EFFECT OF CLINICAL OUTCOMES DATA ON INTENSIVE-CARE UNIT UTILIZATION BY BONE-MARROW TRANSPLANT PATIENTS

Objective: To determine if a program to educate referring physicians a s to the poor outcome of mechanically ventilated bone marrow transplan t patients would result in a change in intensive care unit (ICU) utili zation. Design: Retrospective chart review. Setting: Medical ICU at an urban university hospital. Patients: Patients undergoing bone marrow transplantation in the interval before (n = 236) vs, the interval afte r (n = 144) a physician education program. Interventions: Two separate educational programs were conducted for oncologists and intensivists to review the finding of an earlier study demonstrating the outcome of bone marrow trans plant patients in the ICU. Measurements and Main Re sults: The results demonstrated that this physician education interven tion did not result in a change in the utilization of medical ICU reso urces by these patients. Comparing the time periods before and after t he intervention, there were no statistically significant differences i n the proportion of patients who were admitted to the medical ICU, the proportion who received mechanical ventilation, or the medical ICU le ngths of stay, Similarly, the two groups did not differ regarding the 100-day survival rate of all bone marrow transplant patients studied, all bone marrow transplant patients admitted to the medical ICU, or al l bone marrow transplant patients intubated. Conclusion: Simple educat ional interventions are not a powerful mechanism by which to alter the practice of physicians regarding the utilization of scarce and expens ive resources, even when the physicians generally agree that the use o f those resources results in dismal patient outcomes.