Abstract
IntroductionThere is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). Due to postponement of elective surgery or delayed admission of emergency patients, outcome may be negatively influenced. To optimize the admission process to intensive care, the post-anaesthesia care unit (PACU) was staffed with intensivist coverage around the clock. The aim of this study is to demonstrate the impact of the PACU on the structure of ICU-patients and the contribution to overall hospital profit in terms of changes in the case mix index for all surgical patients.MethodsThe administrative data of all surgical patients (n = 51,040) 20 months prior and 20 months after the introduction of a round-the-clock intensivist staffing of the PACU were evaluated and compared.ResultsThe relative number of patients with longer length of stay (LOS) (more than seven days) in the ICU increased after the introduction of the PACU. The average monthly number of treatment days of patients staying less than 24 hours in the ICU decreased by about 50% (138.95 vs. 68.19 treatment days, P <0.005). The mean LOS in the PACU was 0.45 (± 0.41) days, compared to 0.27 (± 0.2) days prior to the implementation. The preoperative times in the hospital decreased significantly for all patients. The case mix index (CMI) per hospital day for all surgical patients was significantly higher after the introduction of a PACU: 0.286 (± 0.234) vs. 0.309 (± 0.272) P <0.001 CMI/hospital day.ConclusionsThe introduction of a PACU and the staffing with intensive care staff might shorten the hospital LOS for surgical patients. The revenues for the hospital, as determined by the case mix index of the patients per hospital day, increased after the implementation of a PACU and more patients can be treated in the same time, due to a better use of resources.
Highlights
There is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU)
The relative number of patients with longer length of stay (LOS) in the ICU increased after the introduction of the postanaesthesia care unit (PACU)
A possible reason for this can be seen in Figure 1, where the distribution of patients according to the length of stay in the ICU is shown
Summary
There is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). The difficulty is a stratification between low-risk and high-risk patient-days using the Therapeutic Intervention Scoring System (TISS) categories [8] or developed indices of level of care defined by the severity of organ failures [9] or by intensive care interventions [10]. This approach to defining the level of care is helpful in planning which level of care is appropriate for the individual patient, but does not solve the problem of restricted availability of ICU beds for emergency admissions, for example
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