According to researchers at the University of Michigan, the more a hospital relies on its ICU to treat heart patients, the worse their results are, especially when it comes to 30-day morbidity. A new study suggests that hospitals that send the highest percentage of patients to the ICU perform the worst on quality measures.
Study authors examined Medicare records from 2,010 of more than 570,000 hospital stays.
More than 150,000 hospitalizations at almost 1,700 hospitals were for myocardial infarction, and or heart attack, and 46 percent of them involved ICU care. Also, 16 percent of the more than 400,000 hospital stays at roughly 2,200 hospitals for heart failure included a stint in ICU, data show.
Results show that the hospitals with the highest percentage of patients admitted to the ICU actually tended to be the ones with the smallest actual numbers of heart attack and heart failure patients, and authors said this could suggest unfamiliarity with the conditions and the possibility that "suboptimal care" was given.
[Also: ICU physician staffing still lacking in many hospitals, Leapfrog report shows]
Results further showed that high-ICU hospitals were less likely to give heart attack patients aspirin when they arrived, or other drugs known to improve heart attack outcomes.
For heart failure patients, high-ICU hospitals were less likely to administer key medicine, heart function tests, and counseling on smoking cessation.
But authors say the biggest difference was in a patient's risk of dying within 30 days of discharge. Results showed heart attacks patients treated in high-ICU hospitals were six percent more likely to die than those treated in low-ICU facilities. For patients with heart failure the difference was eight percent.
On a related note, study co-author Michael Sjoding, M.D., M.Sc., in a previous study, a similar pattern among patients hospitalized for pneumonia emerged, with hospitals that sent the most such patients to the ICU showing the lowest quality performance on that condition, too.
Study first author Thomas Valley, MD, said these results show that hospitals that frequently use the ICU could be targets for improvement and finding the reason behind this frequent use is crucial to improving overall care.
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"In this country, we still have an open question of what to use the ICU for, and when, and very little evidence to guide physicians," says Valley, a critical care specialist who takes care of patients in the U-M Health System's Critical Care Medicine Unit. "Is it for those who were already sick and got worse, or is it a place to send people proactively when we think they might get sicker? And the answer can vary on different days, or based on how many beds are available right then. We hope to build a body of evidence about how to use this valuable resource in the most effective way."
The health system says the authors of this study will continue to evaluate data to determine which patients benefit most from ICU-level care, and what care could be safely tried on general hospital floors.
Meanwhile, Valley and his colleagues stress the need for patients and families of people hospitalized for heart attack and heart failure to speak up about the patient's wishes for the intensity of care they should receive.
It's also important to understand both the benefits and risks of an ICU stay, like the closer monitoring from nurses but also the risk of infections and complications resulting from the more invasive nature of care provided in an ICU, University of Michigan Health said.
Twitter: @BethJSanborn