Recognition of Neonatal Hospitalization Cost in an Intensive Care Unit in Greece and the Deviation from Its Current Reimbursement System

In this paper efforts have been made to record the actual, real cost of health care services in a Neonatal Intensive Care Unit (N.I.C.U.) of a public hospital. It is well known that, in recent years, the hospitals have been reimbursed with the system of Diagnosis-Related Groups (D.R.G.’s). The purpose of this study is to determine whether the costs according with D.R.G.’s correspond to the actual-real cost, as this is recorded in the N.I.C.U. This cost is called direct cost. Here is a case study of a premature neonate in the intensive care unit (N.I.C.U.). From the outset, the age of pregnancy, the birth weight, the duration of hospitalization in N.I.C.U. and the needs of the newborn in oxygen, medication, as well as nutrition are defined which are very important in shaping the cost. Then, the cost is calculated according to the D.R.G.’s system. By setting three basic diagnoses (I.C.D.-10), we find the D.R.G. which better describes the case, as well as the associated costs. Then, we calculate the direct cost and list all the consumables, exams, staff costs, overheads. Comparing the two results we find that the cost of D.R.G. does not meet the direct cost of hospitalization. There is a significant deviation from the actual real cost, which proves the under-costing of the health services. The D.R.G.’s system leads hospitals to increase their financial deficits and provide degraded quality health services. It is necessary to readjust the D.R.G.’s according to the reality and the redefinition of the hospital’s reimbursement system to meet the direct – real cost of the health services offered.

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Predictors of and Trends in High-Intensity End-of-Life Care Among Children With Cancer: A Population-Based Study Using Health Services Data

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.8283 ◽

2017 ◽

Vol 35 (2) ◽

pp. 236-242 ◽

Cited By ~ 23

Author(s):

Alisha Kassam ◽

Rinku Sutradhar ◽

Kimberley Widger ◽

Adam Rapoport ◽

Jason D. Pole ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Health Services ◽

High Intensity ◽

Hematologic Malignancies ◽

Population Based ◽

Children With Cancer ◽

Eol Care ◽

Related Mortality

Purpose Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health-services databases. Methods A retrospective decedent cohort of patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada, was assembled using a provincial cancer registry and linked to population-based health-care data. Based on previous studies, the primary composite measure of HI-EOL care comprised any of the following: intravenous chemotherapy < 14 days from death; more than one emergency department visit; and more than one hospitalization or intensive care unit admission < 30 days from death. Secondary measures included those same individual measures and measures of the most invasive (MI) EOL care (eg, mechanical ventilation < 14 days from death). We determined predictors of outcomes with appropriate regression models. Sensitivity analysis was restricted to cases of cancer-related mortality, excluding treatment-related mortality (TRM) cases. Results The study included 815 patients; of these, 331 (40.6%) experienced HI-EOL care. Those with hematologic malignancies were at highest risk (odds ratio, 2.5; 95% CI, 1.8 to 3.6; P < .001). Patients with hematologic cancers and those who died after 2004 were more likely to experience the MI-EOL care (eg, intensive care unit, mechanical ventilation, odds ratios from 2.0 to 5.1). Excluding cases of TRM did not substantively change the results. Conclusion Ontario children with cancer continue to experience HI-EOL care. Patients with hematologic malignancies are at highest risk even when excluding TRM. Of concern, rates of the MI-EOL care have increased over time despite increased palliative care access. Linking health services and clinical data allows monitoring of population trends in EOL care and identifies high-risk populations for future interventions.

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Staff cost in direct nursing care at an intensive care unit

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692007000500019 ◽

2007 ◽

Vol 15 (5) ◽

pp. 1005-1009 ◽

Cited By ~ 5

Author(s):

Sandra Cristina Ribeiro Telles ◽

Valéria Castilho

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nursing Staff ◽

Work Load ◽

Direct Care ◽

Personnel Cost ◽

Simple Method ◽

Personnel Costs ◽

Staff Cost ◽

The Cost

This quantitative case study aimed to learn and analyze the personnel cost in nursing direct care in the intensive care unit. We opted to use a therapeutic intervention score index, TISS-28, for the analysis of the indirect gravity of patients and the dimension of the nursing staff working time. Evaluating the cost by a gravity score presented to be a logical and relatively simple method to allocate costs per patient in the intensive care unit. In this exploratory and descriptive study, the average TISS-28 per patient was 31 points, requiring a daily expenditure of care hours of R$ 298.69. It was evidenced in this study that personnel costs are variable since there are patients with different complexities. Therefore is possible to estimate the nursing staff cost by assessing its work load.

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The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient

Medical Care ◽

10.1097/mlr.0000000000000975 ◽

2018 ◽

Vol 56 (10) ◽

pp. 890-897 ◽

Cited By ~ 24

Author(s):

Eduard E. Vasilevskis ◽

Rameela Chandrasekhar ◽

Colin H. Holtze ◽

John Graves ◽

Theodore Speroff ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Patient ◽

Icu Delirium ◽

The Cost

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A study of medication errors during the prescription stage in the pediatric critical care services of a secondary-tertiary level public hospital

BMC Pediatrics ◽

10.1186/s12887-020-02442-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lorena Michele Brennan-Bourdon ◽

Alan O. Vázquez-Alvarez ◽

Jahaira Gallegos-Llamas ◽

Manuel Koninckx-Cañada ◽

José Luis Marco-Garbayo ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Medication Errors ◽

Public Hospital ◽

Care Practice ◽

Tertiary Level ◽

Skin Reactions ◽

Pediatric Critical Care ◽

Care Services

Abstract Background Medication Errors (MEs) are considered the most common type of error in pediatric critical care services. Moreover, the ME rate in pediatric patients is up to three times higher than the rate for adults. Nevertheless, information in pediatric population is still limited, particularly in emergency/critical care practice. The purpose of this study was to describe and analyze MEs in the pediatric critical care services during the prescription stage in a Mexican secondary-tertiary level public hospital. Methods A cross-sectional study to detect MEs was performed in all pediatric critical care services [pediatric emergency care (PEC), pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and neonatal intermediate care unit (NIMCU)] of a public teaching hospital. A pharmacist identified MEs by direct observation as the error detection method and MEs were classified according to the updated classification for medication errors by the Ruíz-Jarabo 2000 working group. Thereafter, these were subclassified in clinically relevant MEs. Results In 2347 prescriptions from 301 patients from all critical care services, a total of 1252 potential MEs (72%) were identified, and of these 379 were considered as clinically relevant due to their potential harm. The area with the highest number of MEs was PICU (n = 867). The ME rate was > 50% in all pediatric critical care services and PICU had the highest ME/patient index (13.1). The most frequent MEs were use of abbreviations (50.9%) and wrong speed rate of administration (11.4%), and only 11.7% of the total drugs were considered as ideal medication orders. Conclusion Clinically relevant medication errors can range from mild skin reactions to severe conditions that place the patient’s life at risk. The role of pharmacists through the detection and timely intervention during the prescription and other stages of the medication use process can improve drug safety in pediatric critical care services.

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THE COST OF ADULT LIVER TRANSPLANTATION IN A REFERRAL CENTER IN SOUTHERN BRAZIL

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201900000-33 ◽

2019 ◽

Vol 56 (2) ◽

pp. 165-171 ◽

Cited By ~ 1

Author(s):

Adriane B de SOUZA ◽

Santiago RODRIGUEZ ◽

Fábio Luís da MOTTA ◽

Ajacio B de Mello BRANDÃO ◽

Claudio Augusto MARRONI

Keyword(s):

Intensive Care Unit ◽

Liver Transplantation ◽

Intensive Care ◽

Liver Disease ◽

Southern Brazil ◽

Referral Center ◽

End Stage Liver Disease ◽

End Stage ◽

The Cost ◽

Surgical Unit

ABSTRACT BACKGROUND: Liver transplantation (LTx) is the primary and definitive treatment of acute or chronic cases of advanced or end-stage liver disease. Few studies have assessed the actual cost of LTx categorized by hospital unit. OBJECTIVE: To evaluate the cost of LTx categorized by unit specialty within a referral center in southern Brazil. METHODS: We retrospectively reviewed the medical records of 109 patients undergoing LTx between April 2013 and December 2014. Data were collected on demographic characteristics, etiology of liver disease, and severity of liver disease according to the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores at the time of LTx. The hospital bill was transformed into cost using the full absorption costing method, and the costs were grouped into five categories: Immediate Pretransplant Kit; Specialized Units; Surgical Unit; Intensive Care Unit; and Inpatient Unit. RESULTS: The mean total LTx cost was US$ 17,367. Surgical Unit, Specialized Units, and Intensive Care Unit accounted for 31.9%, 26.4% and 25.3% of the costs, respectively. Multivariate analysis showed that total LTx cost was significantly associated with CTP class C (P=0.001) and occurrence of complications (P=0.002). The following complications contributed to significantly increase the total LTx cost: septic shock (P=0.006), massive blood transfusion (P=0.007), and acute renal failure associated with renal replacement therapy (dialysis) (P=0.005). CONCLUSION: Our results demonstrated that the total cost of LTx is closely related to liver disease severity scores and the development of complications.

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Microbial Air Contamination in an Intensive Care Unit

International Journal of Public Health Science (IJPHS) ◽

10.11591/.v4i3.4725 ◽

2015 ◽

Vol 4 (3) ◽

pp. 145

Author(s):

Chih-Yi Chang ◽

Liang Tseng ◽

Lung-Shih Yang

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Medical Center ◽

Statistical Significance ◽

Incidence Density ◽

Air Contamination ◽

Care Services ◽

Air Sampler ◽

Significant Difference ◽

Central Taiwan

Unit layout affects every aspect of intensive care services, including patient safety. A previous study has shown that patients admitted to beds adjacent to the sink and to the door of a large bayroom had the highest number of positive blood cultures and the highest blood culture incidence density, respectively. The present study measures microbial air contamination in a medical intensive care unit of a medical center in central Taiwan. Of the 17 rooms, 8 rooms with distinct physical environmental characteristics were selected. Sampling tests were conducted between December 2013 and February 2014 with a microbial air sampler (MAS-100NT). TSA was used for bacteria collection and DG18 for fungi collection. The overall average bacterial and fungal concentrations were 83CFU/m3 and 69CFU/m3, respectively. The ranges were between 8-354 CFU/m3 and 0-1468 CFU/m3, respectively. A significant difference was found in the bacterial concentration (p=.005) between different room locations. The highest concentration was found in the rooms located at the front end of the circulation (99 CFU/m3), while the lowest was found in the rooms located at the rear end of the circulation (55CFU/m3). Differences in fungal concentrations for different room locations did not reach statistical significance. In addition, differences in bacterial and fungal concentrations for rooms with different sink locations did not reach statistical significance. Even though the microbial concentrations generally complied with standards, the results may help designers and hospital administrators develop a healthier environment for patients.

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Mobile laboratory unit based on the Kodak Ektachem DT system.

Clinical Chemistry ◽

10.1093/clinchem/34.11.2313 ◽

1988 ◽

Vol 34 (11) ◽

pp. 2313-2315 ◽

Cited By ~ 2

Author(s):

A R Pettigrew ◽

J M Orrell ◽

M H Dominiczak

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

High Throughput ◽

Outpatient Clinic ◽

Renal Unit ◽

Mobile Laboratory ◽

Laboratory Unit ◽

The Cost ◽

Selective Analysis ◽

Test Profiles

Abstract We evaluated the Kodak Ektachem DT system (DT60, DTE, DTSC modules), using it as a mobile laboratory unit (MLU) in different hospital settings. Imprecision of 19 assays performed with the system and correlation with routine methods in the main laboratory were assessed. The system was then transported to different departments within the hospital, where limited test profiles were offered and the time taken to produce results was recorded. It proved practicable to offer a six-test electrolyte profile to a five-bed intensive-care unit but not to an 18-bed renal unit, where more selective analysis would be required. In a low-throughput outpatient clinic (five patients per hour) it was feasible to provide a six-test on-site profile on every patient, whereas the maximum number of tests was four in a high-throughput clinic (10 patients per hour). The cost of providing a flexible extra-laboratory biochemistry service must be balanced against the benefit of having on-site results, e.g., fewer outpatient-clinic visits.

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Ventilator-Associated Tracheobronchitis: To Treat or Not to Treat?

Antibiotics ◽

10.3390/antibiotics9020051 ◽

2020 ◽

Vol 9 (2) ◽

pp. 51

Author(s):

Despoina Koulenti ◽

Kostoula Arvaniti ◽

Mathew Judd ◽

Natasha Lalos ◽

Iona Tjoeng ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Healthcare Costs ◽

Treatment Duration ◽

Cost Benefit ◽

Narrative Review ◽

Mechanically Ventilated ◽

Treat All ◽

The Cost

Ventilator-associated tracheobronchitis (VAT) is an infection commonly affecting mechanically ventilated intubated patients. Several studies suggest that VAT is associated with increased duration of mechanical ventilation (MV) and length of intensive care unit (ICU) stay, and a presumptive increase in healthcare costs. Uncertainties remain, however, regarding the cost/benefit balance of VAT treatment. The aim of this narrative review is to discuss the two fundamental and inter-related dilemmas regarding VAT, i.e., (i) how to diagnose VAT? and (ii) should we treat VAT? If yes, should we treat all cases or only selected ones? How should we treat in terms of antibiotic choice, route, treatment duration?

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