Suchard J R, Fenton F R, Powers R D
Division of Emergency Medicine, University of Connecticut School of Medicine, Farmington, USA.
J Emerg Med. 1999 Sep-Oct;17(5):801-5. doi: 10.1016/s0736-4679(99)00086-4.
Numerous studies have shown the futility of continued emergency department (ED) resuscitative efforts for victims of out-of hospital cardiac arrest when prehospital resuscitation has failed. Nevertheless, these patients continue to arrive in the ED, where they create a strain on resources. To assess the economic cost of this, Medicare expenditures were determined for resuscitative efforts on victims of atraumatic, out-of-hospital cardiac arrest subsequently pronounced dead in the ED. Charts of patients pronounced dead in the ED of a 65,000-visit urban teaching hospital during 1995 were reviewed. Selected patients met the following criteria: 1) Medicare recipient age 65 or over; 2) atraumatic, out-of-hospital arrest; 3) transported to the ED by an EMS crew authorized to perform advanced cardiac life support interventions. A total of 105 cases were identified that met inclusion criteria and for which Medicare had claims on file corresponding to the date of death. Ambulance service payments ranged from $105-$391; mean = $263. Physician service payments ranged from $8-$106; mean = $65. Payments for Medicare Part A (hospital facility) ranged from $59-$1,025; mean = $436. The total Medicare reimbursement was $80,197, mean = $764. This annualizes to a national expenditure projection of $58 million. Failed out-of-hospital resuscitation for Medicare patients is associated with poor outcome and high cost. Termination of these efforts in the prehospital arena is unlikely to affect outcome, and would result in considerable cost savings on physician and hospital facility charges. Compassionate protocols that recognize these principles should be developed and implemented.
众多研究表明，对于院外心脏骤停患者，若院前复苏失败，继续在急诊科进行复苏努力是徒劳的。然而，这些患者仍不断被送至急诊科，给资源带来了压力。为评估其经济成本，我们确定了医疗保险对在急诊科最终宣告死亡的非创伤性院外心脏骤停患者的复苏费用支出。回顾了一家年就诊量达65000人次的城市教学医院1995年期间在急诊科宣告死亡患者的病历。入选患者符合以下标准：1）年龄65岁及以上的医疗保险参保者；2）非创伤性院外心脏骤停；3）由授权实施高级心脏生命支持干预措施的急救医疗服务人员转运至急诊科。共识别出105例符合纳入标准且医疗保险有与死亡日期对应的理赔记录的病例。救护车服务费用在105美元至391美元之间；平均为263美元。医生服务费用在8美元至106美元之间；平均为65美元。医疗保险A部分（医院设施）费用在59美元至1025美元之间；平均为436美元。医疗保险总报销金额为80197美元，平均为764美元。这相当于每年全国支出预计达5800万美元。医疗保险患者院外复苏失败与不良预后及高成本相关。在院前阶段终止这些努力不太可能影响预后，且会在医生和医院设施费用方面节省可观成本。应制定并实施认可这些原则的人性化方案。
