ICU Admission For Pulmonary Embolism Varies By Hospital

Dr. Colin Cooke MD, MSc, MS Assistant Professor, Department of Internal Medicine University of Michigan Center for Healthcare Outcomes and Policy Ann Arbor, Interview with:
Dr. Colin Cooke MD, MSc, MS
Assistant Professor, Department of Internal Medicine
University of Michigan
Center for Healthcare Outcomes and Policy
Ann Arbor, MI

Medical Research: What are the main findings of the study?

Dr. Cooke: We determined that when patients who are hospitalized for pulmonary embolism (PE), a blood clot in the lung, approximately 1 in 5 will be admitted to an intensive care unit (ICU). However, the chances that a patient will go to an ICU is highly dependent upon which hospital they are admitted to. For example, some hospitals admitted only 3% of patients with pulmonary embolism to an ICU while others admitted almost 80%.

Importantly, the differences in how hospitals use their ICU for patients with pulmonary embolism was not entirely related to the patient’s need for life support measures, the things that the ICU is designed to deliver. For example, the ICU patients in high ICU-use hospitals tended to receive fewer procedures, including mechanical ventilation, arterial catheterization, central lines, and medications to dissolve blood clots. This suggest that high utilizing hospitals are admitting patients to the ICU with weaker indications for ICU admission.

Medical Research: Were any of the findings unexpected?

Dr. Cooke: We know from prior research that care delivered in an ICU is often quite expensive relative to the care provided in other areas of the hospital. We expected that hospitals that admitted more of their patients with pulmonary embolism to the ICU would also be the higher cost hospitals. However, this was not the case. In fact, we observed no differences in either the costs for other outcomes, such a patient’s risk of death or their risk for hospital readmission, in hospitals using more ICU care. This may be because hospitals that admit more patients with pulmonary embolism to the ICU are admitting those with fewer needs for ICU therapies, thereby negating some of the excess costs of care in an ICU.

Medical Research: What should clinicians and patients take away from your report?

Dr. Cooke: Clinicians should recognize that in many patients with pulmonary embolism the ICU is an appropriate location within the hospital to best care for patients. In particular, those who require life support measures as well as those who are at risk of rapid decompensation certainly benefit from ICU care. However, there are also likely a subset of low risk patients with PE who could effectively be managed in alternative locations. Doing so may free up ICU beds for more acutely ill patients, and ultimately reduce the costs of care for patients with this condition.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Cooke: The most important next steps will require a better understanding of why ICU admission practice varies so dramatically across hospitals. Because we observed no differences in outcomes in pulmonary embolism patients across hospitals with differing ICU use, this suggests that there may be great opportunities to improve the efficiency in use of the ICU.


Hospital-level variation in intensive care unit admission and critical care procedures for patients hospitalized for pulmonary embolism

Andrew J. Admon, MD, MPH; Christopher W. Seymour, MD, MSc; Hayley B. Gershengorn, MD; Hannah Wunsch, MD, MSc; Colin R. Cooke, MD, MSc, MS

Chest. 2014. doi:10.1378/chest.14-0059



Last Updated on July 10, 2014 by Marie Benz MD FAAD