Objectives: To compare the utilization and cost of common laboratory and imaging tests following admission to the intensive care unit (ICU) after coronary artery bypass surgery in two hospitals. The hospitals use different strategies to order tests postoperatively: one hospital uses a mandated protocol while the other does not.
Design: Demographic and testing data were prospectively collected in both hospitals as part of an ongoing ICU management program. Thirteen commonly performed laboratory tests or imaging procedures were compared. Average costs for each test were calculated, and utilization and cost of testing were compared per admission and per day in ICU.
Setting: Two tertiary care ICUs in different Canadian cities.
Patients: Consecutive patients admitted to ICU following coronary artery bypass graft surgery over a two-year period.
Main results: There were 415 admissions to the Health Sciences Centre in Winnipeg, Manitoba and 504 to the Jewish General Hospital (JGH) in Montreal, Quebec. There were no demographic, length of stay or ICU mortality differences. A postoperative protocol for ordering investigations is used at JGH. Striking differences in test utilization were noted, with more investigations performed per admission and per unit day at JGH (P < 0.001). The average cost of the investigations was greater at JGH ($160 more per admission; $75 more per intensive care day).
Conclusions: There are marked differences in the investigation pattern and costs for coronary artery bypass patients admitted to ICU in these hospitals. It is suggested that the benefits of frequent routine determinations of bloodwork, electrocardiograms and chest radiographs should be reevaluated in this patient population.