The frequency and cost of patient-initiated device removal in the ICU

Objective. To determine the frequency and pattern with which patients in th e intensive care unit (ICU) remove medical devices on their own, and the co sts associated with this problem. Design. Prospective observational study. Setting. Two 10-bed sections of a multidisciplinary ICU in a tertiary care teaching hospital. Patients. Adults admitted to the ICU for longer than 24 hours during Octobe r 1998. Interventions. None. Measurements and Main Results. Medical records were reviewed prospectively for the occurrence of patient-initiated device removal and the responses to those events by health care providers. Associated costs were estimated usi ng hospital databases and Medicare physician reimbursement schedules. Annua l cost estimates were calculated using 1997 admission statistics for 1211 a dults in an ICU for more than 24 hours. Thirty-six patients were studied fo r 199 patient-days. Ten patients (28%) removed 42 devices: 88% of these eve nts involved gastrointestinal tubes and vascular catheters. Significant agi tation was documented within 2 hours before 74% of the events. associated w ith device removal was $7606, or $18l/event. annual cost in this 42-bed ICU was more than $250,000. Estimated cost The estimated Conclusions. Patients commonly remove medical devices on their own, and thi s represents significant consumption of health care resources.