The financial cost of intensive care in Australia: a multicentre registry study

Hicks, Peter; Huckson, Sue; Fenney, Emma; Leggett, Isobel; Pilcher, David; Litton, Edward

doi:10.5694/mja2.50309

Cited by 61 publications

(68 citation statements)

References 4 publications

(4 reference statements)

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“…43 Such studies appear warranted given that stakeholders consider unnecessary testing in ICU to be a highly prevalent problem, ICU care is extremely costly with pathology and radiology costs representing 5%-25% and 4%-10% of direct costs respectively, and we consistently found in this study that targeted testing interventions were associated with decreased test ordering and costs. [44][45][46][47][48] Our review found that adverse events were not increased in the majority of studies, and that in the two studies that did observe an increase in adverse events, these were minor and not associated with an increase in ICU LOS or mortality. These findings are reassuring given the concern that decreasing testing may increase the number of missed diagnoses.…”

Section: Discussionmentioning

confidence: 68%

Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

Hooper

Anstey

Litton

2021

Anaesth Intensive Care

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Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

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Section: Discussionmentioning

confidence: 68%

Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

Hooper

Anstey

Litton

2021

Anaesth Intensive Care

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“…Looking at the present, it is clear we need more ICU beds to meet current demands, to improve care for our present patients and to cater for future patients. However, we can also deliver these ICU beds more efficiently and responsibly by streamlining processes of care which reduce ICU length of stay, using ICU telehealth, developing practitioner specialist roles and leveraging economies of scale in larger ICUs [15]. The need for 'more ICU' has never been more obvious than today as we watch a global pandemic overwhelm our present ICU resources.…”

Section: Lack Of Icu Beds Is a Problem Right Nowmentioning

confidence: 99%

ICU beds: less is more? No

2020

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“…As part of this expansion there has been a reduction in small, low acuity units, mostly because many have graduated to become larger units that provide the full complement of ICU interventions. Additionally, mega‐units (major ICUs with more than 40 beds divided into multiple smaller pods supporting a range of highly specialised services) are now well established in all major cities . Across Australia, there are now 183 ICUs with 2219 beds (inclusive of paediatric and private units).…”

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confidence: 99%