Relationship between availability of physiotherapy services and ICU costs / Relação entre a disponibilidade de serviços de fisioterapia e custos de UTI

ABSTRACT Objective: To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. Methods: This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. Results: The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. Conclusions: In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

RESUMO Objetivo: Determinar se a disponibilidade de serviços de fisioterapia 24 h/dia reduz os custos de UTI comparada à disponibilidade padrão de 12 h/dia entre pacientes admitidos pela primeira vez na UTI. Métodos: Estudo de prevalência observacional, envolvendo 815 pacientes ≥ 18 anos de idade que estavam em ventilação mecânica invasiva (VMI) por ≥ 24 h e que tiveram alta de uma UTI para uma enfermaria em um hospital universitário terciário no Brasil. Os pacientes foram divididos em dois grupos de acordo com a disponibilidade de serviços de fisioterapia na UTI em h/dia: 24 h (PT-24; n = 332); e 12 h (PT-12; n = 483). Os dados coletados incluíram os motivos das internações hospitalares e das admissões na UTI; a pontuação Acute Physiology and Chronic Health Evaluation II (APACHE II); a duração da VMI; o tempo de permanência na UTI (TP-UTI); e o escore Ômega. Resultados: A gravidade da doença foi similar em ambos os grupos. A disponibilidade ininterrupta de serviços de fisioterapia foi associada a tempos menores de VMI e TP-UTI, bem como a menores custos (totais, médicos e com pessoal), comparada à disponibilidade padrão de 12 h/dia. Conclusões: Na população estudada, os custos totais e os custos com pessoal foram menores no grupo PT-24 do que no grupo PT-12. A disponibilidade em h/dia dos serviços de fisioterapia mostrou ser um preditor significativo dos custos de UTI.

A realidade dos pacientes que necessitam de ventilação mecânica prolongada: um estudo multicêntrico / The reality of patients requiring prolonged mechanical ventilation: a multicenter study

Objetivo: Na última década ocorreu um aumento no número de pacientes que necessitam manutenção de ventilação mecânica prolongada, resultando no surgimento de uma grande população de pacientes crônicos criticamente enfermos. Este estudo estabeleceu a incidência de ventilação mecânica prolongada em quatro unidades de terapia intensiva e relatou as diferentes características, desfechos hospitalares e impacto nos custos e serviços de pacientes com ventilação mecânica prolongada (dependência de ventilação mecânica por 21 dias ou mais) em comparação a pacientes sem ventilação mecânica prolongada (dependência de ventilação mecânica inferior a 21 dias). Métodos: Este foi um estudo multicêntrico de coorte que envolveu todos os pacientes admitidos em quatro unidades de terapia intensiva. As principais avaliações de desfechos incluíram o tempo de permanência na unidade de terapia intensiva e no hospital, a incidência de complicações durante a permanência na unidade de terapia intensiva, e a mortalidade na unidade de terapia intensiva e no hospital. Resultados: Durante o período do estudo, ocorreram 5.287 admissões às unidades de terapia intensiva. Alguns desses pacientes (41,5%) necessitaram de suporte ventilatório (n = 2.197), e 218 dos pacientes (9,9%) cumpriram os critérios de ventilação mecânica prolongada. Algumas complicações se desenvolveram durante a permanência na unidade de terapia intensiva como fraqueza muscular, úlceras de pressão, sepse nosocomial bacteriana, candidemia, embolia pulmonar, e delirium hiperativo; estas se associaram com um risco significantemente maior de ventilação mecânica prolongada. Os pacientes de ventilação mecânica prolongada tiveram um aumento significante da mortalidade na unidade de terapia intensiva (diferença absoluta = 14,2%; p < 0,001) e da mortalidade hospitalar (diferença absoluta = 19,1%; p < 0,001). O grupo com ventilação mecânica prolongada permaneceu mais dias no hospital após receber alta ...

Objective: The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). Methods: This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. Results: There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs. Conclusion: The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation ...

Cost of neonatal intensive care in a tertiary care center.

BACKGROUND: The number of neonatal intensive care units (NICUs) in India has increased substantially over the last decade; yet many more are required. There is limited information on the actual costs of setting up and running an NICU in India. OBJECTIVE: Systematic and comprehensive calculation and analysis of the costs of neonatal intensive care in a tertiary care teaching hospital. METHODS: The costs were compiled by studying the detailed records of various hospital departments and prospectively documenting the costs of drugs, consumables and investigations for a representative group of 30 babies. RESULTS: The total cost of establishing a 16 bed level III tertiary care NICU was Rs 3.78 crore (Rs. 37.8 million, USdollar 860,000) (2003). Equipment cost formed two-thirds of the establishment cost. The running cost of NICU care per patient per day was Rs 5450 (USdollar 125). NICU and ancillary personnel salary comprised the largest proportion of the running costs. The average total cost of care for a baby less than 1000 grams was Rs. 168000 (USdollar 3800), Rs. 88300 (USdollar 2000) for babies 1000 g to 1250 g. and Rs. 41700 (USdollar 950) for those between 1250 to 1500 g. The family had to bear only 25 percent; rest was subsidized. CONCLUSIONS: Equipment and personnel salary form the biggest proportion of establishment and running costs. The costs of treatment for a baby in NICU should be seen in context with costs of other types of health care and the number of useful life years gained.