Shorr Andrew F, Micek Scott T, Jackson William L, Kollef Marin H
Pulmonary and Critical Care Medicine Section, Washington Hospital Center, USA.
Crit Care Med. 2007 May;35(5):1257-62. doi: 10.1097/01.CCM.0000261886.65063.CC.
To determine the financial impact of a sepsis protocol designed for use in the emergency department.
Retrospective analysis of a before-after study testing the implications of sepsis protocol.
Academic, tertiary care hospital in the United States.
Persons with septic shock presenting to the emergency department.
A multifaceted protocol developed from recent scientific literature on sepsis and the Surviving Sepsis Campaign. The protocol emphasized identification of septic patients, aggressive fluid resuscitation, timely antibiotic administration, and appropriateness of antibiotics, along with other adjunctive, supportive measures in sepsis care.
We compared patients treated before the protocol with those cared for after the protocol was implemented. Overall hospital costs represented the primary end point, whereas hospital length of stay served as a secondary end point. All hospital costs were calculated based on charges after conversion to costs based on department-specific cost-to-charge ratios. We also attempted to measure the independent impact of the protocol on costs through linear regression. We conducted a sensitivity analysis assessing these end points in the subgroup of subjects who survived their hospitalization. The total cohort included 120 subjects (evenly divided into the before and after cohorts) with a mean age of 64.7 +/- 18.2 yrs and median Acute Physiology and Chronic Health Evaluation II score of 22.5 +/- 8.3. There were more survivors following the protocol's adoption (70.0% vs. 51.7%, p = .040). Median total costs were significantly lower with use of the protocol ($16,103 vs. $21,985, p = .008). The length of stay was also on average 5 days less among the postintervention population (p = .023). A Cox proportional hazard model indicated that the protocol was independently associated with less per-patient cost. Restricting the analysis to only survivors did not appreciably change our observations.
Use of a sepsis protocol can result not only in improved mortality but also in substantial savings for institutions and third party payers. Broader implementation of sepsis treatment protocols represents a potential means for enhancing resource use while containing costs.
确定为急诊科设计的脓毒症治疗方案的财务影响。
对一项前后对照研究进行回顾性分析，以测试脓毒症治疗方案的影响。
美国一家学术性三级护理医院。
因感染性休克就诊于急诊科的患者。
根据近期关于脓毒症的科学文献和拯救脓毒症运动制定的多方面方案。该方案强调脓毒症患者的识别、积极的液体复苏、及时的抗生素给药以及抗生素的合理性，同时还有脓毒症护理中的其他辅助性、支持性措施。
我们将方案实施前治疗的患者与方案实施后护理的患者进行了比较。医院总费用为主要终点指标，而住院时间为次要终点指标。所有医院费用均根据收费情况进行计算，并基于各科室特定的成本收费比换算为成本。我们还试图通过线性回归来衡量该方案对成本的独立影响。我们进行了敏感性分析，评估了在住院存活的亚组患者中的这些终点指标。总队列包括120名受试者（前后队列各60名），平均年龄为64.7±18.2岁，急性生理与慢性健康状况评分II中位数为22.5±8.3。采用该方案后存活者更多（70.0%对51.7%，p = 0.040）。使用该方案时，总费用中位数显著降低（16,103美元对21,985美元，p = 0.008）。干预后人群的住院时间平均也少5天（p = 0.023）。Cox比例风险模型表明，该方案与每位患者较低的成本独立相关。仅对存活者进行分析并未明显改变我们的观察结果。
使用脓毒症治疗方案不仅可以提高生存率，还能为机构和第三方支付方节省大量费用。更广泛地实施脓毒症治疗方案是在控制成本的同时提高资源利用效率的一种潜在手段。
