Pietermaritzburg Metropolitan Complex, Edendale Hospital, Department of General Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, South Africa.
Burns. 2011 Sep;37(6):1033-7. doi: 10.1016/j.burns.2011.04.004. Epub 2011 May 18.
Institutional data shows a high burden of burn injury, which is managed by a conservative delayed approach. This is daily dressing until spontaneous eschar separation occurs followed by delayed skin grafting. Early excision and grafting is considered active management and is shown to be more cost effective in first world situations. We developed a costing model for both approaches to analyse financial costs in a developing country burns unit.
Utilising previous audit data of burn care at our institution, a costing model was developed. Individual cost drivers such as dressing, analgesia, theatre costs, and hospital stay were identified. Cost for each driver was multiplied by number of patients and or number of days in hospital. Total cost was a summation of these individual drivers. The costs derived from this model were compared to the cost of care of a single patient in which the burn wound was actively managed.
The total cost of care for patients admitted with a burn injury was 29,549,750 ZAR. The estimated total cost of the single patient with a 20% body surface area deep dermal thickness burn treated conservatively at our institution was estimated at 154,000 ZAR, compared with a single patient with equivalent injury treated with an active approach costing 103,000 ZAR. The potential cost saving was ten million rand.
This simple cost model suggests considerable savings could be made with active burn wound management implementation. Accurate costing of a larger cohort should define these savings more accurately.
机构数据显示烧伤负担沉重，采用保守的延迟治疗方法进行管理。这是一种日常换药方法，直到自发性焦痂分离，然后再进行延迟植皮。早期切除和植皮被认为是积极的治疗方法，在第一世界国家的情况下，这种方法被证明更具成本效益。我们为这两种方法开发了一个成本模型，以分析发展中国家烧伤单位的财务成本。
利用我们机构烧伤护理的先前审计数据，开发了一个成本模型。确定了个体成本驱动因素，如敷料、镇痛、手术室成本和住院时间。每个驱动因素的成本乘以患者数量或住院天数。总成本是这些单个驱动因素的总和。将该模型得出的成本与积极管理烧伤伤口的单个患者的护理成本进行比较。
因烧伤而住院的患者的总护理费用为 29549750 南非兰特。在我们机构，一名 20%体表面积深真皮厚度烧伤的患者接受保守治疗的估计总费用为 154000 南非兰特，而接受积极治疗的同等损伤患者的费用为 103000 南非兰特。潜在的节省成本为 1000 万兰特。
这个简单的成本模型表明，积极的烧伤伤口管理实施可以节省大量成本。对更大的患者群体进行准确的成本核算可以更准确地确定这些节省。
