Critical care medicine in the United States 1985–2000: An analysis of bed numbers, use, and costs*

  title={Critical care medicine in the United States 1985–2000: An analysis of bed numbers, use, and costs*},
  author={Neil A. Halpern and Stephen M Pastores and Robert J. Greenstein},
  journal={Critical Care Medicine},
Objective:To establish a database that permits description and analysis of the evolving role, patterns of use, and costs of critical care medicine (CCM) in the United States from 1985 to 2000. Design:Retrospective study combining data from federal (Hospital Cost Report Information System, Center for Medicare and Medicaid Services, Baltimore, MD) and private (Hospital Statistics, American Hospital Association, Chicago, IL) databases to analyze U.S. hospitals, hospital and CCM beds, and occupancy… 
Critical care medicine in the United States 2000–2005: An analysis of bed numbers, occupancy rates, payer mix, and costs*
The evolving role, patterns of use, and costs of critical care medicine in the United States from 2000 to 2005 are analyzed to provide a contemporary benchmark for the strategic planning ofcritical care medicine services within the U.S. hospital system.
Changes in critical care beds and occupancy in the United States 1985–2000: Differences attributable to hospital size
Although the CCM bed capacity is increasing at a greater percentage rate in smaller hospitals, the assignment of hospital beds to CCM remains higher in the larger hospitals, andCCM bed occupancy is greater in larger institutions.
Trends in Critical Care Beds and Use Among Population Groups and Medicare and Medicaid Beneficiaries in the United States: 2000–2010
The increasing use of critical care medicine by the premature/neonatal and Medicaid populations should be considered by healthcare policy makers, state agencies, and hospitals as they wrestle with critical care bed growth and the associated costs.
Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review*
This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the ICU
Growth of intensive care unit resource use and its estimated cost in Medicare*
Medicareintensive care unit use is rising rapidly and will likely continue to do so, despite significant healthcare system changes, adjusted daily critical care costs remained stable, yet care outside the intensive care unit became more expensive.
Hospital-Level Changes in Adult ICU Bed Supply in the United States
Increasingly, intensive care bed expansion in the United States is occurring in larger hospitals and teaching centers, particularly following a year with high ICU occupancy.
Can the costs of critical care be controlled?
  • N. Halpern
  • Medicine, Political Science
    Current opinion in critical care
  • 2009
Cost containment is difficult to attain in critical care as the programs proposed to achieve cost control may be so pricey, that potential cost savings are offset.
Increasing Critical Care Admissions From U.S. Emergency Departments, 2001–2009*
The amount ofcritical care provided in U.S. EDs has increased substantially over the past decade, driven by increasing numbers of critical care ED visits and lengthening ED length of stay.
Critical care bed growth in the United States. A comparison of regional and national trends.
National trends in ICU bed growth are not uniformly reflected at the regional level, with most growth occurring in a small number of highly populated regions.
Variation in critical care services across North America and Western Europe*
The findings demonstrate the need for critical care data from all countries, as they are essential for interpretation of studies, and policy decisions regarding critical care services, with wide differences in both numbers of beds and volume of admissions.


Federal and nationwide intensive care units and healthcare costs: 1986–1992
Until customized Health Care Financing Administration analyses become available, nationwide ICU costs are best determined by the Russell equation, and Department of Veterans Affairs' ICUs have a consistent cost advantage over nationwide ICUs.
Descriptive analysis of critical care units in the United States
Notably, available technology within hospitals and individual units was increased as hospital size increased; surgical units tended to have more available technology than other unit types.
Descriptive analysis of critical care units in the United States: Patient characteristics and intensive care unit utilization
Elimination of units predominantly treating children (pediatric and neonatal) from the analysis left “adult” units with three primary admitting diagnoses: ischemic heart disease, postoperative management, and respiratory insufficiency/failure with variation according to specific unit type.
National estimates of intensive care utilization and costs: Canada and the United States.
The results demonstrated steady growth in Canadian utilization from 1969 to 1986, with increased ICU patient days (17 to 42 days/1000 population), and national costs for 1986 were estimated at $1.03 billion, which was roughly 8% of total inpatient costs and 0.2% of Canada's gross national product (GNP).
Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model
Two task forces were convened by the Society of Critical Care Medicine to review available information on critical care delivery in the ICU and to ascertain, if possible, a “best” practice model, and the role and practice of an intensivist.
Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population?
It is forecast that the proportion of care provided by intensivists and pulmonologists in the United States will decrease below current standards in less than 10 years, and most anticipated effects are minor in comparison with the growing disease burden created by the aging US population.
Availability of critical care personnel, facilities, and services in the United States
This survey of 1474 special care units in the United States found that smaller hospitals tended to have only one ICU, and regardless of hospital size, geographic area, or urban setting, more than 80% of units thought that they were adequately staffed and supplied.
Critical care medicine: Observations from the Department of Veterans Affairs' intensive care units
The results of this study suggest that the Department of Veterans Affairs would benefit from increasing the number of critical care Medicine board eligible/certified directors, and increasing the program's participation in accredited critical care medicine fellowship training programs and research endeavors.
Understanding costs and cost-effectiveness in critical care: report from the second American Thoracic Society workshop on outcomes research.
It is recommended all CEAs in the critically ill include a PCEHM reference case, where the cost-effectiveness ratio is calculated by adopting a societal perspective, estimating long-term costs and quality of life after ICU care, applying a 3% annual discount rate to costs and effects, and conducting multiway sensitivity analyses.
Cost burdens influencing the delivery of intensive care.
  • Medicine
    Critical care nursing quarterly
  • 2003
While there have been many significant medical advances in ICU care that could reduce medical complications and ensure operational efficiencies, few ICUs are able to ensure they are incorporated into routine practice and avoidable waste continues and unnecessary expenditure is perpetuated.