• B M Block, C A Sirio, G S Cooper, D L DiGiuseppe, and G E Rosenthal.
• Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
• Crit. Care Med. 2000 Apr 1;28(4):1204-7.

ObjectiveTo compare the use of 40 specific medical interventions in intensive care units (ICUs) of major teaching and other hospitalsDesignRetrospective cohort study.SettingThirty-eight ICUs in 28 hospitals in a large metropolitan region.PatientsA total of 12,929 consecutive eligible admissions to medical, surgical, neurologic, or mixed medical/surgical ICUs between January 1, and June 30, 1994.MeasurementsThe use of 40 diagnostic and therapeutic interventions during the first 24 hrs of ICU admission were obtained from patient medical records and a weighted intervention score was determined for each patient. Admission severity of illness was measured by using the Acute Physiology and Chronic Health Evaluation III methodology.Main ResultsPatients at the five teaching hospitals had a greater severity of illness (mean predicted risk of in-hospital death, 15.1%+/-21.9% vs. 11.2%+/-19.0%; p < .01) than patients at the 23 other hospitals. Patients at major teaching hospitals also had higher mean intervention scores (3.5+/-4.9 vs. 2.3+/-3.7; p < .01). Differences in intervention scores persisted after controlling for severity of illness, admission diagnosis, and admission source. However, scores varied among the major teaching hospitals. When examined individually, only three of the five major teaching hospitals had higher (p < .05) interventions scores, compared with other hospitals, whereas one had a lower (p < .05) intervention score.ConclusionsPatients in ICUs at major teaching hospitals were, in aggregate, more likely to receive diagnostic and therapeutic interventions than patients at other hospitals. Variation among major teaching hospitals suggests that factors other than teaching status also affect the use of these interventions.

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