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The high cost of critical care unit over-utilization for patients with NSTE ACS.

Publication ,  Journal Article
van Diepen, S; Tran, DT; Ezekowitz, JA; Zygun, DA; Katz, JN; Lopes, RD; Newby, LK; McAlister, FA; Kaul, P
Published in: Am Heart J
August 2018

BACKGROUND: There is substantial variability among hospitals in critical care unit (CCU) utilization for patients admitted with non-ST-Segment Elevation Acute Coronary Syndromes (NSTE ACS). We estimated the potential cost saving if all hospitals adopted low CCU utilization practices for patients with NSTE ACS. METHODS: National hospital claims data were used to identify all patients with a primary diagnosis of NSTE ACS initially admitted to an acute care hospital between 2007 and 2013. Hospital CCU utilization was classified as low (<30%), medium (30-70%), or high (>70%). RESULTS: Among the 270,564 NSTE ACS hospitalizations (71.6% non-ST-segment elevation myocardial infarction; 28.4% unstable angina) admitted to 261 hospitals, 41.9% (inter-hospital range 0.3%-95.1%) were admitted to a CCU. The proportion of patients admitted to a CCU in low, medium and high utilization hospitals was 16.3%, 49.5%, and high 81.1%, respectively. No differences in adjusted inpatient mortality were observed by hospital CCU utilization. The overall inpatient costs of caring for NSTE ACS were $1.1 billion. CCU care accounted for 45.2% of all hospitalization costs including 22.6%, 49.9%, and 69.0% (P < .001) of costs in low, medium and high utilization centers. The national potential direct cost savings of medium and high CCU utilization centers adopting low NSTE ACS CCU utilization practices was $113.4 million over the study period. CONCLUSIONS: In a population-based contemporary cohort, CCU utilization for patients with NSTE ACS varied widely and in-hospital mortality was similar between low, medium and high utilization centers. CCU care accounted for 45% of hospitalization costs; thus, implementing policies and admission practices to align hospital resources with patient care needs have the potential to reduce overall health care costs.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2018

Volume

202

Start / End Page

84 / 88

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Admission
  • Non-ST Elevated Myocardial Infarction
  • Medical Overuse
  • Humans
  • Hospital Costs
  • Direct Service Costs
  • Coronary Care Units
  • Cardiovascular System & Hematology
  • Canada
 

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van Diepen, S., Tran, D. T., Ezekowitz, J. A., Zygun, D. A., Katz, J. N., Lopes, R. D., … Kaul, P. (2018). The high cost of critical care unit over-utilization for patients with NSTE ACS. Am Heart J, 202, 84–88. https://doi.org/10.1016/j.ahj.2018.05.003
Diepen, Sean van, Dat T. Tran, Justin A. Ezekowitz, David A. Zygun, Jason N. Katz, Renato D. Lopes, L Kristin Newby, Finlay A. McAlister, and Padma Kaul. “The high cost of critical care unit over-utilization for patients with NSTE ACS.Am Heart J 202 (August 2018): 84–88. https://doi.org/10.1016/j.ahj.2018.05.003.
van Diepen S, Tran DT, Ezekowitz JA, Zygun DA, Katz JN, Lopes RD, et al. The high cost of critical care unit over-utilization for patients with NSTE ACS. Am Heart J. 2018 Aug;202:84–8.
van Diepen, Sean, et al. “The high cost of critical care unit over-utilization for patients with NSTE ACS.Am Heart J, vol. 202, Aug. 2018, pp. 84–88. Pubmed, doi:10.1016/j.ahj.2018.05.003.
van Diepen S, Tran DT, Ezekowitz JA, Zygun DA, Katz JN, Lopes RD, Newby LK, McAlister FA, Kaul P. The high cost of critical care unit over-utilization for patients with NSTE ACS. Am Heart J. 2018 Aug;202:84–88.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2018

Volume

202

Start / End Page

84 / 88

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Patient Admission
  • Non-ST Elevated Myocardial Infarction
  • Medical Overuse
  • Humans
  • Hospital Costs
  • Direct Service Costs
  • Coronary Care Units
  • Cardiovascular System & Hematology
  • Canada