the most efficient use of the healthcare system's limited resources."