The frequency and cost of patient-initiated device removal in the ICU

To determine the frequency and pattern with which patients in the intensive care unit (ICU) remove medical devices on their own, and the costs associated with this problem.

Prospective observational study.

Two 10-bed sections of a multidisciplinary ICU in a tertiary care teaching hospital.

Adults admitted to the ICU for longer than 24 hours during October 1998.

None.

Medical records were reviewed prospectively for the occurrence of patient-initiated device removal and the responses to those events by health care providers. Associated costs were estimated using hospital databases and Medicare physician reimbursement schedules. Annual cost estimates were calculated using 1997 admission statistics for 1211 adults in an ICU for more than 24 hours. Thirty-six patients were studied for 199 patient-days. Ten patients (28%) removed 42 devices: 88% of these events involved gastrointestinal tubes and vascular catheters. Significant agitation was documented within 2 hours before 74% of the events. Estimated cost associated with device removal was $7606, or $181/event. The estimated annual cost in this 42-bed ICU was more than $250,000.

Patients commonly remove medical devices on their own, and this represents significant consumption of health care resources.