重症监护病房资源使用和费用的产生

Analysis of resource use and cost-generating factors in a surgical intensive care unit employing the therapeutic intervention scoring system

目的 :采用TISS评分评估重症监护病房 (ICU)资源使用和费用产生。方法 :前瞻性研究。ICU住院日大于 2 4h的患者。每日评估APACHEⅡ和TISS得分。患者按照TISS参数回顾性分为积极治疗组 (AT)和非积极治疗组 (NAT)。结果 :14 8个患者中 131人 (88.5 % )分入AT组。AT组患者APACHEⅡ和TISS得分高于NAT组 (P <0 .0 1)。所有患者平均每天的费用为 (6 2 32 .7± 4 36 5 .7)元。AT组患者总费用 (32 80 0 .5± 4 6 72 3.5 )元明显高于NAT组 (6 85 2 .1± 6 132 .4 )元 (P <0 .0 1) ,每天的费用 (6 2 32 .7± 4 36 5 .7)元高于NAT组 (2 74 5 .8± 15 4 1.3)元 (P <0 .0 1) ,平均ICU住院日 (5 .4± 4 .2 )d也高于NAT组 (2 .2± 1.3)d(P <0 .0 1)。结论 :接受AT治疗的患者病情重 ,总费用和每天的费用均明显高于NAT组 。

Objective:To evaluate the resource use and costs in a surgical intensive care unit (SICU) with the Therapeutic Intervention Scoring System (TISS). Methods:Prospective observation were carried in consecutive patients with an ICU length of stay(ICU LOS) more than 24 hours. Patients were retrospectively classified as receiving active treatment(AT) or non-active treatment(NAT) according to the TISS variables, where AT mean therapeutic intervention that could not performed outside the ICU. Total expenditure for each patient was calculated. Results:of the 148 consecutive patients within this pariod,131 (88.5%), including non-survivors, were categorized as group in AT. TISS and LCU LOS were higher in patients receiving AT (P<0.01). Daily costs of the group AT were much higher than in the there of NAT patients (P<0.01). Conclusions:Total and daily costs of care were significantly higher in those receiving AT and in the ICU LOS. Therefore the cost-saving stratey should aim at reducing the ICU LOS, without compromising the quality of admittion.