Oye R K, Bellamy P E
Department of Medicine, UCLA School of Medicine 90024-1685.
Chest. 1991 Mar;99(3):685-9. doi: 10.1378/chest.99.3.685.
Intensive care is being scrutinized as a major factor in increasing health care costs. We examined 404 consecutive admissions to the medical ICUs at a university medical center to study patterns of consumption of ICU resources and the proportion of resources used by patients admitted for monitoring only. We found a skewed distribution of ICU resource consumption, with the "high-cost" 8 percent using as many ICU resources as the "low-cost" 92 percent. Forty-one percent of admissions did not receive acute ICU treatments, but these admissions consumed less than 10 percent of ICU resources. Reducing the number of patients admitted for monitoring will have a relatively small impact on hospital charges. Since over 70 percent of the high-cost patients died, improved understanding of prognosis and better physician-patient communication may substantially reduce the proportion of critical care resources expended on futile treatment.
重症监护作为医疗成本增加的一个主要因素正在受到严格审查。我们研究了一所大学医学中心内科重症监护病房连续收治的404名患者，以探讨重症监护病房资源的使用模式以及仅为监测而收治的患者所使用资源的比例。我们发现重症监护病房资源消耗分布不均衡，“高成本”的8%患者使用的重症监护病房资源与“低成本”的92%患者一样多。41%的入院患者未接受急性重症监护治疗，但这些患者消耗的重症监护病房资源不到10%。减少因监测而收治的患者数量对医院收费的影响相对较小。由于超过70%的高成本患者死亡，更好地了解预后情况并改善医患沟通可能会大幅减少用于无效治疗的重症监护资源比例。
