The costs of Respiratory Insufficiency, Arrest and Failure (RIAF), detailed in a 2010 AHRQ Statistical Brief, place RIAF among five conditions with the most rapidly increasing hospital costs for Medicare-covered stays in the US. The purpose of this study is to determine costs specifically associated with RIAF occurring in nonsurgical (medical) patients on the general care floor (GCF).
Our hypothesis is that RIAF among medical patients and originating on the GCF represents a large clinical and economic burden to hospitals.
We identified all adult medical inpatients admitted to the GCF on Day One of hospitalization from the Premier Database, CY 2010. RIAF were identified using ICD codes and excluded those cases with Present on Admission indicators. We used descriptive statistics to examine the incidence, distribution of Major Diagnostic Categories (MDC) and population characteristics. We evaluated outcomes including discharge disposition, hospital and ICU length of stay, and hospital costs.
Of the 1,620,985 discharges included, 0.91% had a diagnosis code for RIAF that was not present on admission. Nearly 60% of RIAF cases fell within three MDCs: respiratory, infectious/parasitic diseases and circulatory. Septicemia, pneumonia, and heart failure were the top three Diagnosis Related Groups. Patients with RIAF were older (mean age: 69.4 vs 53.7 years) and had more comorbidities (mean comorbidity index: 3.5 vs 1.4) than those without RIAF. Males/whites had higher RIAF incidence than females/nonwhites. Mortality rates were higher for RIAF cases (34.6%) than non-RIAF cases (1.2%, p<0.001). Lengths of hospital and ICU stays were higher for RIAF cases (11.5, 5.8 days) than non-RIAF cases (4.1, 2.9 days), respectively. Total hospital costs were higher for RIAF cases ($24,578) than non-RIAF cases ($6,370). About 40% of the costs of RIAF cases were attributed to ICU stay.
RIAF that originates on the GCF may result in significant mortality, clinical and economic burden among medical inpatients. Better strategies for prevention of, monitoring for and management of RIAF among medical patients on the GCF could lead to improved patient outcomes and improved hospital economics.