Chest ACCP Education Calendar
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bell, D. D.
Right arrow Articles by Roberts, D. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bell, D. D.
Right arrow Articles by Roberts, D. E.
(Chest. 1997;111:1030-1038.)
© 1997 American College of Chest Physicians

A Citywide Analysis of the Utilization of Common Laboratory Tests and Imaging Procedures in ICUs

Dean D. Bell MD1; Trish Ostryzniuk RN1; Mary Cheang Mmath2; Ed Roberts MSc2; and Daniel E. Roberts MD3

1 From the Department of Anesthesia; and the Section of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
2 From the Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
3 From the Section of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

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 after 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 in 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 in teaching hospitals.

Key Words: cost • cost analysis • diagnostic tests • hospital • teaching • hospital • university • intensive care units

Submitted on April 26, 1996
Accepted on October 1, 2007






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1997 by the American College of Chest Physicians.