Patient Management Strategies to Contain Cost in the ICU

Abstract

Despite consuming a large proportion of health care resources, efforts to develop unified strategies by which to reduce ICU costs have been stymied by the existing heterogeneity in their organization and management. Local practice variations, coupled with deficient scientific data by which to optimize the effectiveness of care, has left a precise characterization of the absolute requirement for ICU resources open to significant debate. In addition to personal practice heuristics, resource use and associated costs are influenced by severity of illness, case mix and length of stay.

Physicians are asked with increasing frequency to help determine appropriate levels of institutional ICU resource support and measure the impact of delivered services. While constraining ICU resource consumption we must not loose sight of the need to provide adequate levels of compassionate patient support. Pressures to reduce costs must not be accomplished by imposition of additional burden on patients or families by increasing anxiety, pain and suffering, or creating the perception of abandonment by a health delivery system whose focus is shifted away from delivering quality care with empathy.

This chapter outlines several areas in which cost reductions may be effectively achieved while maintaining standards of high quality. Topics for consideration include: patient triage (e.g., reducing low risk, monitor patient admissions, utilization of step down units and other forms of less intensive therapy, alternative strategies for managing the chronically ill), decreasing ICU length of stay, more effective use of diagnostic and therapeutic tools, reducing drug costs, the implications of organizational structure on costs, focused quality improvement, managing patients destined to die, and measuring and monitoring outcomes. This wide array of topics can provide the framework for evaluating an institution's potential for reducing ICU costs while maintaining a quality delivery system and measurable outcomes.

Key Words:

Cost containment - quality of health care - outcome assessment - critical care medicine - intensive care units - severity of illness - length of stay - health services research - hospital utilization - ethics