Kastrup Marc, Seeling Matthes, Barthel Stefan, Bloch Andy, le Claire Marie, Spies Claudia, Scheller Matthias, Braun Jan
Crit Care. 2012 Jul 18;16(4):R126. doi: 10.1186/cc11428.
There is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). Due to postponement of elective surgery or delayed admission of emergency patients, outcome may be negatively influenced. To optimize the admission process to intensive care, the post-anaesthesia care unit (PACU) was staffed with intensivist coverage around the clock. The aim of this study is to demonstrate the impact of the PACU on the structure of ICU-patients and the contribution to overall hospital profit in terms of changes in the case mix index for all surgical patients.
The administrative data of all surgical patients (n = 51,040) 20 months prior and 20 months after the introduction of a round-the-clock intensivist staffing of the PACU were evaluated and compared.
The relative number of patients with longer length of stay (LOS) (more than seven days) in the ICU increased after the introduction of the PACU. The average monthly number of treatment days of patients staying less than 24 hours in the ICU decreased by about 50% (138.95 vs. 68.19 treatment days, P <0.005). The mean LOS in the PACU was 0.45 (± 0.41) days, compared to 0.27 (± 0.2) days prior to the implementation. The preoperative times in the hospital decreased significantly for all patients. The case mix index (CMI) per hospital day for all surgical patients was significantly higher after the introduction of a PACU: 0.286 (± 0.234) vs. 0.309 (± 0.272) P <0.001 CMI/hospital day.
The introduction of a PACU and the staffing with intensive care staff might shorten the hospital LOS for surgical patients. The revenues for the hospital, as determined by the case mix index of the patients per hospital day, increased after the implementation of a PACU and more patients can be treated in the same time, due to a better use of resources.
医院对重症监护的需求日益增加，这可能导致重症监护病房（ICU）的容量受限。由于择期手术推迟或急诊患者入院延迟，治疗结果可能受到负面影响。为了优化重症监护的入院流程，麻醉后护理单元（PACU）配备了全天候的重症监护医生。本研究的目的是证明PACU对ICU患者结构的影响以及对所有手术患者病例组合指数变化而言对医院整体利润的贡献。
评估并比较了PACU引入全天候重症监护医生配备之前20个月和之后20个月所有手术患者（n = 51,040）的管理数据。
引入PACU后，ICU中住院时间较长（超过7天）的患者相对数量增加。在ICU住院少于24小时的患者平均每月治疗天数减少了约50%（138.95天对68.19天，P <0.005）。PACU的平均住院时间为0.45（±0.41）天，而实施前为0.27（±0.2）天。所有患者在医院的术前时间显著减少。引入PACU后，所有手术患者每天的病例组合指数（CMI）显著更高：0.286（±0.234）对0.309（±0.272），CMI/每天，P <0.001。
引入PACU并配备重症监护人员可能会缩短手术患者的住院时间。由于资源得到更好利用，实施PACU后，根据患者每天的病例组合指数确定的医院收入增加，并且在同一时间可以治疗更多患者。
