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Large Variations in Cost Has No Effect on Length of Stay or Mortality

Although intensive care doctors are responsible for large cost variations in the medical management of critically ill patients in the intensive care unit (ICU), higher resource// use has no effect on patient length of stay or possible mortality.

This research appears in the first issue for December 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Allan Garland, M.D., of the Division of Pulmonary and Critical Care Medicine at MetroHealth Medical Center in Cleveland, and three associates studied costs ordered by nine intensivists in a single medical ICU who provided care to 1,184 patients during 14-day rotating shifts over a 29-month period. Average daily discretionary costs varied by 43 percent or $1,003 per admission between the intensivists who spent the most and those who spent the least.

“In this single ICU, we demonstrated large differences in resource use that are attributable to differences in physicians’ practice styles,” said Dr. Garland. “Higher-spending intensivists did not generate better outcomes than their lower spending colleagues, so it may be possible to reduce ICU costs without worsening outcomes by altering these practice styles.”

In addition to accumulating higher total discretionary costs in the ICU, the highest-spending physicians spent more on pharmacy, radiology, laboratory, blood banking and echocardiography. During the study, the respiratory system was the organ system most frequently associated with ICU admission, comprising 27 percent of the patients. Seventy-five percent of those in the ICU were transferred from the hospital’s emergency department.

Slightly less than one-quarter of the patients required invasive mechanical ventilation. The ICU mortality rate was 7.3 percent, and another 5.3 percent survived the ICU, but died before hospital discharge.

Contrary to the researchers’ early expectations, s
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