POSTOPERATIVE LABORATORY AND IMAGING INVESTIGATIONS IN INTENSIVE-CAREUNITS FOLLOWING CORONARY-ARTERY BYPASS-GRAFTING - A COMPARISON OF 2 CANADIAN HOSPITALS

OBJECTIVES: To compare the utilization and cost of common laboratory a nd imaging tests following admission to the intensive care unit (ICU) after coronary artery bypass surgery in two hospitals. The hospitals u se different strategies to order tests postoperatively: one hospital u ses a mandated protocol while the other does not. DESIGN: Demographic and testing data were prospectively collected in both hospitals as par t of an ongoing ICU management program. Thirteen commonly performed la boratory tests or imaging procedures were compared. Average costs for each test were calculated, and utilization and cost of testing were co mpared per admission and per day in ICU. SETTING: Two tertiary care IC Us in different Canadian cities. PATIENTS: Consecutive patients admitt ed to ICU following coronary-artery bypass graft surgery over a two-ye ar period. MAIN RESULTS: There were 415 admissions to the Health Scien ces Centre in Winnipeg, Manitoba and 504 to the Jewish General Hospita l (JGH) in Montreal, Quebec. There were no demographic, length of stay or ICU mortality differences. A postoperative protocol for ordering i nvestigations is used at JGH. Striking differences in test utilization were noted, with more investigations performed per admission and per unit day at JGH (P<0.001). The average cost of the investigations was greater at JGH ($160 more per admission; $75 more per intensive care d ay). CONCLUSIONS: There are marked differences in the investigation pa ttern and costs for coronary artery bypass patients admitted to ICU in these hospitals. It is suggested that the benefits of frequent routin e determinations of bloodwork, electrocardiograms and chest radiograph s should be reevaluated in this patient population.