Magnitude and economic impact of inappropriate use of stress ulcer prophylaxis in non-ICU hospitalized patients

BACKGROUND: Although administration of stress ulcer prophylaxis (SUP) has been recommended for specific patients in the intensive care unit (ICU) setting, this practice has been extrapolated to care of non-ICU patients without evidence to support need or efficacy. AIMS: To examine the practice of SUP in non-ICU patients in a university hospital setting, with specific attention to resource utilization. METHODS: Retrospective chart review of adult non-ICU admissions to one family medicine and five general internal medicine teaching services over a consecutive 4-month period. Proportion of patients prescribed SUP was ascertained after exclusion of patients admitted on antisecretory therapy (AST) or prescribed AST for non-SUP indications. Annual cost estimates were calculated assuming full compliance. RESULTS: Of 1,769 patient admissions, 22% received SUP and 54% of these were discharged home on AST. None of these patients met evidence-based criteria for appropriate SUP. Inpatient SUP cost $11,024 over the 4 months of the study ($44,096 annually), and outpatient costs based on discharge prescriptions were $16,924 ($67,695 annually), yielding a total cost expenditure of $27,948 ($111,791 annually). CONCLUSION: SUP is overutilized in the non-ICU setting, and patients are often discharged unnecessarily on AST, resulting in significant cost expenditure. Interventions to ensure appropriate use of SUP should decrease resource expenditures without detrimental impact on quality of care.