Pharmacoeconomic Impact of Critically Ill Surgical Patients

1988 ◽  
Vol 22 (12) ◽  
pp. 994-998 ◽  
Author(s):  
Joseph F. Dasta ◽  
Deborah K. Armstrong
Keyword(s):  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Total Hospital ◽  
Icu Patients ◽  
Related Information ◽  
Projected Length

Financial information on 131 patients and drug-related information on 176 patients admitted to a surgical intensive care unit (ICU) were prospectively collected. The average stay was nearly five days and patients received 8.6 drugs per day for a total average exposure of 12.2 different drugs. Antibiotics and analgesics were used in over 90 percent of patients. The patients' diagnoses fit into 53 different diagnosis-related groups (DRG). Hospital costs were significantly greater than DRG payment for an average revenue loss of $17 803 per patient. Patients with a primary diagnosis of sepsis had the largest revenue loss, averaging $54 738. One hundred patients were revenue losers. Total hospital stay was statistically longer than DRG-projected length of stay. Pharmacy charges averaged 13.6 percent of total hospital charges. Patients receiving systemic antifungals, triple antibiotics, catecholamines, and total parenteral nutrition had high hospital and pharmacy costs. This study suggests that ICU patients are costly to hospitals and that drug use is expensive. We suggest that increased pharmacy involvement in the care of ICU patients may help curtail escalating drug costs in these patients.

Aspirin Increases the Risk of Venous Thromboembolism in Surgical Patients

2014 ◽  
Vol 80 (10) ◽  
pp. 920-925 ◽  
Author(s):  
Galinos Barmparas ◽  
Monica Jain ◽  
Devorah Mehrzadi ◽  
Nicolas Melo ◽  
Rex Chung ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Primary Outcome ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Forward Logistic Regression ◽  
Surgical Icu ◽  
Level I

The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE.

scholarly journals Telemedicine coverage for post-operative ICU patients

2016 ◽  
Vol 23 (2) ◽  
pp. 360-364 ◽  
Author(s):  
Tara Ann Collins ◽  
Matthew P Robertson ◽  
Corinna P Sicoutris ◽  
Michael A Pisa ◽  
Daniel N Holena ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Service ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surge Capacity ◽  
Icu Patients ◽  
Critical Care Service ◽  
Surgical Critical Care

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47–69) versus 58 (IQR 44–70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7–14) versus 15 (IQR 11–21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /–9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.

scholarly journals Copeptin and Arginine Vasopressin Concentrations in Critically Ill Patients

2006 ◽  
Vol 91 (11) ◽  
pp. 4381-4386 ◽  
Author(s):  
Stefan Jochberger ◽  
Nils G. Morgenthaler ◽  
Viktoria D. Mayr ◽  
Günter Luckner ◽  
Volker Wenzel ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Healthy Volunteers ◽  
Critically Ill ◽  
Arginine Vasopressin ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
University Teaching ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients

Abstract Context: Determination of arginine vasopressin (AVP) concentrations may be helpful to guide therapy in critically ill patients. A new assay analyzing copeptin, a stable peptide derived from the AVP precursor, has been introduced. Objective: Our objective was to determine plasma copeptin concentrations. Design: We conducted a post hoc analysis of plasma samples and data from a prospective study. Setting: The setting was a 12-bed general and surgical intensive care unit (ICU) in a tertiary university teaching hospital. Patients: Our subjects were 70 healthy volunteers and 157 ICU patients with sepsis, with systemic inflammatory response syndrome (SIRS), and after cardiac surgery. Interventions: There were no interventions. Main Outcome Measures: Copeptin plasma concentrations, demographic data, AVP plasma concentrations, and a multiple organ dysfunction syndrome score were documented 24 h after ICU admission. Results: AVP (P &lt; 0.001) and copeptin (P &lt; 0.001) concentrations were significantly higher in ICU patients than in controls. Patients after cardiac surgery had higher AVP (P = 0.003) and copeptin (P = 0.003) concentrations than patients with sepsis or SIRS. Independent of critical illness, copeptin and AVP correlated highly significantly with each other. Critically ill patients with sepsis and SIRS exhibited a significantly higher ratio of copeptin/AVP plasma concentrations than patients after cardiac surgery (P = 0.012). The American Society of Anesthesiologists’ classification (P = 0.046) and C-reactive protein concentrations (P = 0.006) were significantly correlated with the copeptin/AVP ratio. Conclusions: Plasma concentrations of copeptin and AVP in healthy volunteers and critically ill patients correlate significantly with each other. The ratio of copeptin/AVP plasma concentrations is increased in patients with sepsis and SIRS, suggesting that copeptin may overestimate AVP plasma concentrations in these patients.

THE IMPACT OF COMPLICATIONS ON THE RESOURCE UTILIZATION, HOSPITAL CHARGES, AND OUTCOME IN THE SURGICAL INTENSIVE CARE UNIT (SICU)

1990 ◽  
Vol 18 (Supplement) ◽  
pp. S196
Author(s):  
Edmund Rutherford ◽  
Robert Rutledge ◽  
Samir Fakhry ◽  
Farid Muakkassa ◽  
Christopher Baker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Resource Utilization ◽  
Hospital Charges ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
The Impact

scholarly journals Ramelteon for Decreasing Delirium in Surgical Intensive Care Unit Patients

2020 ◽  
Vol 11 ◽  
pp. 117955732095122
Author(s):  
Chelsea N Lopez ◽  
Amaris Fuentes ◽  
Atiya Dhala ◽  
Jonathan Balk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Median Number ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Primary Objective ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Surgical Icu

In intensive care unit (ICU) patients, delirium contributes to prolonged hospitalization, long-term cognitive impairment and increased mortality. Sleep disturbance, a risk factor for delirium, has been attributed to impaired melatonin secretion in critically ill patients. Ramelteon, a synthetic melatonin receptor agonist, is indicated for insomnia; there is limited, but growing evidence, to support its use for the prevention of delirium. The primary objective of this study is to describe the use of ramelteon and the incidence of delirium, assessed by Confusion Assessment Method for the ICU (CAM-ICU) scores, in adult surgical ICU patients from May 22, 2016 to June 30, 2018. The primary endpoint is the number of delirium free days in the week prior to and post first ramelteon administration. A total of 231 patients were included in the study with 201 (87%) positive for delirium at least once during the study timeframe. The median number of CAM-ICU negative days in the week pre-ramelteon administration was 4 days (IQR 2-7 days) compared to 6 days (IQR 3-7 days) in the week post-first ramelteon administration ( P < .05). The time to CAM-ICU positive increased slightly to 3 days (IQR 1-7 days) following ramelteon initiation compared to 2 days (IQR 1-5 days) from initial ICU admission. Additionally, the median number of antipsychotic doses per patient decreased from 4 doses (IQR 1.25-14 doses) prior to ramelteon to 2 doses (IQR 1-4 doses) after ramelteon. Ramelteon administration was associated with a greater number of CAM-ICU negative days in surgical ICU patients. These findings describe a potential role for ramelteon in mitigating delirium in this patient population.

scholarly journals Determinants of Hospital Costs for Management of Chronic-Disease Patients in Southern Thailand

2021 ◽  
Author(s):  
Wichayaporn Thongpeth ◽  
Apiradee Lim ◽  
Sunee Kraonual ◽  
Akemat Wongpairin ◽  
Thaworn Thongpeth
Keyword(s):  
Chronic Disease ◽  
Length Of Stay ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
Disease Patient ◽  
Tertiary Hospital ◽  
Primary Diagnosis ◽  
Linear Regression Models ◽  
Health Security ◽  
And Gender

Objective: Diagnosis-related groups (DRGs) are the main mechanism for assessing payments for medical treatment. This study aimed to analyze the determinants of costs for chronic-disease patient visits in a major public hospital.Material and Methods: Hospital cost data available from the hospital database relating to claims made to the Thailand Health Security Office were obtained from a major tertiary hospital for all such patients admitted and discharged in 2016. Linear regression models were created to predict the cost based on several determinants including age and gender, primary diagnosis, number of diagnoses, length of stay, number of procedures, and discharge status.Results: Only length of stay in hospital and number of procedures were significant predictors of the total hospital costs.Conclusion: It thus appears that just a combination of these two factors might be a better measure of the true hospital visit costs for patients with chronic disease than DRGs.

Tap Water Colonization With Psmdomonas aeruginosa in a Surgical Intensive Care Unit (ICU) and Relation to Psmdomonas Infections of ICU Patients

2001 ◽  
Vol 22 (1) ◽  
pp. 49-52 ◽  
Author(s):  
Matthias Trautmann ◽  
Thomas Michalsky ◽  
Heidemarie Wiedeck ◽  
Vladan Radosavljevic ◽  
Markus Ruhnke
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Tap Water ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Time Periods ◽  
Care Ward ◽  
Intensive Care Ward

AbstractWater faucets on a surgical intensive care ward were examined prospectively as a source of Pseudomonas aeruginosa infections. All water outlets harbored distinct genotypes of P aeruginosa over prolonged time periods. Over a period of 7 months, 5 (29%) of 17 patients were infected with P aeruginosa genotypes also detectable in tap water.

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