Abstract 105: 24/7 In-House Consultant Staffing for Cardiac Surgical ICU Patients: A Cost-Effective Model

Abstract

Introduction: Intensive care staffing models vary amongst institutions. There is increasing evidence that in-house consultant care is beneficial in the intensive care unit. We have previously published beneficial results associated with 24-hour / 7-days a week in-house consultants working in a dedicated post-cardiac surgical unit. The cost-effectiveness of employing 24-hour / 7-days a week in-house consultants (both in the postoperative cardiac surgery and the general systems intensive care unit settings) remains largely unknown. The objective of this study was to analyze the cost implications of such a model. Methods: Using a prospectively collected database, an observational before and after cohort analysis of consecutive patients undergoing a cardiac surgical procedure at a single tertiary center was performed. The control cohort (n=1425) consisted of patients admitted to a traditional mixed surgical intensive care unit (SICU) from Jan.2005 - Jan.2007. The intervention cohort (n=1824) consisted of patients admitted to a newly created cardiac surgery ICU (CICU) from Jan.2007 - Sept.2008, which was staffed by 24/7 in-house consultants. Cost estimates were calculated for each patient from time of ICU admission to hospital discharge. For comparison purposes, propensity analysis was performed matching both cohorts on over twenty clinical, physiological, and surgical variables. Results: 1,182 patients (83%) per cohort were matched. Pre-operative demographics and surgical variables were similar between both cohorts. The CICU model was associated with a significant decrease in mean hospital bed, laboratory, and blood transfusion costs (Table 1). A higher mean ICU consultant salary cost offset this. Total estimated median cost was ∼14% lower in the CICU model relative to the SICU model (Table 1). Conclusions: We present a large before-after observational study examining the cost-effectiveness of 24/7 ICU consultant staffing. Our data suggests that the greater savings associated with improvement in post-operative care offsets the salary costs associated with 24/7 in-house consultants.