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
