Elpern E H, Silver M R, Rosen R L, Bone R C
Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago.
Chest. 1991 Jan;99(1):205-8. doi: 10.1378/chest.99.1.205.
Clinical, socioeconomic, and ethical dilemmas have prompted reevaluation of traditional methods of providing intensive care. Six years ago, we established a noninvasive respiratory care unit (NRCU) for selected patients in need of intensive respiratory monitoring and therapy, particularly those requiring prolonged mechanical ventilation. One impetus for the formation of the NRCU was the expectation that it might prove to be a less costly alternative to the intensive care unit (ICU) for selected patients. We reviewed data from all patients admitted to the NRCU from July 1, 1987 through June 30, 1988 to identify characteristics of the patient population and to evaluate potential cost savings. During one year of operation, 136 patients were admitted to the unit, 107 of whom were mechanically ventilated. Overall, hospital costs for these patients exceeded payments by $1,519,477. Losses were greatest for mechanically ventilated patients and those for whom Medicare or Medicaid were the primary payors. Daily costs of care for mechanically ventilated patients were $1,976 lower in the NRCU than in the medical intensive care unit (MICU). We conclude that the NRCU represents a cost-effective approach to the care of substantial numbers of patients requiring specialized respiratory care.
临床、社会经济和伦理困境促使人们重新审视提供重症监护的传统方法。六年前，我们为部分需要强化呼吸监测和治疗的患者，尤其是那些需要长期机械通气的患者，设立了一个无创呼吸护理单元（NRCU）。设立NRCU的一个推动因素是，预计对于部分患者而言，它可能是一种成本更低的替代重症监护病房（ICU）的选择。我们回顾了1987年7月1日至1988年6月30日期间所有入住NRCU患者的数据，以确定患者群体的特征并评估潜在的成本节约情况。在运营的一年中，该单元收治了136名患者，其中107名接受了机械通气。总体而言，这些患者的医院费用超出支付金额1,519,477美元。机械通气患者以及以医疗保险或医疗补助作为主要支付方的患者损失最大。NRCU中机械通气患者的每日护理费用比内科重症监护病房（MICU）低1,976美元。我们得出结论，NRCU是一种具有成本效益的护理大量需要特殊呼吸护理患者的方法。
