Skip to main content

ICU Utilization

Current Trends in ICU Beds, Use, Occupancy, and Costs in the United States

  • Reference work entry
  • First Online:
  • 219 Accesses

Abstract

Oncologic critical care units specialize in the care of patients with critical illness related to their malignancy, treatment, or other conditions. Intensive care unit (ICU) beds, utilization, and costs have continuously increased in general acute care hospitals in the United States over the past three decades. This chapter reviews and summarizes current literature related to ICU beds, utilization, and costs in general and oncologic critical care units as well as recommendations to improve access, quality, and costs of healthcare. The concept of the specialty ICU and its associated outcomes is briefly covered. Evidence-based recommendations of best practices for ICU resource optimization are delineated. In conclusion, effective critical care organizations will develop and align the multiple facets of research, quality improvement, culture of safety, and outcomes to improve the value of critical care units in healthcare delivery.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   949.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   1,299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Admon AJ, Seymour CW, Gershengorn HB, Wunsch H, Cooke CR. Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism. Chest. 2014;146(6):1452–61.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Azoulay E, Soares M, Dramon M, Benoit D, Pastores S, Afessa B. Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care. 2011;1:5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Barrett, ML, Smith MW, Elixhauser A, Honigman LS, Pines JM. Utilization of Intensive Care Services, 2011. Available at: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb185-Hospital-Intensive-Care-Units-2011.pdf. Accessed 9 Sept 2018.

  4. Brenner H. Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet. 2002;360(9340):1131–5.

    Article  PubMed  Google Scholar 

  5. Chang DW, Shapiro MF. Association between ICU utilization during hospitalization and costs, use of invasive procedures and mortality. JAMA Intern Med. 2016;176(10):1492–9.

    Article  PubMed  Google Scholar 

  6. Cooper L, Line-Zwirble. Medicare intensive care unit use: analysis of incidence, cost, and payment. Crit Care Med. 2004;32(11):2245–53.

    Article  Google Scholar 

  7. Encina B, Lagunes L, Morales-Codina M. The immunocompromised oncohematologial critically ill patient: considerations in severe infections. Ann Transl Med. 2016;4(17):327–30.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gershengorn HB, Iwashyna TJ, Cooke CR, Scales DC, Kahn JM, Wunsch H. Variation in use of intensive care for adults with diabetic ketoacidosis. Crit Care Med. 2012;40(7):2009–15.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gooch RA, Kahn JM. ICU bed supply, utilization, and health care spending: an example of demand elasticity. JAMA. 2014;311(6):567–8.

    Article  CAS  PubMed  Google Scholar 

  10. Gooley TA, Chien JW, Pergam SA, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med. 2010;363(22):2091–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Gutierrez C, Pastores S. When should ICU patients get an ICU bed? Available at: http://learnicu.org/Lists/Web%20Contents/Attachments/7824/When%20Should%20the%20Cancer%20Patient%20Get%20an%20ICU%20Bed.pdf. Accessed 29 Aug 2018.

  12. Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985–2000: an analysis of bed numbers, use, and costs. Crit Care Med. 2004;32(6):1254–9.

    Article  PubMed  Google Scholar 

  13. Halpern NA, Pastores SM. Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38(1):65–71.

    Article  PubMed  Google Scholar 

  14. Halpern NA, Pastores SM. Critical care medicine beds, use, occupancy and costs in the United States: a methodological review. Crit Care Med. 2015;43(11):2452–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Halpern NA, Goldman DA, Tan KS, Pastores SM. Trends in critical care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States: 2000–2010. Crit Care Med. 2016;44(8):1490–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Helbing C, Supervisory Statistician, office of Research, Division of Beneficiary Studies, health Care financing administration, US Dept of Health and Human services, June 6, 1983, data from MedPar File.

    Google Scholar 

  17. Horster S, Stemmler HJ, Mandel PC, et al. Mortality of patients with hematological malignancy after admission to the intensive care unit. Onkologie. 2012;35(10):556–61.

    Article  PubMed  Google Scholar 

  18. Iwashyna TJ, Kramer AA, Kahn JM. Intensive care unit occupancy and patient outcomes. Crit Care Med. 2009;37(5):1545–57.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jain M, Miller L, Belt D, King D, Berwick DM. Decline in icu adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. BMJ Qual Saf. 2006;15(4):235–9.

    Article  CAS  Google Scholar 

  20. Kane-Gill SL, Dasta JF, Buckley MS, Devabhakthuni S, Liu M, Cohen H, et al. Clinical practice guideline: safe medication use in the ICU. Crit Care Med. 2017;45(9):e877–915.

    Article  PubMed  Google Scholar 

  21. Khandelwal N, Curtis JR. Economic implications of end-of-life care in the icu. Curr Opin Crit Care. 2014;20(6):656–61.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Koch A, Checkley W. Do hospitals need oncological critical care units? J Thor Dis. 2017;9(3):E304–9.

    Article  Google Scholar 

  23. Leung S, Gregg SR, Coopersmith CM, Layon AJ, Oropello J, Brown DR, et al. Critical care organizations: business of critical care and value/performance building. Crit Care Med. 2018;46(1):1–11.

    Article  PubMed  Google Scholar 

  24. Margin of Excellence: Intensive Care Unit (ICU) Utilization. Available at: https://www.premierinc.com/downloads/icu-utilization-whitepaper.pdf. Accessed 20 Aug 2018.

  25. Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Crit Care Clin. 2017;33(2):225–43.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Matthews K, Jenq G, Siner J, Long E, Pisani M. ICU utilization by “subacute” patients reasons for admission and opportunities for improvement. Crit Care Med. 2012;40(12):1–328.

    Article  Google Scholar 

  27. Moore JE, Oropello JM, Stoltzfus D, Masur H, Coopersmith CM, Nates J, et al. Critical care organizations: building and integrating academic programs. Crit Care Med. 2018;46(4):e334–41.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, Fowler CS, Byrum D, Miles WS, Bailey H, Sprung CL. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44(8):1553–602.

    Article  PubMed  Google Scholar 

  29. Nordon-Craft A, Moss M, Quan D, Schenkman M. Intensive Care unit- acquired weakness: implications for physical therapist management. Phys Ther. 2012;92(12):1494–506.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Optimizing critical care with the ABCDEF Bundle. Available at: http://www.sccm.org/ICULiberation/News/Optimizing-Critical-Care-with-the-ABCDEF-Bundle. Accessed 16 Oct 2018.

  31. Puxty K, McLoone P, Quasim T, Kinsella J, Morrison D. Survival in solid cancer patients following intensive care unit admission. Intensive Care Med. 2014;40(10):1409–28.

    Article  PubMed  Google Scholar 

  32. Romano AM, Gade KE, Nielsen G, Havard R, Harrison JH Jr, Barclay J, et al. Early palliative care reduces end-of life Intensive Care (ICU) use but not ICU course in patients with advanced cancer. Oncologist. 2017;22(3):318–23.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shimabukuro-Vornhagen A, Boll B, Kochanek M, Azoulay E, von Bergwelt-Baildon MS. Critical care of patients with cancer. CA Cancer J Clin. 2016;66(6):496–517.

    Article  PubMed  Google Scholar 

  34. Soares M, Bozza FA, Angus DC, Japiassu AM, Viana WM, Costa R, et al. Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Med. 2015;41(12):2149–60.

    Article  PubMed  Google Scholar 

  35. Soares M, Bozza FA, Azevedo LC, Silva UV, Correa TD, Colombari F, et al. Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol. 2016;34(27):3315–24.

    Article  PubMed  Google Scholar 

  36. Solberg BC, Dirksen CD, Nieman FH, van Merode G, Ramsay G, Roekarts P, et al. Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study. BMC Anesthesiol. 2014;14:76.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL. Characteristics and outcomes of cancer patients in European ICUs. Crit Care. 2009;13(1):R15.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with non- small- cell lung cancer. N Engl J Med. 2010;363(8):733–42.

    Article  CAS  PubMed  Google Scholar 

  39. Teno JM, Gozalo PL, Bynum JP, Leland NE, Miller SC, Morden NE, et al. Changes in end-of-life care for Medicare beneficiaries site of death, place of care and health care transitions in 2000, 2005 and 2009. JAMA. 2013;309(5):470–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. The Joint Commission: Performance Measurement. Available at: http://www.jointcommission.org/performance_measurement.aspx. Accessed 17 Oct 2018.

  41. Wallace SK, Rathi NK, Waller DK, Ensor JE, Haque SA, Price KJ, et al. Two decades of ICU utilization and hospital outcomes in a comprehensive cancer center. Crit Care Med. 2016;44(5):926–33.

    Article  PubMed  Google Scholar 

  42. Weled BJ, Adzhigirey LA, Hodgman TM, Brilli RJ, Spevetz A, Kline AM, et al. Critical care delivery: the importance of process of care and icu structure to improved outcomes: an update from the American College of Critical Care Medicine Task Force on models of critical care. Crit Care Med. 2015;43(7):1520–5.

    Article  PubMed  Google Scholar 

  43. Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, et al. Variation in critical care services across North America and Western Europe. Crit Care Med. 2008;36(10):2787–93.

    Article  PubMed  Google Scholar 

  44. Wunsch H, Wagner J, Herlim M, Chong DH, Kramer AA, Halpern SD. ICU occupancy and mechanical ventilator use in the United States. Crit Care Med. 2013;41(12):2712–9.

    Article  PubMed  Google Scholar 

  45. Zimmerman JE, Wagner DP, Knaus WA, Williams JF, Kolakowski D, Draper EA. The use of risk predictions to identify candidates for intermediate care units: implications for intensive care utilization and cost. Chest. 1995;108(2):490–9.

    Article  CAS  PubMed  Google Scholar 

  46. Society of Critical Care Medicine. Critical care units: A descriptive analysis. 2nd Ed. Des Plainness, IL: Society of Critical Care Medicine; 2011.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joseph L. Nates .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Chen, K., Wallace, S.K., Nates, J.L. (2020). ICU Utilization. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74588-6_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74587-9

  • Online ISBN: 978-3-319-74588-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics