RESUMO
OBJECTIVE: Lung volume reduction surgery (LVRS) represents a potential breakthrough in the management of advanced emphysema, although questions remain about clinical and economic implications of widespread application of LVRS. In this report, we describe hospital costs, excluding physicians' fees, for LVRS. DESIGN: Hospital charges were obtained from billing records and converted to costs by applying multiple cost-to-charge ratios. SETTING: A large, urban academic medical center. PATIENTS: Fifty-two consecutive patients who received bilateral LVRS through a median sternotomy between April 1995 and August 1996. RESULTS: Median hospital stay was 10 days (mean= 14.8+/-12.8 days; range=3 to 48 days), including 2 days (mean=6+/-9.2 days; range=1 to 35 days) in the ICU. One hospital death occurred. Hospital costs per case ranged from $11,712 to $121,829, with mean costs of $30,976 and median costs of $19,771. Costs were related significantly to duration of ICU stay and length of hospitalization. Patients who accrued the highest costs were significantly older than the remainder of the sample (69.3 years vs 62.4 years). CONCLUSIONS: Hospital costs of LVRS vary significantly but are related directly to hospital stay. Identification of factors associated with prolonged stays can be used in assessing benefits and risks of LVRS against utilization of health-care dollars.
Assuntos
Custos Hospitalares/estatística & dados numéricos , Pneumonectomia/economia , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Chicago , Feminino , Hospitais Urbanos/economia , Hospitais Urbanos/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-IdadeRESUMO
A flexible staffing model for the patient service associate (PSA), a type of multiskilled worker, was developed at an academic medical center. The model uses the patient census, admissions, and discharges on a patient care unit to determine how many PSAs are needed during a 24-hour period. The authors discuss the staffing model's effects on labor costs and the quality of PSA work.
Assuntos
Zeladoria , Modelos Organizacionais , Assistentes de Enfermagem/provisão & distribuição , Admissão e Escalonamento de Pessoal/organização & administração , Centros Médicos Acadêmicos , Chicago , Custos e Análise de Custo , Estudos de Avaliação como Assunto , Humanos , Modelos de Enfermagem , Assistência Centrada no Paciente , Qualidade da Assistência à Saúde , Recursos HumanosRESUMO
A statistical model can be used to quantify the relationship between cost and quality in nurse staffing decisions and to demonstrate that high-quality health care is not necessarily synonymous with high-cost health care.
