Associations between two nursing workload scales and the cost of intensive care unit nursing staff: A retrospective study of one Belgian hospital.

AIMS: The aim of this study was to assess associations between a general nursing funding scale and an intensive care unit specific nursing workload scale and the cost of nursing staff. BACKGROUND: Nurse staffing represents the most important cost in the intensive care unit, so it is essential to evaluate it accurately. In addition, the assessment of nursing workload is important for the daily management of the intensive care unit and to ensure quality of care. METHODS: This was a retrospective and quantitative study carried out in the intensive care unit of a Belgian hospital. The extraction of data from the Nursing Activities Score and the Minimum Hospital Summary Nursing Dataset were carried out during 2 periods of 15 days, from 1 June 2018 to 15 June 2018 and from 1 September 2018 to 15 September 2018. RESULTS: A total of 234 patients were included in the study. A total of 773 Nursing Activities Score and Minimum Hospital Summary Nursing Dataset recordings were analyzed in the study per intensive care unit day. A strong correlation was observed between Nursing Activities Score and Minimum Hospital Summary Nursing Dataset for the entire intensive care unit stay with a rho (95% CI) of .88 (0.83-.93); however, the correlation was moderate per intensive care unit day with a rho of .51 (0.45-0.57). A strong association was observed between the Minimum Hospital Summary Nursing Dataset and the Nursing Activities Score with the costs of intensive care unit nurses with a rho (95% CI) of .78 (0.72-0.86) and .74 (0.65-0.84), respectively. CONCLUSIONS: A general nursing funding scale in Belgium was strongly correlated with the nursing workload for the whole intensive care unit stay, but this correlation was moderate per intensive care unit day. In contrast, both scales showed a good correlation with intensive care unit nursing costs. IMPLICATIONS FOR NURSING MANAGEMENT: In Belgium, a general funding scale for nurses does not allow for an assessment of the nursing workload in the intensive care unit. The Nursing Activities Score is strongly correlated with the cost of nursing staff in the intensive care unit. The authors recommend that the Belgian authorities carry out this type of study in several intensive care units in the country and eventually replace the general funding scale for nurses with the Nursing Activities Score.

Predictors of costs from the hospital perspective of primary pulmonary embolism.

The objective of this study was to estimate the total hospital cost per patient admitted through the emergency department with a primary diagnosis of pulmonary embolism (PE), and to identify the main components and predictors of costs.Actual costs of care of 652 consecutive patients hospitalised in 10 general hospitals in Belgium, including 31 outlier patients in terms of length of stay (4.8%), were obtained by aggregating all cost components contributing to care of each patient.In both inlier and outlier patients, the mean total cost per patient increased linearly with the degree of severity of illness classes related to the All Patient Refined Diagnosis Related Group (p<0.0001). Medical procedures, nursing activities and hospitalisation accommodation were the main cost components. We identified six independent predictors of costs in inliers: age group, chronic pulmonary heart disease, heart failure, admission to intensive care unit, initial thrombolysis treatment and type of hospital. There was a statistically significant linear trend between age groups and costs (p<0.0001).An increasing burden of comorbid illness was strongly associated with increasing actual cost for caring hospitalised patients for PE. Increasing age was associated with an increase in all main cost components.

[Medical and economic evaluation of oncological inpatients in 14 Belgian hospitals]. / Analyse médico-économique de la patientèle oncologique de 14 hôpitaux belges.

INTRODUCTION: A prospective payment system per DRG is announced in Belgium. Is this kind of financing system adequate for oncology? Objectives of this study are: to analyze medical and economical characteristics of oncological inpatients and evaluate the homogeneity of costs and length of stay per DRG. METHODS: The study was realized in 14 Belgian hospitals, with 2010 data. Inpatients with primary diagnosis of neoplasms were selected in medical and administrative databases. Characteristics of patients as well as length of stay and cost (hospital perspective) were analyzed. The homogeneity of costs and length of stay is measured by calculating the coefficient of variation (standard deviation divided by the mean). RESULTS: The length of stay (standard deviation) is 9.72 days (12.64). The variation is high per DRG. The average cost (standard deviation) is 7689.28€ (10,418) and is also variable from one DRG to another one. There are 5% of high-length of stay outliers and 0.2% of low-length of stay outliers. There are 4.7% of high-cost outliers and 0.2% of low-cost outliers. The withdrawal of outliers improves the homogeneity of cost and length of stay per APR-DRG. DISCUSSION AND CONCLUSION: There is a homogeneity of costs and length of stay per DRG and per severity of illness. A prospective payment system per DRG would probably be applicable for these patients. It is however necessary to plan an appropriate and additional financing of all elements susceptible to stimulate innovation in the management of oncology and to stimulate the quality of care by adding financial stimulants.

[Cost evaluation of hospital inpatient stays induced by injuries due to falls for elderly people]. / Évaluation économique des lésions associées aux chutes des personnes âgées vivant à domicile.

Thirty percent of people aged 65 and older, living at home fall at least once a year. Few economic data are available in Belgium on this issue. We evaluated the cost borne by social security. 823 inpatient stays aged 65 and more, from home and admitted for injuries after a fall were selected. We observe an average (SD) age of 81 years. The proportion of women is 76%. 75% of admissions are related to fractures. 18% of patients are 'institutionalized' after falls. The death rate is 6%. The median (Q1-Q3) of cost is € 4.182 (2.385-6.820), for a length of stay median (Q1-Q3) of 11 days (4-25). The cost of hospital stays is estimated at €135 millions. Based on population projections, the cost could be estimated at € 243 millions in 2050. The overall cost of the treatment of these lesions is much more important, because costs are also generated after the hospitalization.

Epidemiology of injuries in Belgium: contribution of hospital data for surveillance.

OBJECTIVES: Investigating injuries in terms of occurrences and patient and hospital stay characteristics. METHODS: 17370 stays, with at least one E code, were investigated based on data from 13 Belgian hospitals. Pearson's chi-square and Kruskal-Wallis tests were used to assess the variations between distributions of the investigated factors according to the injury's types. RESULTS: Major injuries were accidental falls, transport injuries, and self-inflicted injuries. There were more men in the transport injuries group and the accidental falls group was older. For the transport injuries, there were more arrivals with the support of a mobile intensive care unit and/or a paramedic intervention team and a general practitioner was more implicated for the accidental falls. In three-quarters of cases, it was a primary diagnostic related to injury and poisoning which was made. The median length of stay was nearly equal to one week and for accidental falls, this value is three times higher. The median cost, from the social security point of view, for all injuries was equal to € 1377 and there was a higher median cost within the falls group. CONCLUSION: This study based on hospitals data provides important information both on factors associated with and on hospital costs generated by injuries.

Evaluation of the cost of atrial fibrillation during emergency hospitalization.

OBJECTIVE: The number of hospitalizations for atrial fibrillation has increased dramatically. This increase, in the number of hospital stays will continue, given the growth projections based on epidemiological data, and will contribute to significantly increase expenses for the social security system.The objective of this study was to evaluate the length of hospital stay, the average cost borne by social security, and the types of hospital stay expenditures for patients admitted through the emergency department for atrial fibrillation. METHODS: Patients were identified by using the minimal clinical summaries of seven general hospitals in Belgium in 2008. Only hospitalized patients having as primary diagnosis code ICD-9-CM 42731 'atrial fibrillation'were selected for this study. Hospital billing files were analysed in order to isolate the costs borne by social security. Outliers were isolated in order not to have results influenced by patients having an atypical length of stay. RESULTS: Results show that the mean length of stay was 8.6 days and the mean cost charged to social security was euro 3,066.02 per hospital stay.The mean cost of care was strongly associated with the degree of severity index related to the APR-DRG. Approximately 85% of the total cost was related to the cost of hospital days and medical procedures with medical imaging and laboratory tests being the two main cost inductors. 18% of patients had cardioversion during their hospital stay, including 4% who had only that treatment. 19% of patients used amiodarone. Flecainide and propafenone were also used, but less frequently. CONCLUSIONS: The mean cost of care for AF patients admitted via the emergency department is strongly associated with the degree of severity. Approximately 85% of the total cost is related to the cost of hospital days and medical procedures. Hypertension is the most common secondary diagnosis. An optimal treatment of this risk factor could help to reduce the risk of atrial fibrillation, and thereby reduce the morbidity and costs associated with this disease.

Variability of nursing care by APR-DRG and by severity of illness in a sample of nine Belgian hospitals.

BACKGROUND: As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier's rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI. METHODS: Study done in 9 Belgian hospitals on a selection of APR-DRG with more than 30 patients (7 638 inpatient stays). The evaluation of the homogeneity is based on coefficients of variation (CV). The 75th percentile + 1.5 × inter-quartile range was used to select high outliers. 25th percentile -1.5 × inter-quartile range was used to select low outliers. Nursing costs per ward were distributed on inpatient stays of each ward following two techniques (the LOS vs. the number of nursing care minutes per stay). RESULTS: The homogeneity of LOS by DRG and by SOI is relatively good (CV: 0.56). The homogeneity of the nursing activity by DRG is less good (CVs between 0.36 and 1.54) and is influenced by nursing activity outliers (high outliers' rate: 5.19%, low outliers' rate: 0.14%). The outlier's rate varies according to the studied variable. The high outliers' rate is higher for nursing activity than for LOS. The homogeneity of nursing costs is higher when costs are based on the LOS of patients than when based on minutes of nursing care (CVs between 0.26 and 1.46 for nursing costs based on LOS and between 0.49 and 2.04 for nursing costs based on minutes of nursing care). CONCLUSIONS: It is essential that the calculation of nursing cost by stay and by DRG for hospital financing purposes was based on nursing activity data, that more reflect resources used in wards, and not on LOS data. The only way to obtain this information is the generalization of computerized nursing files.