BMJ  2006;333:1190 (9 December), doi:10.1136/bmj.39055.352384.DB

News

High spending intensive care doctors do not always achieve better outcomes

¹ BMJ

Wide variation in spending on intensive care patients resulting from doctors' different treatment styles does not affect patients' length of stay in the unit or mortality, a new study from one US hospital says.

The report said that doctors' adoption of a more uniform approach would not harm patients and could save resources (American Journal of Respiratory and Critical Care Medicine 2006;174:1206-10).

The report, by Allan Garland and colleagues at the Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, Ohio, also said that intensive care doctors who spent more on care of their patients also spent more on imaging, laboratory services, blood banking, and drugs.

The study, which looked at nine intensive care doctors' treatment of more than 1000 patients over 29 months, found that "higher resource use was not associated with lower length of stay or mortality."

The study found a difference between the highest and lowest spending doctors of $1000 (£505; 750) per patient admitted. The report said that doctors had "an accurate sense" of the cost of their own treatment style and that "perhaps the higher spenders believe their practice style produces better outcomes."

The study claims to be the first to compare objective measures of practice patterns and doctors' own assessment of their treatment style.

The investigators adjusted for workload and severity of cases, leaving them confident of their findings, despite the limitation of looking at only one intensive care unit. They said that the workload and staffing at this unit were similar to those at other large centres and that the results would be useful in addressing problems of resource allocation.

More than 25% of cases were related to the respiratory system, and the overall mortality in the unit was 7%. Less than a quarter of patients needed invasive mechanical ventilation.