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Changes in hospital costs after introducing an intermediate care unit: a comparative observational study.

Solberg BC, Dirksen CD, Nieman FH, van Merode G, Poeze M, Ramsay G - Crit Care (2008)

Bottom Line: The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs).The mean total hospital cost per patient increased significantly.After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.

View Article: PubMed Central - HTML - PubMed

Affiliation: Staff Department of Research, Care and Education, Maastricht University Hospital, P. Debyelaan 25 6229 HX Maastricht, The Netherlands.

ABSTRACT

Introduction: The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht.

Methods: The design was a comparative longitudinal study. The setting was a university hospital with a mixed intensive care unit (ICU), an IMC, and general wards. Changes in total hospital costs were measured for patients who were admitted to the ICU before and after the introduction of the IMC. The comparison of interest was the opening of a six-bed mixed IMC.

Results: The mean total hospital cost per patient increased significantly. Before the introduction of the IMC, the total hospital cost per patient was n12,961 (+/- n14,530) and afterwards it rose to n16,513 (+/- n17,718). Multiple regression analysis was used to determine to what extent patient characteristics explained these higher hospital costs using mortality, type of stay, diagnostic categories, length of ICU and ward stay, and the Therapeutic Intervention Scoring System (TISS) as predictors. More surgical patients, greater requirements of therapeutic interventions on the ICU admission day, and longer ICU stay in patients did explain the increase in hospital costs, rather than the introduction of the IMC.

Conclusion: After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.

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Related in: MedlinePlus

Pre-intermediate care unit (IMC) and IMC period flowchart of intensive care unit (ICU) patients. GW, general ward; LOS, length of stay; N*, number of admissions; N**, number of readmissions.
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Figure 1: Pre-intermediate care unit (IMC) and IMC period flowchart of intensive care unit (ICU) patients. GW, general ward; LOS, length of stay; N*, number of admissions; N**, number of readmissions.

Mentions: Figure 1 shows the numbers of admissions to the ICU, the IMC, and the general ward; ICU readmissions; ICU discharges; ICU mean LOS; and the number of deceased patients in the pre-IMC and IMC periods. Table 1 summarises demographic and hospital characteristics for patients in the same two periods.


Changes in hospital costs after introducing an intermediate care unit: a comparative observational study.

Solberg BC, Dirksen CD, Nieman FH, van Merode G, Poeze M, Ramsay G - Crit Care (2008)

Pre-intermediate care unit (IMC) and IMC period flowchart of intensive care unit (ICU) patients. GW, general ward; LOS, length of stay; N*, number of admissions; N**, number of readmissions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481456&req=5

Figure 1: Pre-intermediate care unit (IMC) and IMC period flowchart of intensive care unit (ICU) patients. GW, general ward; LOS, length of stay; N*, number of admissions; N**, number of readmissions.
Mentions: Figure 1 shows the numbers of admissions to the ICU, the IMC, and the general ward; ICU readmissions; ICU discharges; ICU mean LOS; and the number of deceased patients in the pre-IMC and IMC periods. Table 1 summarises demographic and hospital characteristics for patients in the same two periods.

Bottom Line: The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs).The mean total hospital cost per patient increased significantly.After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.

View Article: PubMed Central - HTML - PubMed

Affiliation: Staff Department of Research, Care and Education, Maastricht University Hospital, P. Debyelaan 25 6229 HX Maastricht, The Netherlands.

ABSTRACT

Introduction: The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht.

Methods: The design was a comparative longitudinal study. The setting was a university hospital with a mixed intensive care unit (ICU), an IMC, and general wards. Changes in total hospital costs were measured for patients who were admitted to the ICU before and after the introduction of the IMC. The comparison of interest was the opening of a six-bed mixed IMC.

Results: The mean total hospital cost per patient increased significantly. Before the introduction of the IMC, the total hospital cost per patient was n12,961 (+/- n14,530) and afterwards it rose to n16,513 (+/- n17,718). Multiple regression analysis was used to determine to what extent patient characteristics explained these higher hospital costs using mortality, type of stay, diagnostic categories, length of ICU and ward stay, and the Therapeutic Intervention Scoring System (TISS) as predictors. More surgical patients, greater requirements of therapeutic interventions on the ICU admission day, and longer ICU stay in patients did explain the increase in hospital costs, rather than the introduction of the IMC.

Conclusion: After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.

Show MeSH
Related in: MedlinePlus