A CITYWIDE ANALYSIS OF THE UTILIZATION OF COMMON LABORATORY TESTS ANDIMAGING PROCEDURES IN ICUS

Objective: To identify and discriminate between patient and institutio nal determinants of investigation costs in the ICU. Design: Retrospect ive survey. Setting: All seven hospitals in the city of Winnipeg, Mani toba, Canada. Participants: One hundred consecutive admissions to each of 11 ICUs. Two teaching hospitals (TH1 and TH2) each have three unit s (medical, surgical, and coronary care), the five community hospitals (CHs) have single combined units, TH1 operates an information-based m anagement: system. Measurements: Each admission was categorized as MED ICAL, SURGICAL, or CARDIAC, The frequency and cost of 17 laboratory or imaging procedures were collected for each admission, Demographic dat a included age, length of ICU stay, APACHE LI (acute physiology and ch ronic health evaluation) score, therapeutic intervention scoring syste m (TISS) data, and ICU survival, The primary diagnosis on admission an d 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 wer e strongly associated with increased costs in all categories (p=0.0001 ). Admission to TH2 was associated with greater costs in all categorie s (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), bu t 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 linke d to patient-dependent factors. Acquisition of nosocomial and iatrogen ic events during ICU admission increases costs dramatically, Costs are not necessarily greater in teaching hospitals.