Early economic assessment of a standardized ICU rounding bundle: Pre-modelling and budget impact analysis

BACKGROUND: ICU ward rounds are a high-leverage coordination process in a complex and resource-intensive care environment. Bundles combining checklists, structured team communication, and digital decision support may reduce omissions and accelerate de-escalation, yet health economic considerations are rarely integrated at an early stage. METHODS: We conducted an early economic assessment from a hospital perspective. A health-economic programme theory was developed to structure the analysis. Model inputs were parameterized using published German ICU daily cost estimates and published evidence on ward-round interventions, including a meta-analytic estimate reporting a mean ICU length-of-stay (LOS) reduction of 0.27 days. We performed (i) a cost-offset threshold analysis, (ii) an illustrative one-year budget impact analysis for an ICU with 1,000 annual admissions, and (iii) scenario analyses distinguishing cash-releasable savings from opportunity value due to released ICU capacity. In addition, we outline a pragmatic real-world evaluation framework combining interrupted time series analysis with process evaluation. RESULTS: For an intervention cost of EUR 50 per ICU admission, break-even was achieved with an average ICU LOS reduction of only 0.03-0.05 days, depending on the ICU day cost applied. Under base-case assumptions (80% adoption, 0.27-day LOS reduction, average ICU day cost EUR 1,237), the estimated annual capacity value amounted to EUR 267,192 for a 1,000-admission ICU. Assuming that 30% of average ICU costs are cash-releasable in the short run, the corresponding annual cash impact was EUR 40,158. CONCLUSIONS: Even small reductions in ICU length of stay may offset realistic implementation costs of a standardized rounding bundle. Explicitly distinguishing cash-releasable savings from capacity value and integrating implementation outcomes into early economic evaluation enhances decision relevance for hospitals considering scale-up of this complex intervention.