Intensive care units costs

SSIs negatively affect patient outcomes and increase health care costs. Patients who develop SSIs are five times more likely to be readmitted to the hospital and have twice the mortality of patients who do not develop an SSI.1 A patient infected with an SSI is also 60% more likely to be admitted to an intensive care unit.1 Clinical studies have shown that SSIs increase lengths of hospital stay and costs.1,3,4 The type of SSI can also affect outcome. Deep SSIs, involving organs or spaces, result in longer durations of hospital stay and higher costs compared to SSIs that are limited to the incision.5... 

Spillover costs on other sectors (e.g. additional educational costs related to the proportion of children who survive neonatal intensive care units with learning disabilities)... 

Doyle JJ, Casciano JP, Arikian SR, et al. Full-cost determination of different levels of care in the intensive care unit. PharmacoEconomics 1996 10 395 08. 

Routine body washing of patients in intensive care units is not cost-beneficial. 

Burn Center Care Is the Most Efficient and Cost-Effective Care for Burn Injuries. Burn injuries are not like other trauma injuries burn injuries often require a lengthy course of treatment as compared with simple or even complex trauma patients. For example, for burn patients with 50% body surface area burn, the average length of stay in the intensive care unit is 50 days. In a mass casualty, the average burn is typically greater than 50% body surface area. 

The CIN Consensus Working Panel considered that hemofiltration deserves further investigation using end points unaffected by the experimental intervention, but the high cost and need for intensive care unit admission will also limit the utdity of this prophylactic approach. [149]. 

White, C.M. Chow, M.S. Cost impact and clinical benefits of focused rounding in the cardiovascular intensive care unit. Hosp. Pharm. 1998, 33 (4), 419-423. 

Miyagawa, C.I. Rivera, J.O. Effect of pharmacist interventions on drug therapy costs in a surgical intensive-care unit. Am. J. Hosp. Pharm. 1986, 43 (12), 3008-3013. Montazeri, M. Cook, D.J. Impact of a clinical pharmacist in a multidisciplinary intensive care unit. Crit. Care Med. 1994, 22 (6), 1044-1048. 

Baldinger, S.L. Chow, M.S.S. Gannon, R.H. Kelly, E.T. Cost savings from having a clinical pharmacist work part-time in a medical intensive care unit. Am. J. Health-Syst. Pharm. 1997,. 54, 2811 2814. 

Chuang, L.C. Sutton, J.D. Henderson, G.T. Impact of a clinical pharmacist on cost saving and cost avoidance in drug therapy in an intensive care unit. Ho.sp. Pharm. 1994, 29 (3), 215 218. 

Miyagawa, C.I. Rivera, J.O. Effect of pharmacist interventions on drug therapy costs in a surgical intensive care unit. Am. J. Hosp. Pharm. 1986, 43, 3008-3113. 

To evaluate cost impact of clinical RPh in intensive care unit... 

In another study, services provided by a pharmacotherapy specialist (e.g., participation on rounds and reviewing of patients medications) in internal medicine and intensive care units was associated with significant cost savings without negatively affecting the quality of care provided to patients. The drug cost savings alone was estimated at approximately 400,000 per year. ... 

ARE is a large burden on the health care system. Much of this cost is due to the fact that many of these patients are in intensive care units where daily costs are high. It has been estimated that the average total hospital cost of a patient with ARP who requires RRT is approximately 50,000. Most patients surviving ARE recover life-sustaining renal function, but the 3% that do not recover renal function continue to incur the costs of a lifetime of dialysis therapy or kidney transplantation. Nonetheless, even in patients who required RRT for their ARP, the quality of life of survivors has been reported to be good. ... 

Sepsis represents a significant burden to the national health care system. In 2000, sepsis affected approximately 660,000 people, an increase of 8.7% per year since 1979. Over half the patients were admitted to the intensive care unit (ICU) with a mean length of stay of 15.7 days. The total number of deaths increased from 21.9 per 100,000 population in 1979 to 43.9 per 100,000 populations in 2000. With the annual cost of approximately 16.7 billion, there remains a vital need for clinicians to comprehend the pathophysiology and to appreciate the management options available for acutely ill patients with sepsis or septic shock. ... 

A study from 1987 has measured the economic impact of aminoglycoside nephrotoxicity. This study had an incidence of nephrotoxicity of 7.3 %. There were 2.74 additional regular hospital days and 1.50 intensive care unit days. The average additional cost of this renal complication calculated over each course of prescribed therapy was US 2501 in 1987 [14]. With the inflation in medical costs this impact was already increased to US 4583 per case in 1997 [15] and can be calculated to US 6133 in 2002. 

Harrell points to a number of difficulties in estimating costs under such circumstances (Harrell, 1996, 1999). For example, the effect of death itself on costs may be difficult to account for. Where a patient has been followed up until death, should the costs be considered complete or not From a hospital s point of view the costs of treating the patient stop with the patient s death thus costs are complete. On the other hand, consider a case where two intensive care units are compared. The unit with higher mortality has shorter lengths of stay and hence lower costs. A statistical model might actually fit better when cumulative costs at time of death are not considered complete (Dudley et al, 1993). (This is an estimation issue. What is to be done with the cost estimates is another matter.) As Harrell (1996, 1999) points out, there are some technical difficulties in... 

As the success of this and related programmes became apparent, a much wider intervention was launched led by the Michigan Health and Hospital Keystone Association for Patient Safety and Quality. 108 Michigan ICUs took part in an 18-month intervention programme aimed particularly at decreasing catheter related bloodstream infections, a common, costly and potentially lethal complication of ICU care. In the United States, 80 000 patients each year were affected, with up to 28 000 deaths in intensive care units from this cause. 

It is increasingly common now for surgical patients to be sent home sooner after the procedure than was the case about a decade ago and telenursing is playing an important role in their follow-up. The most effective monitoring phone calls are made in the first 12-24 h [48]. There is a current lack of intensivists in the United States and consequently about 55,000 lives are lost annually. A practical and cost-effective interim measure to remedy this situation is to set up a tele-intensive care unit (tele-ICU), which has been shown to provide... 

DiGiovine B, Chenoweth C, Watts C, Higgins M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999 160 976-81. 

Balegar VKK, Azeem MI, Spence K, Badawi N. Extending total parenteral nutrition hang time in the neonatal intensive care unit is it safe and cost effective J Paediatr Child Health January 2013 49(1) E57-61. 

Dimick JB, Pronovost PJ, Heitmiller RF, et al. Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection. Crit Care Med 2001 29(4) 753-758. 

Dasta JF, McLaughlin TP, Mody SH, et al. Daily cost of an intensive care unit day the contribution of mechanical ventilation. Crit Care Med 2005 33(6) 1266-1271. 

Recent advances in intensive care have resulted in an increased salvage of critically ill patients a number of patients have become dependent upon mechanical ventilation as a chronic form of life support (1). The increased use of prolonged mechanical ventilation (PMV) has led to greater intensive care unit (ICU) bed use, resource consumption, and costs (2,3). It is important to characterize such patients to define treatment goals and expectations, to establish ventilatory care units for their specialized care, and to provide prognostic information for overall survival, morbidities, and health-related quality of life. The goals of this chapter are to provide definitions of PMV, to characterize the patient population requiring this modality of treatment, and to briefly describe a multidiscipUnaiy approach to treatment. 

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