Costs of Providing Intensive Care for Adult Non-survivors in a Caribbean Teaching Hospital.

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.