Supply Induced Demand in Intensive Care Unit: a Retrospective Trial

Intensive Care Unit (ICU) represents a high-level healthcare and expensive resource in hospitals. The causes of hospitalization in critical care are therefore multiple, and over the years numerous prognostic scores have been proposed, which therefore correlate the severity of the pathology with the predicted mortality from a statistical point of view. The function of the scores is also to assist the physician in clinical choices. The two most frequently used prognostic scores in critical care are the Acute Physiology And Chronic Health Evaluation (APACHE) II score and the Simplified Acute Physiology Score (SAPS) II. The choice to admit a patient to Intensive Care, therefore, is a clinical, economic and managerial choice. Due to the costs of the ICU beds, as well as to the fact that shortage of beds may have a significant clinical impact on patients, many studies addressed the issue of supply-induced scarcity (SIS), i.e. scarcity due to a lack of supply and not to an excess of demand. On the other side, Health Economics has demonstrated that often an increase in supply can generate an increase in demand, even when this increase is not strictly necessary or appropriate. This phenomenon, called supply-induced demand (SID), to the best of our knowledge, few studies have been conducted in critical care settings; moreover, the correlation between SID and outcomes, specifically mortality, has never been demonstrated. The aim of this retrospective, single-center study, therefore, is to investigate the presence of SID, and the consequent effects on mortality outcome, in a multispecialty Postoperative Intensive Care Unit.