Variation in severity-adjusted resource use and outcome in intensive care units.

Takala, Jukka; Moser, André; Raj, Rahul; Pettilä, Ville; Irincheeva, Irina; Selander, Tuomas; Kiiski, Olli; Varpula, Tero; Reinikainen, Matti; Jakob, Stephan M. (2022). Variation in severity-adjusted resource use and outcome in intensive care units. Intensive care medicine, 48(1), pp. 67-77. Springer-Verlag 10.1007/s00134-021-06546-4

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Intensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure.


Data of 207,131 patients treated in 2008-2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015-2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015-2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models.


SMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5-5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR.


The wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Takala, Jukka, Moser, André, Irincheeva, Irina, Jakob, Stephan


600 Technology > 610 Medicine & health








Doris Kopp Heim

Date Deposited:

19 Oct 2021 16:35

Last Modified:

20 Feb 2024 14:16

Publisher DOI:


PubMed ID:


Additional Information:

Open Access funding provided by Universität Bern.

Uncontrolled Keywords:

Cost control Health care benchmarking Health resources Hospital mortality Intensive care unit Resource allocation




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