Fewer Beds Lead to More Effective ICUs

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According to an opinion piece published in the Journal of the American Medical Association, fewer beds in intensive care units (ICUs) could help curb disparity in service use.

Intensive care accounts for around 3 percent of healthcare spending and almost 1 percent of gross domestic product (GDP), wrote Rebecca Gooch, M.D., of the University of Pittsburgh School of Medicine and Jeremy M. Kahn, M.D., of the University of Pittsburgh Graduate School of Public Health. However, in the United Kingdom, intensive care accounts for only 0.1 percent of GDP.

In the U.K., Gooch and Kahn wrote, there are only five ICU beds for every 100,000 people, and they are used almost exclusively for patients who are at a high risk for death. In the United States, however, there are 25 ICU beds for every 100,000 people and many ICU patients are admitted simply for observation.

"At the same time, compared with patients in the United Kingdom, substantially more patients in the United States die in the ICU, suggesting that increased bed availability appears to reduce the incentive to keep dying patients out of the ICU," they wrote.ICU BED

Gooch and Kahn link this correlation to the economic concept of demand elasticity, which is the notion that a product creates its own demand.

"Just as the creation of a new lane on the interstate highway can lead to increased traffic as new drivers seize the opportunity to travel on the larger road, new critical care beds can lead to increased use. As supply constraints are removed, clinicians are more likely to use the service, even for patients unlikely to benefit,” they wrote.

In an ideal setting, organizations would target ICU admissions for critically or seriously ill patients, who woustand the greatest chance of benefiting from ICU care, the authors suggest.

“With a reduced ICU bed supply, hospitals would have the incentive to keep patients who would benefit from care elsewhere, out of the ICU,” the concluded.

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