Death and dollars: The cost of dying in the surgical intensive care unit

Introduction: The effect of resuscitation status on the use of laboratory and radiologic studies was analyzed in patients at the Waiter Reed Army Medical Center's Surgical Intensive Care Unit. Methods: A retrospective assessment of laboratory and radiologic charges incurred during the last 48 hours of life by 81 patients who died in the Surgical Intensive Care Unit between 1990 and 1992 was performed. Data were analyzed after separation by patient's resuscitation status. Each patient was assigned a resuscitation category: no limitation, do not resuscitate (no CPR in event of arrest), or limited therapy (specific order limiting care or monitoring). Results: There were 4,095 laboratory tests performed for a total charge of $191,247. Arterial blood gas testing accounted for over $75,000 of these charges. Resuscitation status significantly affected test frequency. Conclusions: During the last 48 hours of life in an intensive care unit, the use of laboratory tests and radiologic exams has a substantial effect on the cost of care and is modified by the patient's resuscitation status.