A citywide analysis of the utilization of common laboratory tests and imaging procedures in ICUs

Objective: To identify and discriminate between patient and institutional determinants of investigation costs in the ICU. Design: Retrospective survey. Setting: All seven hospitals in the city of Winnipeg, Manitoba, Canada. Participants: One hundred consecutive admissions to each of 11 ICUs. Two teaching hospitals (TH1 and TH2) each have three units (medical, surgical, and coronary care), the five community hospitals (CHs) have single combined units. TH1 operates an information-based management system. Measurements: Each admission was categorized as MEDICAL, SURGICAL, or CARDIAC. The frequency and cost of 17 laboratory or imaging procedures were collected for each admission. Demographic data included age, length of ICU stay, APACHE II (acute physiology and chronic health evaluation) score, therapeutic intervention scoring system (TISS) data, and ICU survival. The primary diagnosis on admission and acquisition of significant problems or complications alter admission were collected. Results: Multivariate models revealed that length of stay, TISS score, and acquisition of a problem after ICU admission were strongly associated with increased costs m all categories (p = 0.0001). Admission to TH2 was associated with greater costs in all categories (p = 0.0001 MEDICAL and CARDIAC; p = 0.0016 SURGICAL). Admission to a CH was associated with lower cost for SURGICAL admissions (p = 0.0014), but costs at CHs were not significantly lower than at TH1 for MEDICAL (p = 0.18) or CARDIAC (p = 0.22) admissions. Conclusions: ICU investigation costs vary significantly between institutions and are not always linked to patient-dependent factors. Acquisition of nosocomial and iatrogenic events during ICU admission increases costs dramatically. Costs are not necessarily greater m teaching hospitals. (CHEST 1997; 111:1030 38) Key words: cost, cost analysis; diagnostic tests; hospital, teaching; hospital, university; intensive care units Abbreviations: ANOVA = analysis of variance, APACHE = acute physiology and chronic health evaluation; CH = community hospital LOS = length of stay; MI = myocardial infarction; PAC = pulmonary artery catheter; TH1 = teaching hospital 1; TH2 = teaching hospital 2; TISS = therapeutic intervention scoring system
In the last decade, most comparative ICU performance evaluations have concentrated on survival outcomes using predictive models.[1-4] Despite the expensive nature of critical care, there have been few attempts to [...]