Gosula Venkata, Hariharan Seetharaman
Anaesthesia and Intensive Care, Eric Williams Medical Sciences Complex, Trinidad, TTO.
Anaesthesia and Intensive Care, The University of the West Indies - St. Augustine, St. Augustine, TTO.
Cureus. 2020 Dec 18;12(12):e12141. doi: 10.7759/cureus.12141.
Introduction Intensive Care Unit (ICU) is a resource intense area consuming a vast majority of the hospital's budget. This study aimed to determine the costs of providing critical care to non-survivors in an adult ICU at a tertiary care teaching hospital in the Caribbean. Methods A chart review of non-survivors over a period of nine months was done in an adult ICU. Admission diagnoses, Simplified Acute Physiology Score (SAPS II) score, daily laboratory investigations, drugs, and all therapeutic interventions including mechanical ventilation were recorded. Activity-based costs were prospectively estimated by data obtained from ICU flowsheets, nursing-activity scores, and various hospital departments. Results A total of 316 days of ICU intervention data were collected from the 39 non-survivors enrolled. The median patient age was 56 years. The median ICU length of stay (LOS) and the median duration of mechanical ventilation were five days. The median SAPS II score was 62. One-third of patients had cardiovascular problems and 28% were surgical patients. The total cost of providing ICU care for the non-survivors was US$ 765,233 with an average cost of US$ 19,621 per patient. Human resources (39%) and consumables (29%) were the highest components of costs. Patients who had a cardiac arrest before admission consumed more resources. A higher SAPS II score predicted a shorter LOS (p=0.01) and lower costs (p=0.03). Conclusions ICU care for non-survivors consume significantly high resources. Stringent admission protocols and consideration of medical futility at an earlier stage, using prognostic models and clinical criteria may prevent unnecessary interventions and costs.
引言 重症监护病房（ICU）是资源密集型区域，消耗了医院大部分预算。本研究旨在确定加勒比地区一家三级护理教学医院的成人ICU为非幸存者提供重症护理的成本。方法 对一家成人ICU中九个月期间的非幸存者进行病历审查。记录入院诊断、简化急性生理学评分（SAPS II）、每日实验室检查、药物以及包括机械通气在内的所有治疗干预措施。通过从ICU流程表、护理活动评分和各医院科室获取的数据，前瞻性地估算基于活动的成本。结果 从39名登记的非幸存者中收集了总共316天的ICU干预数据。患者中位年龄为56岁。ICU中位住院时间（LOS）和机械通气中位持续时间均为五天。SAPS II中位评分为62。三分之一的患者有心血管问题，28%为外科手术患者。为非幸存者提供ICU护理的总成本为765,233美元，平均每位患者成本为19,621美元。人力资源（39%）和消耗品（29%）是成本的最高组成部分。入院前发生心脏骤停的患者消耗更多资源。较高的SAPS II评分预示住院时间较短（p = 0.01）和成本较低（p = 0.03）。结论 为非幸存者提供ICU护理消耗的资源显著较高。采用严格的入院方案并在早期阶段使用预后模型和临床标准考虑医疗无效性，可能会避免不必要的干预和成本。
