Key result
Among 1,137 adult ICU patients, ICU mortality was 9% (SMR 0.9) and hospital mortality was 16.2% (SMR 1.2), with case-mix funding resulting in a mean loss of AUS$5,200 per ICU patient.
Observational (n=1,137)
No
Answers are grounded in this paper and cite their sources.
While ICU care produced good clinical and economic outcomes, hospital outcomes were deficient due to excess post-ICU mortality, and current case-mix funding models inadequately compensated for critically ill patients.
Objective: To examine the unit and hospital outcome, appropriateness and costs of adult patients admitted to an intensive care unit (ICU). Design: Twelve-month prospective descriptive study using the APACHE III severity of illness and prognostic system. Setting: Twelve-bed general ICU in a 950-bed Australian teaching hospital. Subjects: A total of 1,137 consecutive adults admitted to the ICU during 1995. Main outcome measures: APACHE III prediction of death on day one, severity of illness, ICU standardised mortality ratio (SMR), hospital SMR, standardised ICU length of stay (SLOS), APACHE III activity level on day one, ICU cost per admission and case-mix funding versus costs. Results: Sixty-nine per cent of the patients were admitted as emergencies. ICU mortality was nine per cent (SMR 0.9), hospital mortality was 16.2% (SMR 1.2) and ICU LOS was 3.9 days (SLOS 0.8 p<0.01). Patients in the predicted day one mortality range of 61-80% had an ICU SMR of 0.7 with a SLOS of 0.64. The day one APACHE III activity was: active treatment 87%, high-risk monitoring four per cent and low-risk monitoring nine per cent. The daily cost of an ICU bed was AUS$1,789-4,282 compared with a daily ward bed cost of AUS$409. High-cost good poor outcome (>50% mortality) diagnoses were sepsis, pneumonia, bleeding varices and liver failure. For the entire hospital admission, on the basis of case-mix funding, patients requiring intensive care incurred a mean loss of AUS$5,200 per patient compared with those not requiring intensive care who incurred a mean loss of only AUS$271. Conclusions: The ICU itself produced good clinical and economic outcomes. The hospital outcome was deficient due to an excess mortality post-ICU. This was felt to be due to premature discharge of patients as a consequence of severe bed pressure due to inadequate ICU bed numbers in a hospital without any general 'high-dependency' beds. Analysis of case-mix data revealed that the current funding model was inadequate and discriminated against hospitals admitting large numbers of critically ill patients.
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Henderson et al. (1997) conducted an observational in Intensive care unit admission (n=1,137). Intensive care unit admission vs. Patients not requiring intensive care (for cost analysis) was evaluated on ICU mortality, hospital mortality, length of stay, and costs (SMR 0.9 (ICU), SMR 1.2 (hospital)). Among 1,137 adult ICU patients, ICU mortality was 9% (SMR 0.9) and hospital mortality was 16.2% (SMR 1.2), with case-mix funding resulting in a mean loss of AUS$5,200 per ICU patient.
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