The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study (original) (raw)
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Critical Care Clinics, 2012
Intensive care is an integral but expensive component of healthcare in developed countries . An estimate in the US is that fully 2% of the population receives intensive care every year , and overall the percentage of patients who receive intensive care before they die is increasing . Projections of the need for mechanical ventilation predict an exponential growth in the coming years due to the aging population and their over-representation among mechanically ventilated cohorts ; this increase in need for mechanical ventilation will be associated with increasing costs of intensive care . Much of the focus of intensive care is on improvements in technology for organ support and resuscitation. Yet quality healthcare also involves appropriate organization of resources, with the potential to both impact patient outcomes and the costs of the care provided. These economic considerations are likely to become increasingly important as the demand for critical care increases in the face of limited resources.
Resource use in the ICU: short- vs. long-term patients*
Acta Anaesthesiologica Scandinavica, 2003
Background: Intensive care medicine uses a disproportionate share of medical resources, and little is known about the distribution of resources between different patient groups. Methods: In this prospective observational study, all patients admitted between 1 January 1998 and 31 December 1999 to our medical-surgical university's ICU were assigned to one of two groups according to length of stay (LOS): patients staying more than 7 days in the unit (group L) and those staying a maximum of 7 days (group S). Resource use was estimated using TISSÀ28, number of nursing shifts, use of mechanical ventilation, and use of renal replacement therapy. Further, SAPS II and ICU and hospital mortalities were recorded. Results: Of 5481 patients, 583 (10.6%) were in group L and 4898 in group S (89.4%). Patients in group L were more severely sick upon admission than those in group S. Patients in group L stayed a total of 9726 days in the ICU (52.5% of the total LOS). In group L, 69.2% of all shifts with respiratory support and 80.1% of all shifts with renal replacement were used. Further, group L patients consumed 53.4% (909225) of all TISS points provided. The ICU-mortality rates were 14.4% in group L and 7.2% in group S, and the hospital mortality rates were 19.9% and 9.8%, respectively. A mean of 1898 TISS points was used per patient surviving the hospital stay in group L compared with 190 points in group S. Conclusions: In this university-based, medical-surgical adult ICU, 11% of all patients stayed more than 7 days in the unit and consumed more than 50% of all resources. Thus, a highly disproportionate amount of resources were used per survivor in group L compared with those in group S.
Critical care medicine, 2015
Matching healthcare staff resources to patient needs in the ICU is a key factor for quality of care. We aimed to assess the impact of the staffing-to-patient ratio and workload on ICU mortality. We performed a multicenter longitudinal study using routinely collected hospital data. Information pertaining to every patient in eight ICUs from four university hospitals from January to December 2013 was analyzed. A total of 5,718 inpatient stays were included. None. We used a shift-by-shift varying measure of the patient-to-caregiver ratio in combination with workload to establish their relationships with ICU mortality over time, excluding patients with decision to forego life-sustaining therapy. Using a multilevel Poisson regression, we quantified ICU mortality-relative risk, adjusted for patient turnover, severity, and staffing levels. The risk of death was increased by 3.5 (95% CI, 1.3-9.1) when the patient-to-nurse ratio was greater than 2.5, and it was increased by 2.0 (95% CI, 1.3-3...
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Critical Care Medicine, 2014
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Profile of ICU Bed Requests at Helen Joseph Hospital
Wits Journal of Clinical Medicine, 2020
Background: Intensive care unit (ICU) beds are a scarce resource at Helen Joseph Hospital (HJH). A limited number of beds serve a population with a large burden of disease. Medical practitioners request ICU beds for patients they deem in need of ICU management. However, the decision to admit patients to the ICU remains the responsibility of the ICU consultant on call. No formal prognostic scoring system (such as Acute Physiological and Chronic Health Evaluation or Simplified Acute Physiology Score) or admission guidelines were in place when performing this study. Aim: To compile a profile of all the ICU admission requests at HJH. Methods: A contextual, prospective, descriptive research design was followed in this study. Data was collected during one winter and one summer month in 2012 using consecutive sampling from ICU consultation forms. Results: A total of 139 patients were included in the study. The median age was 44 years. The majority of patients (79%) were under the age of 60 years. The overall admission rate was 35.25% and the most common reason for admission was mechanical ventilation. Of the patients refused ICU admission, 41% were assessed as being too ill, 30% were assessed as too well and 29% were refused admission due to a lack of resources. Patients admitted to the ICU had a 77.55% survival rate. The relationship between ICU admission and 30-day improved outcome was statistically significant, with those being admitted to ICU having a better outcome. Conclusions: Overall a relatively young population is admitted to ICU at HJH. The allocation of beds between the disciplines is fairly equal, both with good survival benefits. The lack of ICU resources is an important limitation to ICU admission. Admission to ICU demonstrated a survival benefit.
Length of Stay Data as a Guide to Hospital Economic Performance for ICU Patients
Medical Care, 2003
CONTEXT. Length of stay data are increasingly used to monitor ICU economic performance. How such material is presented greatly affects its utility. OBJECTIVE. To develop a weighted length of stay index and to estimate expected length of stay. To assess alternative ways to summarize weighted length of stay to evaluate ICU economic performance. DESIGN. Retrospective database study. SUBJECTS. Data for 751 ICU patients in 1998 at two hospitals used to develop weighted length of stay index. Data on 42,237 patients from 72 ICUs used as the basis of economic performance evaluation. MAIN OUTCOME MEASURES. Difference between actual and expected weighted length of stay, where expected weighted length of stay is based on patient clinical characteristics. RESULTS. Length of stay statistically explains approximately 85 to 90% of interpatient variation in hospital costs. The first ICU day is approximately four times as expensive, and other ICU days approximately 2.5 times as expensive, as non-ICU hospital days. In a regression model for weighted length of stay, patient clinical characteristics explain 26% of variation. ICU economic performance can be measured by excess weighted length of stay of a "typical" patient or by occurrence of long excess weighted lengths of stay. Although different summary measures of performance are highly correlated, choice of measure affects relative ranking of some ICUs' performance CONCLUSION. Providers of statistical data on ICU economic performance should adjust length of stay for patient characteristics and provide multiple summary measures of the statistical distribution, including measures that address both the typical patient and outliers.
Cost Analysis of an Intensive Care Unit
We proposed a retrospective cost analysis of patients hospitalized in the intensive care unit of San Leonardo Hospital (Southern-Italy), stratified for diagnostic groups at hospital admission in 2010, from National Health Service perspective. The cost analysis was performed on patients with a length of stay longer than 24 hours. Direct medical costs were estimated: hospitalization costs and surgical procedures were calculated by tariff system DRG (diagnosis related group) while device-related costs were provided by the management of the hospital pharmacy. In order to evaluate the burden of the diagnostic groups, we used two indicators proposed by Rossi C. et al.: cost per surviving patient and money loss per patient. The most frequent admission diagnoses were edema (16.4%) and left heart failure (13.9%). There was a wide variation in the mean costs per patient (from €2,777 for stroke to €7,227 for nephro-urological disease). Intracranial bleeding had the highest cost for dead and survived patients, whereas neurological diseases and COPD (chronic obstructive pulmonary disease) had the lowest costs, indicating a better efficiency. Our findings are a starting point for further investigations aimed at the exploitation of resources that are currently being absorbed by ICU (intensive care unit), in order to provide patients with the best possible healthcare.
Variable costs of ICU patients: a multicenter prospective study
Intensive Care Medicine, 2006
Objective To analyze the costs of treating critically ill patients. Design and setting Multicenter, observational, prospective, cohort, bottom-up study on variable costs in 51 ICUs. Patients and participants A total of 1,034 patients aged over 14years who either spent less than 48h in the ICU or had multiple trauma, major abdominal surgery, ischemic stroke, chronic obstructive pulmonary disease, cardiac failure, isolated head injury, acute lung injury/adult respiratory distress syndrome (ALI/ARDS), nontraumatic intracranial hemorrhage or coronary surgery. Interventions Data recorded for each patient: length of ICU stay, and cost in euros of all diagnostic and therapeutic procedures, drugs and equipment used, and consultations by physicians from other units. To express cost-efficiency we calculated for each diagnostic group the cost per surviving patient (expenditure for all patients/number of surviving patients) and money loss per patient (expenditure for patients who died/total number of patients). Measurements and results Median costs for a multiple trauma patient were €4076 and for coronary surgery patient €380. The variability is largely due to different lengths of ICU stay. Cost per surviving patient was higher for ALI/ARDS, nontraumatic intracranial hemorrhage, multiple trauma, and emergency abdominal surgery. Money loss per patient was higher for ALI/ARDS and lower for multiple trauma. Planned coronary and major abdominal surgery and short-stay patients were treated most cost-efficiently. Conclusions Cost of treatment in an ICU varies widely for different types of patients. Strategies are needed to contain the major determinants of high costs and low cost-efficiency. For the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva. GiViTI is the
Crit Care, 2007
Introduction Intensive care unit (ICU) costs account for up to 20% of a hospital's costs. We aimed to analyse the individual patient-related cost of intensive care at various hospital levels and for different groups of disease. Methods Data from 51 ICUs all over Germany (15 primary care hospitals and 14 general care hospitals, 10 maximal care hospitals and 12 focused care hospitals) were collected in an observational, cross-sectional, one-day point prevalence study by two external study physicians (January-October 2003). All ICU patients (length of stay > 24 hours) treated on the study day were included. The reason for admission, severity of illness, surgical/diagnostic procedures, resource consumption, ICU/ hospital length of stay, outcome and ICU staffing structure were documented. Results Altogether 453 patients were included. ICU (hospital) mortality was 12.1% (15.7%). The reason for admission and the severity of illness differed between the hospital levels of care, with a higher amount of unscheduled surgical procedures and patients needing mechanical ventilation in maximal care hospital and focused care hospital facilities. The mean total costs per day were €791 ± 305 (primary care hospitals, €685 ± 234; general care hospitals, €672 ± 199; focused care hospitals, €816 ± 363; maximal care hospitals, €923 ± 306), with the highest cost in septic patients (€1,090 ± 422). Differences were associated with staffing, the amount of prescribed drugs/ blood products and diagnostic procedures. Conclusion The reason for admission, the severity of illness and the occurrence of severe sepsis are directly related to the level of ICU cost. A high fraction of costs result from staffing (up to 62%). Specialized and maximum care hospitals treat a higher proportion of the more severely ill and most expensive patients.