Variation in the use of intensive care units (ICU) for low-risk conditions contributes to health system inefficiency. We sought to examine the relationship between ICU utilization for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use.
We performed a retrospective cohort study including 61,249 adults with PE discharged from 263 hospitals in three states between 2007 and 2010. We generated hospital-specific ICU admission rate quartiles and used a series of multilevel models to evaluate relationships between admission rates and risk-adjusted in-hospital mortality, readmission, and costs, and between ICU admission rates and several critical care procedures.
Hospitals quartiles varied in unadjusted ICU admission rates for PE (range ≤15% to >31%). Among all patients, there was a small trend towards increased use of arterial catheterization (0.6% to 1.1%, p<0.01) in hospital quartiles with higher levels of ICU admission. However, use of invasive mechanical ventilation (14.4 to 7.9%, <0.01), non-invasive ventilation (6.6% to 3.0%, p<0.01), central venous catheterization (14.6% to 11.3%, p<0.02), and thrombolytics (11.0% to 4.7%, p<0.01) in ICU patients declined across hospital quartiles. There was no relationship between ICU admission rate and risk-adjusted hospital mortality, costs, or readmission.
Hospitals vary widely in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission. Patients admitted to ICUs in higher utilizing hospitals received many critical care procedures less often, suggesting that these patients may have had weaker indications for ICU admission. Hospitals with greater ICU admission may be appropriate targets for improving efficiency in ICU admissions.