Moerer Onnen, Plock Enno, Mgbor Uchenna, Schmid Alexandra, Schneider Heinz, Wischnewsky Manfred Bernd, Burchardi Hilmar
Department of Anaesthesiology, Emergency and Critical Care Medicine, University of Göttingen, Robert-Koch-Strasse 40, Göttingen 37075, Germany.
Crit Care. 2007;11(3):R69. doi: 10.1186/cc5952.
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.
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.
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 euro 791 +/- 305 (primary care hospitals, euro 685 +/- 234; general care hospitals, euro 672 +/- 199; focused care hospitals, euro 816 +/- 363; maximal care hospitals, euro 923 +/- 306), with the highest cost in septic patients (euro 1,090 +/- 422). Differences were associated with staffing, the amount of prescribed drugs/blood products and diagnostic procedures.
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.
重症监护病房（ICU）的费用占医院成本的比例高达20%。我们旨在分析不同医院级别以及不同疾病组别的个体患者重症监护相关成本。
由两名外部研究医生在一项观察性、横断面、单日时点患病率研究中收集了德国各地51个ICU的数据（15家基层医院、14家普通护理医院、10家最高护理医院和12家专科护理医院）（2003年1月至10月）。纳入了研究当天接受治疗的所有ICU患者（住院时间>24小时）。记录了入院原因、疾病严重程度、手术/诊断程序、资源消耗、ICU/医院住院时间、结局以及ICU人员配备结构。
共纳入453例患者。ICU（医院）死亡率为12.1%（15.7%）。不同护理级别的医院之间，入院原因和疾病严重程度有所不同，最高护理医院和专科护理医院设施中计划外手术程序和需要机械通气的患者数量更多。每天的平均总成本为791欧元±305欧元（基层医院，685欧元±234欧元；普通护理医院，672欧元±199欧元；专科护理医院，816欧元±363欧元；最高护理医院，923欧元±306欧元），脓毒症患者的成本最高（1090欧元±422欧元）。差异与人员配备、处方药/血液制品的使用量以及诊断程序有关。
入院原因、疾病严重程度和严重脓毒症的发生与ICU成本水平直接相关。很大一部分成本来自人员配备（高达62%）。专科医院和最高护理医院治疗病情更严重、费用更高的患者的比例更高。
