Incidence and socioeconomic cost of care to patients candidates to withdrawing life sustaining treatments in a Tunisian intensive care unit

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

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Organization and Structure of the Cardiothoracic Intensive Care Unit

Oncology ◽

10.4018/978-1-5225-0549-5.ch027 ◽

2017 ◽

pp. 709-727

Author(s):

Michael H. Wall

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Patient Outcomes ◽

Nurse Practitioners ◽

Physician Assistants ◽

Cost Of Care ◽

Team Members ◽

Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

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Skin Integrity in Critically Ill and Injured Children

American Journal of Critical Care ◽

10.4037/ajcc2007.16.6.568 ◽

2007 ◽

Vol 16 (6) ◽

pp. 568-574 ◽

Cited By ~ 23

Author(s):

Christine A. Schindler ◽

Theresa A. Mikhailov ◽

Kay Fischer ◽

Gloria Lukasiewicz ◽

Evelyn M. Kuhn ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Ventilatory Support ◽

Pediatric Intensive Care ◽

Cost Of Care ◽

Respiratory Illnesses ◽

Skin Breakdown ◽

Potential Risk Factors

Background Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children. Objectives To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not. Methods Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined. Results The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not. Conclusions Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown.

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Intensive Care Unit Readmission after Elective Coronary Artery Bypass Grafting

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300407 ◽

2005 ◽

Vol 13 (4) ◽

pp. 325-329 ◽

Cited By ~ 3

Author(s):

Joseph Alex ◽

Rajesh Shah ◽

Steven C Griffin ◽

Alexander RJ Cale ◽

Michael E Cowen ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Cost Of Care ◽

Sternal Dehiscence ◽

Elective Coronary Artery Bypass ◽

Group B ◽

Parsonnet Score

Prospective data of 3,120 consecutive patients who had elective coronary artery bypass were analyzed to identify patient profile, cost, outcome and predictors of those readmitted to the intensive care unit. Group A ( n = 3,002) had a single intensive care unit admission and group B ( n = 118) were readmitted within 30 days after surgery. Parsonnet score, EuroSCORE, age, body mass index, chronic obstructive airway disease, peripheral vascular disease, renal dysfunction, unstable angina, congestive cardiac failure, and poor left ventricular function were higher in group B. Bypass and crossclamp times were longer, and the prevalence of inotropic and balloon pump support, arrhythmias, myocardial infarction, re-exploration, blood loss and transfusion, cerebrovascular accident, wound infection, sternal dehiscence, and multisystem failure were higher in group B. Despite a 4-fold increase in cost of care, the mortality rate (32.4%) of patients readmitted to intensive care was 23-times higher than routine patients (1.4%). Crossclamp time > 80 min, Parsonnet score > 10, EuroSCORE > 9, sternal dehiscence, ventricular arrhythmias, and renal failure predicted readmission.

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Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.488 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 488-488

Author(s):

Nizar Bhulani ◽

Ang Gao ◽

Arjun Gupta ◽

Jenny Jing Li ◽

Chad Guenther ◽

...

Keyword(s):

Health Care ◽

Pancreatic Cancer ◽

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Health Care Utilization ◽

End Of Life ◽

Cancer Patients ◽

Cost Of Care ◽

Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

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Patient length of stay and mortality prediction: A survey

Health Services Management Research ◽

10.1177/0951484817696212 ◽

2017 ◽

Vol 30 (2) ◽

pp. 105-120 ◽

Cited By ~ 16

Author(s):

Aya Awad ◽

Mohamed Bader–El–Den ◽

James McNicholas

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Length Of Stay ◽

Length Of Hospital Stay ◽

Hospital Performance ◽

Mortality Prediction ◽

Cost Of Care ◽

Resource Utilisation ◽

Number Of Patients

Over the past few years, there has been increased interest in data mining and machine learning methods to improve hospital performance, in particular hospitals want to improve their intensive care unit statistics by reducing the number of patients dying inside the intensive care unit. Research has focused on prediction of measurable outcomes, including risk of complications, mortality and length of hospital stay. The length of stay is an important metric both for healthcare providers and patients, influenced by numerous factors. In particular, the length of stay in critical care is of great significance, both to patient experience and the cost of care, and is influenced by factors specific to the highly complex environment of the intensive care unit. The length of stay is often used as a surrogate for other outcomes, where those outcomes cannot be measured; for example as a surrogate for hospital or intensive care unit mortality. The length of stay is also a parameter, which has been used to identify the severity of illnesses and healthcare resource utilisation. This paper examines a range of length of stay and mortality prediction applications in acute medicine and the critical care unit. It also focuses on the methods of analysing length of stay and mortality prediction. Moreover, the paper provides a classification and evaluation for the analytical methods of the length of stay and mortality prediction associated with a grouping of relevant research papers published in the years 1984 to 2016 related to the domain of survival analysis. In addition, the paper highlights some of the gaps and challenges of the domain.

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