Relationship between availability of physiotherapy services and ICU costs

Abstract

Objective:To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. Methods:This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. Results:The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. Conclusions:In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

Cost analysis in the ICU from the standpoint of physical therapy

“…As stated by Bürge et al, 5 although adding physical therapy to usual care increases fixed costs, its effects can reduce the costs associated with lost productivity, medication use, or treatments by other health care professionals. An indirect reduction in costs could support the finding of Rotta et al, 1 who estimated that, despite the increase in the costs associated with the team, hospitalization costs decreased. Their study 1 reiterates the importance of standardized approaches for cost analysis in the ICU.…”

“…An indirect reduction in costs could support the finding of Rotta et al, 1 who estimated that, despite the increase in the costs associated with the team, hospitalization costs decreased. Their study 1 reiterates the importance of standardized approaches for cost analysis in the ICU. In the future, broader-perspective analyses assessing the impact that interventions in the ICU have on the daily lives of patients and their families will be needed in order to foster public policies aimed at critically ill patients.…”

“…Although the logarithmic transformation of data in the linear regression analysis presented by Rotta et al 1 might be statistically acceptable, it limits direct analysis of the results. For instance, we observed that length of ICU stay and severity as measured by the Acute Physiology and Chronic Health Evaluation II were independently associated with increased costs, and that 24-h physical therapy showed an inverse association.…”

“…The study conducted by Rotta et al, 1 published in the current issue of the JBP, analyzed costs by means of an instrument designed in the early 1990s, the Omega score. The first question that comes to mind is “why did they use this instrument?” This question arises for obvious reasons, since time has a clear influence on the economy and on the costs of certain procedures, which can also undergo changes due to modernization.…”

“…As mentioned by Rotta et al, 1 the Omega score was developed in France in 1992 and has not been validated for use in or adapted to the currency of Brazil. In addition, the cost of the procedures, as well as the procedures themselves, may have changed over time.…”