Blackstone M E, Miller R S, Hodgson A J, Cooper S S, Blackhurst D W, Stein M A
Department of Trauma Surgery, Greenville Hospital System, South Carolina, USA.
J Trauma. 1995 Dec;39(6):1041-4. doi: 10.1097/00005373-199512000-00004.
The goal of this study was to determine if trauma intensive care unit (TICU) charges could be reduced through informal daily bedside resident-attending physician discussions regarding relative patient costs of diagnostic and therapeutic alternatives.
This was a prospective pre- and postinterventional study.
The study took place in a TICU in a level I, community-based, university-affiliated teaching hospital.
Ninety-one consecutive patients were admitted to the TICU during a 6-month period.
The TICU charges were tracked over two consecutive 3-month periods. The first 3 months served as control. No attempt was made to alter cost of care, and residents were unaware that a study was in progress. During the ensuing 3-month period, attendings explicitly discussed with residents relative costs of diagnostic and therapeutic interventions in an attempt to lower charges. Composition of the surgical trauma team remained constant throughout the study.
The median and mean age, Injury Severity Score, intensive care unit length of stay, and sex ratio were not statistically different between the two study groups. Total median daily charges of the postintervention group were reduced over the control group by $818/intensive care unit day (p = 0.0002). The major categories in which charges were reduced included medications ($151/day, p = 0.003), laboratory tests ($120/day, p = 0.072), chest x-ray films ($61/day, p = 0.001), respiratory therapy ($185/day, p = 0.21), and miscellaneous charges ($141/day, p = 0.055). Mortality rates and number of major complications were not statistically different between groups.
Increased awareness of cost factors and specific attempts to achieve patient cost reduction resulted in a demonstrable decrease in daily TICU charges, without compromising the quality of care.
本研究的目的是确定通过住院医师与主治医师在床边进行关于诊断和治疗替代方案相对患者成本的日常非正式讨论，能否降低创伤重症监护病房（TICU）的费用。
这是一项前瞻性干预前后研究。
研究在一所一级社区型大学附属医院的TICU进行。
在6个月期间，91例连续患者入住TICU。
连续两个3个月期间跟踪TICU费用。前3个月作为对照。未尝试改变护理成本，住院医师也不知道正在进行一项研究。在随后的3个月期间，主治医师与住院医师明确讨论诊断和治疗干预的相对成本，以试图降低费用。整个研究期间手术创伤团队的组成保持不变。
两个研究组之间的年龄中位数和均值、损伤严重度评分、重症监护病房住院时间和性别比无统计学差异。干预后组的每日总费用中位数比对照组降低了818美元/重症监护病房日（p = 0.0002）。费用降低的主要类别包括药物（151美元/天，p = 0.003）、实验室检查（120美元/天，p = 0.072）、胸部X光片（61美元/天，p = 0.001）、呼吸治疗（185美元/天，p = 0.21）和杂项费用（141美元/天，p = 0.055）。两组之间的死亡率和主要并发症数量无统计学差异。
对成本因素认识的提高以及为降低患者成本所做的具体努力，导致TICU每日费用明显降低，而不影响护理质量。
