ABSTRACT
PURPOSE: The objective of our study was to figure out costs of nursing services in ICU based on the PCS in order to determine an appropriate nursing fee schedule. METHOD: Data was collected from 2 hospitals from April 15-16 to April 22-23, 2003. The costs of nursing services in the ICU were analyzed by nursing time based on the nursing intensity. The inpatients in the ICU were classified by a PCS tool developed by the Korean Clinical Nurses Association(2000). RESULTS: The distribution of patients by PCS in the ICU ranged from class IV to Class VI. The higher PCS in ICU consumed more nursing time. As a result, the higher nursing intensity, the more the daily average nursing costs in the ICU. CONCLUSION: Our study provides evidence to refine the current nursing fee schedule that does not differentiate from the volume of nursing services based on nursing time. We strongly recommend that the current reimbursement system for nursing services should be applied not only to the general nursing units but also to the ICU or other special nursing units.
Subject(s)
Humans , Costs and Cost Analysis , Fee Schedules , Inpatients/classification , Intensive Care Units/economics , Nursing Service, Hospital/economics , Prospective Payment System , Time FactorsABSTRACT
A enfermagem neonatal acompanha o processo de enfermagem e demonstra através de diagnósticos específicos como este processo se aplica ao recém-nascido e sua família. Enfatiza os cuidados que devem ser realizados pelos familiares e considera o papel que a cultura pode ter nas necessidades ou anseios de um paciente. A assistência de enfermagem neonatal deve basear-se num sistema que garanta cuidados contínuos e de complexidade crescente em relação proporcional ao nível de risco do neonato. A determinação do risco de cada paciente, em cada momento do processo assistencial, permite alocar recursos adequados às necessidades de forma eficiente. Desta maneira, para cada momento, desde o nascimento até a alta neonatal, devem ser definidas e planejadas as atividades assistenciais, considerando: o nível e a área de cuidado, os recursos humanos e as normas e procedimentos a serem utilizados. O presente estudo objetivou adequar e aperfeiçoar o instrumento para classificação de pacientes em unidade neonatal proposto por Toledo & Fugulin (2000) de acordo com as necessidades assistenciais de enfermagem e validar o conteúdo deste instrumento com os juízes especialistas. Para compor o instrumento foram consideradas 16 áreas de cuidado: Termorregulação, Peso, Atividade Espontânea, Reação à Estímulos, Cor da Pele, Tonicidade, Nutrição e Hidratação, Eliminações, Oxigenação, Integridade Cutâneo-Mucosa, Cuidado Corporal, Controle de Sinais Vitais, Controle de Sondas e Drenos, Controle de Cateteres, Terapêutica medicamentosa, Educação à Saúde. Cada uma destas áreas possui gradação de 1 a 3, apontando a intensidade crescente de complexidade assistencial. O neonato é classificado em todos os indicadores em um dos 3 níveis que melhor descreva sua situação. Para a validação do conteúdo foi aplicada a técnica Delphi em 2 fases. Participaram como juízes 5 profissionais da área de enfermagem obstétrica e neonatal que atuam junto a ) instituições assistenciais ou vinculados a Hospital-Escola. Os resultados obtidos mostraram concordância dos juízes quanto à: manutenção das 16 áreas de cuidado no instrumento; pertinência e clareza das áreas de cuidado e a existência de nível de complexidade assistencial crescente.
The nursing neonate's follow the nursing process and demonstrate through specific diagnosis how this process to apply for neonates and his/her family. Emphasize the care should be done by family and consider the paper of the culture can have in the needing and longings of the patient. The nursing care neonate should be based in the system that garantees continuous care and increasing complexity in proportional relation the level of risk in the neonates. The determination of the risk of each patient in each moment of the assistance of process permits to destine recourses adequate for necessities efficient form. Thus, for each moment, since the nativity until the discharge from hospital, should be done Thus, for each moment, since the nativity until the discharge from hospital, should be defined and plan the assistance activities, to considering the level and the area of the care, the human recourses and the norm and proceeding to be used. The purpose of this study was to adapt and improve a patient classification system in neonate unity proposed for Toledo & Fugulin (2002) in according of dependence degree and to validate a content this instrument with the judge experts. It was considered in the instrument 16 caring area: regulation temperature, weight, spontaneous activity, stimulus reaction, color skin, tonic muscle, nutrition and hydration, elimination, breathing, skin integrity, corporal hygiene, vital signals control, probes and drains control, catheters control, therapy of medicine and health teaching. Each one of areas has a 1 to 3 gradation denoting an increasing level the nursing care complexity. The neonates is classified in all the areas is one of the three levels, in the option that better describes his/her situation. The Delphi technique application though 2 rounds did the content validation of the instrument. A team of 5 experts nursing professionals of neonate and obstetric area whom attends patients or teaches in the Medical School. The obtained results have showed the experts agreement concerned to: the maintenance of the 16 caring area in the instrument; property and intelligibility of the caring area contents and presence of an increasing level in the nursing care complexity.
Subject(s)
Neonatal Nursing , Infant, Newborn , Nursing CareABSTRACT
With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U. S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U. S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the difference in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated for its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed ad payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U. S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.