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Tailoring Burn and Surgical ICU care to patient backgrounds can improve outcomes and reduce costs by addressing unique challenges faced by each patient group.

A patient’s background impacts the quality of care and outcomes when treated in Burn and Surgical Intensive Care Units (BICU and SICU, respectively), according to study findings published online in Burns. Tomer Lagziel, MD, and colleagues found that healthcare strategies should be tailored to consider multiple challenges faced by each patient group that will ultimately mitigate differences in overall health outcomes and spending.

“Of the modifiable contributors to population health outcomes, medical care is estimated to account for approximately 20%, with the remaining 80% attributable to the social determinants of health, Dr. Lagziel and colleagues wrote. “The National Institutes of Health (NIH) and the American College of Surgeons (ACS) created a list of priorities to guide research efforts addressing healthcare disparities within a surgical setting, and they identified factors such as race/ethnicity, socioeconomic status, culture, and geography.”

“Evidence also shows an association between social determinants and chronic disease, potentially by mediating access to resources that promote healthy behavior or health maintenance.”

The research team conducted a retrospective analysis to understand the impact of social determinants of health and prevalent comorbidities on various quality of care indicators in patients admitted to the BICU and SICU. The authors analyzed data from January 2016 to November 2019, focusing on length of hospital stay (LOS), mortality rates, 30-day readmission rates, and hospital charges as primary outcomes.

Results revealed significant differences between BICU and SICU patients regarding mean hospital charges and LOS. BICU patients with a history of mental health issues, end-stage renal disease (ESRD), sepsis, and venous thromboembolism (VTE) experienced notably higher costs and longer LOS compared to SICU patients. Additionally, higher mortality rates were observed among BICU patients with ESRD, ST-Elevation Myocardial Infarction (STEMI), sepsis, VTE, and diabetes mellitus. Furthermore, BICU patients with mental health concerns, drug dependence, heart failure, and diabetes faced increased rates of 30-day readmissions.

“This population-based study examined the impact of pre-existing comorbidities on clinical outcomes in BICU patients versus SICU patients,” they wrote. “To our knowledge, this study was the first of its kind to compare BICU to SICU patients by comorbidities. Overall, patients with burns share many similarities, and based on institutional resources, their admission may be carried in a dedicated burn ICU or a general surgical ICU.”

The authors emphasized the significance of considering social determinants of health and comorbidities in the care of patients with burns, highlighting the need for tailored healthcare strategies. Dr. Lagziel and colleagues identified social determinants of health, including race/ethnicity, socioeconomic status, culture, and geography, as crucial components influencing health outcomes and healthcare spending. The study underscored the importance of addressing these determinants to mitigate disparities in health outcomes and optimize healthcare utilization.

Notably, the research aimed to fill a gap in the existing literature by comparing BICU and SICU patients based on comorbidities, providing valuable insights into the variability of outcomes among critically ill patients. By understanding how patient backgrounds and the quality of care received contribute to outcomes, the study emphasized the need for targeted interventions to improve patient outcomes and reduce healthcare costs.

“This study sheds new knowledge on the considerable variability of outcomes between the different population health groups of critically ill patients,” Dr. Lagziel and colleagues concluded. “The difference in BICU vs. SICU patient outcomes as it relates to a patient’s comorbidities provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare by shifting focus to considering a patient’s entire environment.”