Critical Care in the Emergency Department

Halpern, Neil A.

doi:10.1097/ccm.0b013e318283d161

Cited by 4 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Between 2000 and 2010, national critical care costs increased 92% (from $56.6 billion to $108 billion), and in 2010 accounted for 13.2% of hospital costs and 4.1% of total national health spending. When comparing cost per day, there was a 61% increase from 2000 to 2010 ($4,300 per day from $2,669) 19 . Materials occasionally used in CVS, such as resorbable plates, may contribute to rising costs.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating the Effects of Enhanced Recovery Pathways in Craniosynostosis

Cai

Sunshine

et al. 2021

Ann Plast Surg

View full text Add to dashboard Cite

Background Enhanced Recovery After Surgery (ERAS) pathways are multimodal approaches aimed at minimizing postoperative surgical stress, reducing hospitalization time, and lowering hospitalization charges. Enhanced Recovery After Surgery is broadly and increasingly implemented in hospitals across the country. Early reports have shown ERAS to reduce length of stay (LOS) after commonly performed pediatric surgeries. However, LOS and hospital charges after craniosynostosis have not been studied. We hypothesized that extended hospital LOS is correlated with increased hospitalization charges associated with open cranial vault surgery (CVS) and that over a multiyear timeframe, LOS and cost would decrease because of the increased adoption of ERAS in pediatric surgery. Methods The Healthcare Cost and Utilization Project's National Inpatient Sample database was analyzed from January 2007 to December 2014. All patients who were diagnosed with craniosynostosis who underwent CVS were included. Variables of interest included demographic data, hospital characteristics, hospitalization data, and total hospital charges. Univariate and generalized linear regression models were used to examine associations between selected variables and the hospitalization charges. Results There were 54,583 patients diagnosed with craniosynostosis between 2007 and 2014. Of these patients, 22,916 (41.9%) received CVS. The median total hospital charge was $66,605.77 (interquartile range, $44,095.60–$101,071.17). The median LOS was 3 days (interquartile range, 2–4 days), and there was no significant change in LOS by year (P = 0.979). However, despite a stable LOS, mean hospitalization charge increased significantly by year (P < 0.01). Regression analysis demonstrated the proportion of eligible patients who underwent CVS substantially increased over the selected timeframe (P < 0.01). Most procedures were performed in urban teaching hospitals and high-volume hospitals. There was no significant association between hospital volume and hospitalization charge (P = 0.331). Conclusions Increasing hospital charges despite constant LOS for craniosynostosis CVS procedures was observed between 2007 and 2014. Although ERAS has reduced LOS for common pediatric surgical procedures, no decrease in LOS for CVS has been observed. The charges significantly increased over the same period including high-volume centers. Further study to safely lower LOS and hospitalization charges for this procedure may reduce the overall health care burden.

show abstract

Section: Discussionmentioning

confidence: 99%

“…When comparing cost per day, there was a 61% increase from 2000 to 2010 ($4,300 per day from $2,669). 19 Materials occasionally used in CVS, such as resorbable plates, may contribute to rising costs.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Effects of Enhanced Recovery Pathways in Craniosynostosis

Cai

Sunshine

et al. 2021

Ann Plast Surg

View full text Add to dashboard Cite

show abstract

“…The multidisciplinary critical care team that renders care to ICU patients may comprise critical care nurses, nurse practitioners, intensivists, hospitalists, respiratory therapists, and other professionals (Halpern, 2020). Although most of the hospital ICUs are still staffed using a traditional model (Nizamuddin & Tung, 2019), where the attending/referring physician is responsible for the care of patients in the ICU, there is a growing trend of using intensivists to oversee the medical care of ICU patients (Halpern et al, 2019).…”

mentioning

confidence: 99%

The organizational and environmental characteristics associated with hospitals’ use of intensivists

Liddle

Weech‐Maldonado

Davlyatov

et al. 2021

Health Care Manage Rev

View full text Add to dashboard Cite

BackgroundAs large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator’s strategic decision to use intensivists.PurposeThe aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator’s decision to use intensivists.MethodologyThe sample consisted of the national acute care hospitals (N = 4,986) for the period 2007–2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors.ResultsThe results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists.Practice ImplicationsWhen significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic.

show abstract

“…The provision of medical services for critically ill patients is a complex and expensive challenge. In 2010, the Society of Critical Care Medicine estimated that an average daily cost of an ICU bed was $4,300, an increase of 61% in a decade (1). In the United Kingdom, a similar estimate of costs from the Welsh Government in 2011 gave a figure of £1,932 per day (2).…”

mentioning

confidence: 99%

The Role of the Long-Term Acute Care Hospital Following Critical Illness—Has the Coronavirus Disease 2019 Pandemic Demonstrated Their Usefulness or Emphasized Their Downside?*

Morgan

2021

Critical Care Medicine

View full text Add to dashboard Cite

he provision of medical services for critically ill patients is a complex and expensive challenge. In 2010, the Society of Critical Care Medicine estimated that an average daily cost of an ICU bed was $4,300, an increase of 61% in a decade (1). In the United Kingdom, a similar estimate of costs from the Welsh Government in 2011 gave a figure of £1,932 per day (2). Compared with the cost of care for a noncritically ill acute inpatient, an ICU bed can cost up to 500% more. In the United States, one solution to this financial challenge has been the creation of the long-term acute care hospital-the LTACH-a type of healthcare facility that came into being during the 1980s, later formalized by the Medicare, Medicaid, and State Children's Health Insurance Program Balanced Budget Refinement Act of 1999 (3). The LTACH is therefore a facility to provide ongoing care to patients requiring more than 25 days of mechanical ventilation who are otherwise clinically stable (4).In early 2020, an unprecedented worldwide demand for ICU beds and ventilators arose as a result of the coronavirus disease 2019 (COVID-19) pandemic, with some countries running out of ICU beds, ventilators, and even oxygen itself. In parts of the United States, one potential option to expand ICU capacity for COVID-19 patients with ongoing respiratory failure was to use LTACHs. They provide a ready-made resource of beds, ventilators, and healthcare staff that could be deployed, with modifications to standard working practices to mitigate the risks of severe acute respiratory syndrome coronavirus 2 infection (5). In this issue of Critical Care Medicine, Saad et al ( 6) describe the clinical characteristics and outcomes of ventilated COVID-19 patients in two free-standing LTACHs in the Chicago area in the year April 1, 2020, to March 31, 2021. Weaning from ventilation was successful in almost 71% of these patients, whereas overall mortality was 8.9%. Seven-percent of patients were still in the LTACH at the study conclusion date. 86.1% were discharged alive, but only 18.4% were discharged home, the rest being transferred to a rehabilitation facility (44.9%), back to an acute hospital (16.5%), or a nursing home (6.3%). None of the home discharges needed home ventilation. Although this is all very interesting in showing that LTACHs may be uprated to create acute ICU capacity, it tells us nothing about how the outcomes of being ventilated for COVID-19 respiratory failure compare to being ventilated for other causes of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).

show abstract

Critical Care in the Emergency Department

Cited by 4 publications

References 5 publications

Evaluating the Effects of Enhanced Recovery Pathways in Craniosynostosis

Evaluating the Effects of Enhanced Recovery Pathways in Craniosynostosis

The organizational and environmental characteristics associated with hospitals’ use of intensivists

The Role of the Long-Term Acute Care Hospital Following Critical Illness—Has the Coronavirus Disease 2019 Pandemic Demonstrated Their Usefulness or Emphasized Their Downside?*

Contact Info

Product

Resources

About