Patient characteristics and ICU organizational factors that influence. Frequency of pulmonary artery catheterization

Context Hemodynamic monitoring of patients with a pulmonary artery catheter is controversial because there are few data confirming its effectiveness, and patient and intensive care unit (ICU) organizational factors associated with its use are unknown. Objective To determine pulmonary artery catheter use in relationship to typ e of ICU organization and staffing, and patient characteristics, including severity of illness and insurance coverage. Design, Setting, and Patients Retrospective database study of 10 217 nonope rative patients who received treatment at 34 medical, mixed medical and sur gical, and surgical ICUs at 27 hospitals during 1998 (patients were enrolle d in Project IMPACT). Main Outcome Measures Pulmonary artery catheter use based on severity of il lness measured by the Simplified Acute Physiology Score, resuscitation stat us at ICU admission, and ICU organizational variables, including type, size , and model. Results A pulmonary artery catheter was used for 831 patients (8.1%) in the ICU. In multivariate analysis adjusted for severity of illness, age, diagn osis, and do-not-resuscitate status, full-time ICU physician staffing was a ssociated with a two-thirds reduction in the probability of catheter use (o dds ratio [OR], 0.36; 95% confidence interval [CI], 0.28-0.45). Higher cath eter use was associated with white race (OR, 1.38; 95% CI, 1.10-1.72) and p rivate insurance coverage (OR, 1.33; 95% CI, 1.10-1.60). Admission to a sur gical ICU was associated with a 2-fold increase in probability of catheter use (OR, 2.17; 95% CI, 1.70-2.76) compared with either medical or mixed med ical and surgical ICUs. Conclusion Organizational characteristics of ICUs, insurance reimbursement, and race, as well as clinical variables, are associated with variation in practice patterns regarding pulmonary artery catheter use. Understanding su ch influences, combined with studies measuring clinical and economic outcom es, can contribute to the development of policies for the rational use of p ulmonary artery catheters.