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

urvey data showed that intensivists had an accurate sense of the ICU costs they generated.

“Perhaps the higher spenders believe their practice style produces better outcomes,” said Dr. Garland. “Alternatively, practice styles may derive from a complex interaction between training and personality traits, such as response to uncertainty. We are not aware of any prior studies that have compared physicians’ self-assessments with objective measurement of their practice patterns or outcomes.”

The authors acknowledged that the study’s major limitation is that it evaluated only one ICU. While this may raise “concern about the generalizability of [the] results,” Drs. Garland and colleagues noted that the nature, organization, operation, staffing and case mix in their ICU was similar to others in large academic medical centers.

In an editorial on the research in the same issue of the journal, Jeremy Kahn, M.D., M.Sc., of the University of Pennsylvania, and Derek C. Angus, M.D., M.P.H., of the University of Pittsburgh School of Medicine, wrote: “Total per capita health care costs have increased 560 percent since 1980 and health care costs comprise over 16 percent of the United States gross domestic product. A large proportion of these costs are directly attributable to the ICU.”

They continued: “The ICU is a resource-intensive environment where new drugs, expensive technologies and specialized clinical care all contribute to dramatic health care expenditures. Reducing the costs of healthcare in general and intensive care in particular, is a priority for physicians, hospital administrators and policy makers.”

“Perhaps the greatest lesson of the Garland study is that cost control is not just the work of the health policy expert or hospital administrator—it is also the task of the individual ICU clinicians. It is now clearer than ever that accepting this task is a difficult but necessary part of critical care in the tw
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