DEATH AND DOLLARS - THE COST OF DYING IN THE SURGICAL INTENSIVE-CARE UNIT

Introduction: The effect of resuscitation status on the use of laborat ory and radiologic studies was analyzed in patients at the Waiter Reed Army Medical Center's Surgical Intensive Care Unit. Methods: A retros pective assessment of laboratory and radiologic charges incurred durin g the last 48 hours of life by 81 patients who died in the Surgical In tensive Care Unit between 1990 and 1992 was performed. Data were analy zed after separation by patient's resuscitation status. Each patient w as assigned a resuscitation category: no limitation, do not resuscitat e (no CPR in event of arrest), or limited therapy (specific order limi ting care or monitoring). Results: There were 4,095 laboratory tests p erformed for a total charge of $191,247. Arterial blood gas testing ac counted for over $75,000 of these charges. Resuscitation status signif icantly affected test frequency. Conclusions: During the last 48 hours of life in an intensive care unit, the use of laboratory tests and ra diologic exams has a substantial effect on the cost of care and is mod ified by the patient's resuscitation status.