National estimates of intensive care utilization and costs

Jacobs, Philip; Noseworthy, Thomas

doi:10.1097/00003246-199011000-00020

Cited by 234 publications

(78 citation statements)

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“…This topdown principle has been used to estimate the cost of intensive care outside the UK [26,27]. It is attractive because laborious costing of individual patients is avoided.…”

mentioning

confidence: 99%

The development of a method for comparative costing of individual intensive care units

et al. 1999

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SummaryIntensive care is one of the most costly areas of hospital care. Unfortunately, because of the diversity of case mix, costing intensive care is difficult. Many described costing methods previously are limited by being cumbersome, laborious to apply and expensive. The aim of this study was to develop a method for costing intensive care which can be applied with ease but facilitate meaningful cost comparisons between intensive care units. The method developed was based on cost blocks where the major components were identified and costed in a 'top-down' manner. Using strict definitions, the cost blocks attempted to measure the costs of equipment, estates, nonclinical support services (such as hospital management costs), clinical support services (such as physiotherapy, laboratory services), consumables (such as drugs, fluids and disposables) and staff. The study found that clinical support services, consumables and staff costs accounted for approximately 85% of the total costs.

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“…This topdown principle has been used to estimate the cost of intensive care outside the UK [26,27]. It is attractive because laborious costing of individual patients is avoided.…”

mentioning

confidence: 99%

The development of a method for comparative costing of individual intensive care units

et al. 1999

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“…Offre servizi medici specialistici ad una piccola percentuale dei pazienti ammessi complessivamente in ospedale (circa il 2 %) ma che rappresentano la componente di pazienti più costosi, tanto che alla sola terapia intensiva è ascrivibile circa il 15%-20% dei costi totali di una struttura ospedaliera [10][11][12]. Il costo di una giornata di degenza in questo reparto è dalle quattro alle sei volte superiore a quello di una giornata di degenza in un qualsiasi altro reparto ospedaliero [13].…”

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The use of dexmedetomidine in intensive care sedation

Antonelli

Conti

Belisari³

et al. 2013

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The goals and recommendations for ICU (Intensive Care Unit) patients’ sedation and analgesia should be to have adequately sedated patients who are calm and arousal, so that they can guarantee a proper evaluation and an adequate control of pain. This way, it is also possible to perform their neurological evaluation, preserving intellectual faculties and helping them in actively participating to their care. Dexmedetomidine is a selective alpha-2 receptor agonist, member of theraputical cathegory: “other hypnotics and sedatives” (ATC: N05CM18). Dexmedetomidine is recommended for the sedation of adult ICU patients who need a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale 0 to -3). After the EMA approval, some European government authorities have elaborated HTA on dexmedetomidine, based on clinical evidence derived from Prodex and Midex trials. Dexmedetomidine resulted to be as effective as propofol and midazolam in maintaining the target depth of sedation in ICU patients. The mean duration of mechanical ventilation with dexmedetomidine was numerically shorter than with propofol and significantly shorter than with midazolam. The resulting favourable economic profile of dexmedetomidine supported the clinical use in ICU. Dexmedetomidine seems to provide clinical benefits due to the reduction of mechanical ventilation and ventilator weaning duration. Within the present review, an economic analysis of costs associated to the use of dexmedetomidine was therefore performed also in the Italian care setting. Thus, four different analyses were carried out based on the quantification of the total number of days in ICU, the time spent on mechanical ventilation, the weighted average number of days with mechanical ventilation or not and TISS points (Therapeutic Intervention Scoring System). Despite the incremental cost for drug therapy associated with dexmedetomidine, a reduction of the management costs for ICU has been estimated, with savings ranging between € 800 and € 1,400 per patient.

http://dx.doi.org/10.7175/fe.v14i1S.674

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“…1,2 In North America, critical care services are estimated to account for 8-20% of all inpatient costs, representing between 0.2 and 0.8% of the gross national product (GNP) of Canada and the United States, respectively. 2 Given advances in technology and therapeutics and an aging population, current evidence suggests that the demand for critical care services will increase. 3,4 It is expected that the severe shortages in critical care human resources will result in further challenges to the current health care system.…”

Section: Introductionmentioning

confidence: 99%

Critical care services in Ontario: a survey-based assessment of current and future resource needs

Hill

Fan

Stewart

et al. 2009

Can J Anesth/J Can Anesth

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Purpose In response to the challenges of an aging population and decreasing workforce, the provision of critical care services has been a target for quality and efficiency improvement efforts. Reliable data on available critical care resources is a necessary first step in informing these efforts. We sought to describe the availability of critical care resources, forecast the future requirement for the highestlevel critical care beds and to determine the physician management models in critical care units in Ontario, Canada. Methods In June 2006, self-administered questionnaires were mailed to the Chief Executive Officers of all acute care hospitals, identified through the Ontario government's hospital database. The questionnaire solicited information on the number and type of critical care units, number of beds, technological resources and management of each unit.Results Responses were obtained from 174 (100%) hospitals, with 126 (73%) reporting one or more critical care units. We identified 213 critical care units in the province, representing 1789 critical care beds. Over half (59%) of these beds provided mechanical ventilation on a regular basis, representing a capacity of 14.9 critical care and 8.7 mechanically ventilated beds per 100,000 population. Sixty-three percent of units with capacity for mechanical ventilation involved an intensivist in admission and coordination of care. Based on current utilization, the demand for mechanically ventilated beds by 2026 is forecast to increase by 57% over levels available in 2006. Assuming 80% bed utilization, it is estimated that an additional 810 ventilated beds will be needed by 2026. Conclusion Current utilization suggests a substantial increase in the need for the highest-level critical care beds over the next two decades. Our findings also indicate that non-intensivists direct care decisions in a large number of Dr. Sibbald is deceased.

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National estimates of intensive care utilization and costs

Cited by 234 publications

References 0 publications

The development of a method for comparative costing of individual intensive care units

The development of a method for comparative costing of individual intensive care units

The use of dexmedetomidine in intensive care sedation

Critical care services in Ontario: a survey-based assessment of current and future resource needs

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