%0 Journal Article
%T Changes in hospital costs after introducing an intermediate care unit: a comparative observational study
%A Barbara CJ Solberg
%A Carmen D Dirksen
%A Fred HM Nieman
%A Godefridus van Merode
%A Martijn Poeze
%A Graham Ramsay
%J Critical Care
%D 2008
%I BioMed Central
%R 10.1186/cc6903
%X The design was a comparative longitudinal study. The setting was a university hospital with a mixed intensive care unit (ICU), an IMC, and general wards. Changes in total hospital costs were measured for patients who were admitted to the ICU before and after the introduction of the IMC. The comparison of interest was the opening of a six-bed mixed IMC.The mean total hospital cost per patient increased significantly. Before the introduction of the IMC, the total hospital cost per patient was ?12,961 (¡À ?14,530) and afterwards it rose to ?16,513 (¡À ?17,718). Multiple regression analysis was used to determine to what extent patient characteristics explained these higher hospital costs using mortality, type of stay, diagnostic categories, length of ICU and ward stay, and the Therapeutic Intervention Scoring System (TISS) as predictors. More surgical patients, greater requirements of therapeutic interventions on the ICU admission day, and longer ICU stay in patients did explain the increase in hospital costs, rather than the introduction of the IMC.After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.The high costs of critical care have resulted in strategies for improving intensive care utilisation and a more effective triage [1-3]. Admitting low-risk or chronically critically ill patients to intermediate care units (IMCs) rather than an intensive care unit (ICU) has been proposed as an effective and efficient strategy [4,5]. Reports on the cost-effectiveness of introducing an IMC show variable results [6-10]. Several retrospective studies indicate reduced total costs of specialised care, which are achieved by reducing nursing procedures and laboratory tests. However, another trial failed to show a significant effect on costs. Some reports show increased ICU costs during increased bed availability. In addition, whether introducing IMCs reduces total hospital costs is u
%U http://ccforum.com/content/12/3/R68