- The study examined outcomes of 84,182 patients admitted to general intensive care units (ICUs) versus specialty ICUs for conditions like heart attacks, strokes, pneumonia and surgery. - Risk-adjusted mortality was similar for general ICUs and "ideal" specialty ICUs that matched a patient's condition. However, admission to a "non-ideal" specialty ICU was associated with higher odds of death. - The results suggest creating more specialty ICU beds may not necessarily improve survival outcomes compared to general ICUs, and patients may face higher risks if admitted to specialty units that do not match their condition.

1. Average age 65.4 ± 14.4 yrs; 41% female 29,460 patients admitted to a general ICU (35%); 47,921 patients admitted to ideal specialty ICU (57%); 6,801 patients admitted to a non-ideal specialty ICU (8%) Crude mortality was similar between patients admitted to general and ideal specialty ICUs, higher for patients admitted to non-ideal specialty ICUs Results Critical illness outcomes in general versus specialty intensive care units Jason P. Lott MA 3 , Theodore J. Iwashyna MD PhD 1-3 , Jason D. Christie MD MSCE 1-3 , David A. Asch MD MBA 1-3 , Andrew A. Kramer PhD 4 , Jeremy M. Kahn MD MS 1-3 Except for patients admitted with pneumonia, no significant differences in risk-adjusted mortality between general versus ideal specialty ICUs (Table) Admission to a non-ideal specialty ICU associated with substantially higher adjusted odds of death (Table) Results consistent between models that did and did not control for annual disease-specific volume 1 Division of Pulmonary, Allergy & Critical Care, 2 Leonard Davis Institute of Health Economics, 3 University of Pennsylvania School of Medicine, Philadelphia PA; 4 Cerner Corporation, Vienna VA OR (95% CI) 1.41 (1.01,1.96) 1.41 (1.03,1.94) Table. Risk-adjusted Odds Ratios of ICU Type a on Hospital Mortality for Select Diagnoses Diagnosis OR (95% CI) b Acute Coronary Syndrome Ideal Specialty ICU (n=9,967) 1.17 (0.95,1.45) Non-ideal Specialty ICU (n=1,161) 1.41 (1.01,1.96) † Ischemic Stroke Ideal Specialty ICU (n=1,457) 1.35 (0.96,1.89) Non-ideal Specialty ICU (n=752) 1.41 (1.03,1.94) † Intracranial Hemorrhage Ideal Specialty ICU (n=6,023) 1.00 (0.79,1.28) Non-ideal Specialty ICU (n=2,126) 1.31 (1.03,1.66) † Pneumonia Ideal Specialty ICU (n=3,925) 1.20 (1.02,1.40) † Non-ideal Specialty ICU (n=314) 1.02 (0.74,1.40) Abdominal Surgery Ideal Specialty ICU (n=3,915) 1.06 (0.83,1.36) Non-ideal Specialty ICU (n=2,373) 1.29 (1.04,1.61) † Cardiothoracic Surgery Ideal Specialty ICU (n=22,634) 0.60 (0.32,1.13) Non-ideal Specialty ICU (n=75) NC NC=Not calculated; a Reference group is general ICU; b Values adjusted for age, race, gender, diagnosis, source of admission, acute physiology score, pre-hospital length of stay, ventilation status (yes/no), hospital location (by region), and hospital teaching status; † Designates significance at p<0.05. General intensive care units (ICUs) provide care across a wide range of diagnoses while specialty ICUs provide focused, diagnosis-specific care Risk-adjusted outcome differences across such units are unknown Understanding the impact of specialty ICUs on patient mortality is a key step toward optimizing the allocation of limited hospital resources Background To determine the association between specialty ICU care and the outcome of critical illness Objectives Design: Retrospective cohort study Setting: 124 ICUs in 55 hospitals participating in the Acute Physiology and Chronic Health Evaluation (APACHE) IV from January 2002 to December 2005 Patients: 84,182 patients admitted to specialty and general ICUs with an admitting diagnosis of acute coronary syndrome, ischemic stroke, intracranial hemorrhage, pneumonia, abdominal surgery, or coronary-artery bypass graft surgery Exposure: Patients classified by admission to: (1) a general ICU, (2) a diagnosis-appropriate (“ideal”) specialty ICU, or (3) an inappropriate (”non-ideal”) specialty ICU Outcome: In-hospital mortality Methods Ideal specialty ICU care appears to offer no survival benefit over general ICU care for select diagnoses Non-ideal specialty ICU care (i.e. “boarding”) is associated with increased risk-adjusted mortality Conclusions No data to adjust for ICU level organizational factors, such as intensivist physician staffing, multidisciplinary care, or nurse-to-patient ratios In-hospital mortality used as the outcome, rather than 28-day mortality Non-random sample of hospitals motivated toward quality improvement limits generalizability Limitations The number of ICU beds in the United States is rapidly increasing, with opportunities to create either specialty or general ICUs as capacity expands Our study suggests that investment in specialty ICUs should not take place with the expectation of improved patient survival Policy Implications