缩短重症监护病房住院时间对医院成本的影响：来自加拿大一家三级保健医院的证据。
The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada.
机构信息
Department of Medicine, The Ottawa Hospital, University of Ottawa, CPC 162 737 Parkdale Avenue, Ottawa, ON, K1Y1J8, Canada.
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada.
出版信息
Can J Anaesth. 2018 Jun;65(6):627-635. doi: 10.1007/s12630-018-1087-1. Epub 2018 Feb 23.
PURPOSE
To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre.
METHODS
We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre.
RESULTS
The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs.
CONCLUSION
Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.
目的
通过理论模型练习，确定加拿大某中心 ICU 住院时间（LOS）缩短对总住院费用的影响。
方法
我们对加拿大一家三级教学医院进行了回顾性成本分析。通过 The Ottawa Hospital Data Warehouse 的病例成本、患者登记和医院摘要系统，获取了 2012 年 4 月至 2013 年 3 月期间所有新入院病房（30483 例）和 ICU（2239 例）患者的成本、人口统计学、临床和 LOS 数据。按入院天数、LOS 和成本中心总结 ICU 与病房患者的平均每日可变直接（VD）成本。
结果
每位 ICU 患者的平均每日 VD 成本为 2472 加元（CAD），占每位 ICU 患者每日总 ICU 成本的 67.0%，而病房患者的 VD 成本为 717 加元。ICU 入院首日的可变直接成本最高（3708 加元），然后下降 39.8%，在入院第 5 天达到平台期。如果 ICU 入住时间≥4 天的患者 LOS 缩短，每年可节省 852146 加元的医院费用，占住院总费用的 0.3%，占 ICU 费用的 1.2%。
结论
鉴于 ICU 成本在入院早期最高，缩短 ICU LOS 的成本节约潜力有限，本研究不支持将缩短 ICU LOS 作为唯一的成本节约策略的观点。
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